Pilates Exercises for Breast Cancer: Rebuilding the Foundation, Part Two

In the second part of phase one programming for breast cancer survivors, the goal is to continue to introduce some very basic biomechanical principles commonly used in Pilates. These basic principles focus on restoring joint mobility with gentle range of motion exercises designed to break down residual scar tissue both from surgery and various treatments. We continue our work to increase overall body awareness with slow, controlled and concentrated movements. These simple exercises in the phase one work are designed to prepare the client for the exercises that will be added for strength and endurance in phase two.

While Pilates is a wonderful format for joint mobility and overall strength, walking is the cardiovascular exercise of choice for breast cancer survivors and should be incorporated as part of a well-balanced recovery regimen. Start slow and progress as able—a little goes a long way in rebuilding the foundation. Remember to work closely with the client’s medical team and don’t begin without clearance.

Phase Two Movements
The following exercises are not meant to replace the foundational exercises from part one of this series (see the April issue), but rather as an adjunct to progress the client in a conservative yet effective fashion. Introduce movements a few at a time to avoid overload. Only add one or two new exercises at a time; it’s easier to determine which exercises are successful and which may prove problematic. If you add too many at a time and the client doesn’t respond favorably, you may not know immediately which exercise was premature. Consistency with quality movement is the key to success with this population.

Vary the exercises from upper to lower body repertoire to avoid stressing the affected areas and allow for adequate rest in between exercises. Work with the client one to three times per week for 30 minutes. This may prove more beneficial than working with her once per week for an hour.

You will note we have added STOTT PILATES® Toning Balls to a couple of the exercises. The weight of the balls is not relevant, as you will not be using them for resistance. Rather, use them to support the limbs and assist in the movements.

1. Scapula Elevation and Depression with Toning Balls
2. Hip Release
3. Butterflies with Toning Balls
4. Spinal Rotation

1. Scapula Elevation and Depression with Toning Balls
The lymphatic system helps rid the body of toxins and is an essential part of the immune system. This is vital for cancer patients. In addition to gravity and muscular contractions, the breath serves as the primary pump for the lymphatic system. The breath also encourages engagement of the deep core musculature—transversus abdominus, internal obliques, pelvic floor and the multifidus.

Benefits: Like the scapula protraction and retraction shown in the first part of this series, this exercise creates awareness of how the scapula glides along the rib cage. This move warms up the shoulders, improves mobility and helps restore range of motion. The balls assist in the muscular action by providing proprioceptive feedback.

Start Position: Lie supine with knees bent, feet hip-distance apart, entire spine neutral, arms long by sides with palms resting on the balls (you may support the weight of the affected arm with a cushion as shown).

Exercise and Breath Pattern:

• Inhale: slide shoulders up toward ears, elevