Okay Isaac Newton, I think you were on to something here… according to your brilliant first law of physics, things will generally just keep doing what they are doing i.e.) either rest or move. This law can even be applied to the overall trend of our bodies; we are either generally at rest or generally in motion.
I began practicing yoga around 1994 to stay fit and deal with several autoimmune issues including Graves disease (over activity of the thyroid gland) and Myasthenia Gravis (a neuromuscular disorder that causes weakness in the skeletal muscles used for movement). In my early forties, I was diagnosed with both conditions and I was determined not to let them define nor deter me. Little did I know that an even bigger battle was ahead.
While attending California Polytechnic State University, San Luis Obispo, I became an aerobics instructor. I had been doing aerobics at a local gym and one day, the instructor did not show up so I said to the gym owner, “I can teach this class.” This was early in the fitness movement and they required no certifications, just good music. After that, I taught several classes a week until I graduated with a Bachelors degree in Social Sciences. I moved to Miami Beach, Florida and worked as a retail manager until I realized this was not what I saw myself doing for the rest of my career, I returned to Seal Beach, California, where I grew up, and earned a Paralegal Certification from the University of Irvine Extension Program and have worked as a paralegal ever since, mostly in construction defect litigation.
Life was very busy with Victoria (now 24), Edward and Elizabeth (both now 22) all born within fifteen months. I mostly worked at home so I could be with them, volunteer at their school and attend all of their activities. Around the time I turned forty, I knew something was not right and all my energy went to my family and job. I could barely make it through the day without a nap and no matter what I ate, I continued to lose weight, eventually getting down to a dangerously low BMI. Fortunately, my family physician (whom I am still with) diagnosed Graves disease quickly and a few months later, I underwent removal of the damaged portion of my thyroid with radioactive iodine. With careful monitoring and thyroid supplements, I overcame this issue but as with most people suffering from autoimmune diseases, I still had another one to identify and did not have the energy to return to working out. This is when I learned that I had to be my own advocate and to be persistent when something does not feel right. While I was much better, I was still exhausted and weak. After undergoing an autoimmune panel, it was determined that I had Myasthenia Gravis. I was just one of about 13,600 people in the USA with it so very little research is done. Once my symptoms from the autoimmune diseases were under control (neither has an actual cure), I decided that I had to become active again. I joined a gym and found that the yoga classes they offered gave me back the strength, agility and stamina I had lost. I began practicing at Yoga Works, where I have remained to this day.
My cancer journey began when I discovered a lump in my breast. Victoria, Edward and Elizabeth were teenagers and I had just met Larry, the love of my life (who is soon to be my husband!). The initial biopsy showed “abnormal cells,” and an eventual diagnosis of breast cancer was determined after I underwent a lumpectomy. With the love and support of Larry, family and close friends, and the advisement of my doctors, I decided to have a bilateral mastectomy because this was the best way for me not only to fight the cancer, but also to prevent a future occurrence. In addition, I underwent lymph node and ovary removal, chemotherapy, and breast reconstruction.
I returned to practicing yoga as a means of rehabilitation. The yoga moves I had previously learned helped me to regain mobility in my chest and arms. At first, I could not even get my arms above my head or my shoulders all the way back to their normal position. Every night, I would get down on the floor and work on these areas, Eventually, I regained a lot of mobility and the courage to practice yoga in front of people again. In returning to Yoga Works, I have found that not only have I regained my strength, but also my confidence. I credit an active lifestyle including yoga, healthy eating and long walks with Larry and our dog, Zoey, with my full recovery as well as close relationships with family and friends. These things have also been essential in combating Lymphedema (impaired flow of the lymphatic system due to lymph node removal) and the side effects of Arimidex (an estrogen blocking drug used for treatment of breast cancer after surgery). I am in the process of becoming a certified yoga instructor so that I can help others to live a healthy lifestyle and maintain their fitness goals. My intention is not only to teach classes at a studio or gym, but also to work with cancer survivors to help them regain their strength, agility and confidence through yoga.
I am now 54 years-old, cancer free and a grandmother to Benjamin (age 3) and Abigail (22 months), Victoria’s and her husband Brice’s children. Together, Larry and I have five grown children and four young grandchildren. I cherish every day and look forward to a very bright future.
Two large new studies provide compelling evidence that obesity increases the risk of the most common type of postmenopausal breast cancer among both African Americans and Hispanics. Over one of every two African American woman and almost one of every two Hispanic woman is obese.
Denise Bell was approaching 10 years as an ovarian cancer survivor and planned to treat herself to an exotic vacation—then, her routine mammogram revealed inflamed lymph nodes. When her doctor diagnosed breast cancer, she knew exactly what to do. She had been a volunteer for five years at Greet the Day, an integrative oncology care group, and had witnessed first-hand the benefits of the restorative program. Now it was her turn to be on the receiving end.
There are three phases of Pilates for breast cancer survivors. The goal of Phase 1, the Protective Phase, is to ensure tissue healing without sacrificing range of motion and flexibility of the chest and arm. In these exercises, only move your arms to shoulder height or 90° and during this phase try to use your affected arm normally to perform daily living tasks such as brushing your teeth, putting on deodorant on, or wiping up your kitchen table.
Below are two examples of Pilates exercises for breast cancer survivors that fall under the Protective Phase. Protective Phase exercises should have three to five repetitions each. This phase will last approximately 2 weeks, or until you feel comfortable progressing to more difficult exercises. The exercises should feel easier and there should be less and less discomfort as you progress.
Exercise 1: Scapula Protraction and Retraction
The scapula is another name for your shoulder blade. The purpose of this exercise (shown in the image below) is to warm up the shoulders in preparation for movement, as well as strengthen the scapular muscles, which are necessary for proper shoulder movement.
Contraindications: None
Equipment: Pad, small pillow, towel, or block under head if needed. Optional medium-sized ball (squeezing the ball between your knees will help to activate the pelvic floor and transverse abdominis muscles and prevent your knees from collapsing in).
Start:
Exercise:
Modification for an Added Challenge: Stretch a resistance band between your hands. If you are undergoing a breast implant expander program, TRAM, or DIEP flap reconstruction, do not use a resistance band until medically cleared.
Exercise 2: Bridging
The goal of bridging is to warm up the spine as well as your hamstrings and gluteal muscles. This exercise will help make it easier to put on your underwear and pants and reposition yourself in bed.
Contraindications: Check with your physician to make sure that this exercise is safe for you to do when recovering with drains in place.
Equipment: Pad, small pillow, towel, or block under head if needed. Optional medium-sized ball (squeezing the ball between your knees will help to activate the pelvic floor and transverse abdominis muscles and prevent your knees from collapsing in).
Start:
Exercise:
NOTE: Be sure to… Keep both shoulder blades on the mat. Do not let the pelvis rock forward/back or side to side.
Modification for an Added Challenge: Hold a Magic Circle between your inner thighs for resistance as you lift your hips. Hold a Magic Circle between your palms with hands facing each other and fingertips toward the ceiling. Squeeze it when the hips are lifted.
Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH; Images via demosHealth article.
Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.
Pilates was first developed by Joseph Pilates to strengthen muscles, increase flexibility, and improve overall health. In the 1950s, Pilates started using his method to rehabilitate dancers, including one of his first protégés, Eve Gentry. She was rehabilitated by Joseph Pilates after a radical mastectomy for breast cancer. After studying Pilates, she was able to regain full use of her arm and torso, a remarkable feat because all of her lymph nodes and chest muscles, as well as breast tissue, were removed with this procedure. Doctors could not believe the success that she had obtained with the Joseph Pilates method; he was a man ahead of the times.
Recent research and studies have helped supported Pilates’ work and demonstrate its benefits for recovering from breast cancer surgery.
Recent Research and Findings
The first study on the benefits of Pilates for breast cancer survivors was completed by physical therapists in 2008 [1]. It was a pilot study with only four participants, so the conclusions we can draw from this study are limited. However, they found that Pilates increased the flexibility of the affected arm after a twelve-week program, with participants exercising three times a week.
Another study done in 2010 [2] examined the effects of Pilates exercises on functional capacity, flexibility, fatigue, depression, and quality of life in female breast cancer patients. Pilates was performed three times a week for eight weeks. After participation in the Pilates exercises, improvements were noted in the participants’ levels of fatigue, flexibility, quality of life, and performance on a six minute walk test. This study helped demonstrate that Pilates was safe and effective for breast cancer survivors.
The most recent study published in 2012 [3] found that after twelve weeks of Pilates, thirteen participants improved their shoulder and neck flexibility. Improvements were noted in quality of life, body image, and mood. Although volume increased on the affected arm (a sign of lymphedema), one must note that this program did not modify the exercises for the class and that the sessions increased in frequency over the twelve-week period.
It is important to note that traditional Pilates mat exercises were used for the studies listed above, and minimal modifications were used which may have affected the results. However, all of these documented results help confirm that Pilates is a gentle but effective way to regain strength and recover from breast cancer.
Footnotes:
Keays, K, Harris, S, et al. “Effects of Pilates Exercises on Shoulder Range of Motion, Pain, Mood and Upper Extremity Function in Women Living with Breast Cancer: A Pilot Study.” Physical Therapy 88(4) (2008): 494–510.
Eyigor, S, Karapolat, H, et al. “Effects of Pilates Exercises on Functional Capacity, Flexibility, Fatigue, Depression and Quality of Life in Female Breast Cancer Patients: A Randomized Study.” European Journal of Physical Medicine 46(4) (2010): 481–87.
Stan, DL, Rausch, SM, et al. “Pilates for Breast Cancer Survivors: Impact on Physical Parameters and Quality of Life After Mastectomy.” Clinical Journal of Oncology Nursing 16(2) (2012): 131–41.
Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH.
Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.
For breast cancer survivors using Pilates, it is extremely important to pay attention to the Pilates principles. Getting physical exercise is essential to recovery, but overdoing it can cause more harm than good. Make sure you review the principles below before beginning Pilates for breast cancer recovery, and ask for help from a certified Pilates instructor if you need it.
The 9 Pilates Principles
These principles guide each Pilates exercise to ensure that they are done correctly and safely. In Pilates, less is more. The emphasis is on a correct starting position with proper execution of the exercises; there is no wasted movement in Pilates. No more than five to eight repetitions are completed (except for the Hundreds), and breathing during each exercise is very important. Concentrate on the correct movement patterns first and then add Pilates breathing.
If you’ve never done Pilates before, this may sound like a lot to think about. If possible, we recommend working with someone who is trained in Pilates first to get you on the right track.
Balanced Muscle Development: Everything that is done on one side of the body must also be done on the other side. For example, if you do an exercise with your right arm, you must also do it with your left.Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH.
Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.
Ann Marie Turo, occupational therapist, yoga and Pilates instructor and Reiki master, owns a thriving Pilates-based studio. When Turo was diagnosed with a breast cancer reoccurrence in 2002, she was devastated. Despite having limited range of motion, strength and endurance, as well as decreased ADL function, it was not recommended that she have any rehabilitation. This situation is not unusual.
After undergoing a self-described “meltdown,” she decided to take matters into her own hands. Turo designed her own rehabilitation program, which included visualization, Pilates, yoga and Reiki, along with traditional occupational therapy modalities.
Turo believes that an “integrated” approach is the best way to heal physically and psychologically from breast cancer. That is why she created Integrated Mind and Body in Boston.
Pilates is enjoying wide popularity throughout the United States as a form of exercise. It focuses on the whole person, uniting mind and body through a series of flowing movements that require both flexibility and strength. Recently, therapists have began incorporating Pilates as part of their general rehabilitation program for athletes, back injuries, hip/knee replacements and even autism.
Breast cancer survivors are starting to benefit from Pilates as well. A recent pilot study (Keays, 2007) found a modest effect in improving shoulder abduction and external rotation. However, further research is necessary to determine both the safety and efficacy of Pilates, as well as optimal exercise guidelines.
There are eight principles of Pilates: relaxation, concentration, control, centering, fluidity, precision, stamina and breathing. Joseph Pilates, who developed this movement method, believed that one must pay attention to each exercise and perform it with the utmost control to avoid injury. He believed that it is not the quantity that counts, but the quality of each repetition.
Pilates exercises initiate from the “powerhouse,” or core musculature. Therefore, every exercise is an abdominal exercise that initiates at the center and flows outward. This is in tune with developmental principles and ensures a proper base from which to perform more distal work.
Proper breathing is another cornerstone of this technique. Deep breathing is essential to activate the transverse abdominal muscles, which is why the exercises are coordinated with both inhalation and exhalation. Inhalation facilitates spinal extension and trunk stability while exhalation facilitates spinal flexion and scapular depression.
During upper extremity work there should be a sense of gliding the scapulae down the back to promote shoulder stability. Pilates can incorporate more than 500 exercises, which can be performed either on a mat or on special equipment, such as the Cadillac, Reformer and barrels. These exercises can be modified to meet the needs of patients through the use of springs to assist and mobilize the muscles, and provide resistance when patients are stronger.
Women who are diagnosed with breast cancer will have surgery, which can be followed by systemic treatment such as chemotherapy and/or hormone therapy and then, possibly, radiation. After undergoing breast cancer surgery and treatment, the body seems lost and out of control. Breast cancer survivors are faced with many issues including fatigue, loss of range of motion and strength in the affected arm, lymphedema risk, weight gain and poor posture.
Furthermore, there are psychological implications to being diagnosed with a life-threatening disease and breast removal. Pilates is one tool that can help one regain a sense of mastery and control over a body that seems foreign and lost.
How Does the Rehab Work?
Loss of range of motion and tightness in the axillary and pectoralis regions is common after breast cancer surgery, especially after axillary lymph node dissection and mastectomies. The more extensive the surgery, the greater the limitations secondary to greater tissue loss, pain and scar formation. Because many of the Pilates exercises are performed in the supine position, the neck and back can be comfortably supported. Active assisted exercises with a towel or band are used to improve mobility of the shoulder girdle while the spine is in a neutral position.
Pilates focuses on the scapula stabilizers including the rhomboids, latissmus dorsi, middle/lower trapezius and serratus anterior while performing active range of motion, which is different than a traditional rehabilitative approach. The use of imagery is often used to coordinate the mind and body, so one may be told to “place those wing bones in your back pocket.” Even some of the exercises can be done in side lying, which eliminates gravity, making the shoulder exercises easier to perform.
Pilates emphasizes proper alignment and posture which improves movement efficiency, opens up all the lymphatic channels and facilitates good breathing.
The risk of lymphedema, the buildup of protein-rich fluid in the chest, trunk and arms, is another concern for anyone who has received lymph node dissection and/or radiation. This is due to scarring of the lymphatic vessels that disrupts lymphatic flow, along with the loss of mobility. This can interfere with normal lymphatic or venous drainage from the arm.
Since diaphragmatic breathing is used in Pilates both to stabilize and mobilize the spine, this enhances trunk organization. Lymphatic fluid can be propelled through the body with this type of breathing, along with proximal to distal exercise. As one inhales and exhales, the pressure changes, stimulating lymphatic return. In addition, diaphragmatic breathing lowers heart rate and blood pressure, creating a relaxation response conducive to emotional healing.
Use of the deep stabilizer muscles, including the transverse rectus abdominas and multifidus, encourages pumping to the thoracic duct, the main area for lymphatic return. This in effect clears the trunk for fluid from the axillary region and pectoralis area where lymph flow may be impaired.
Once the trunk is cleared, one can exercise the arm at risk. Compression garments or bandages should be worn while exercising if at risk. Exercises should be progressed slowly and gradually to allow the lymphatic system to adjust to an increased lymphatic load.
There are usually few repetitions for each Pilates exercise, which is a natural fit for women at lymphedema risk.
Dealing with Fatigue
Fatigue both during and after cancer treatment is the most common side effect of the treatment. Many women feel unable to function and perform daily activities while undergoing chemotherapy or radiation treatments, and this fatigue can become overwhelming as treatments accumulate. However, many research studies have confirmed the advantages of both strength and aerobic conditioning even during treatment. Pilates offers a gentle introduction or re-introduction to regular exercise that can slowly help restore strength and endurance. One can gradually build up by performing the exercises at least twice a week. This should be combined with an aerobic conditioning program, such as walking, when able.
It is time to think about alternative approaches to meeting the needs of this population, along with individuals suffering from other chronic conditions. As one can readily see, Pilates offers many benefits to women recovering from cancer, especially since occupational therapists are well trained in the modification of such activities and exercises.
At Integrated Mind and Body, Turo works with breast cancer survivors as well as individuals who have had depression, total knee replacements and total hip replacements. She requires a signed physician’s release form, and does a full intake on clients that includes medical history, pain, postural analysis and ADL evaluation, as well as the standard occupational therapy assessments.
Clients pay out of pocket to receive Pilates and Reiki in conjunction with traditional therapy services. Turo demonstrates that therapists can balance an occupational therapy frame of reference along with other healing modalities to be successful.
Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on Advance Healthcare Network.
Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.
October is National Breast Cancer Awareness Month, when pink ribbons remind women to schedule their mammograms and honor those who have died from or survived breast cancer. According to the National Cancer Institute, one in eight American women (12.3%) will develop invasive breast cancer during her lifetime.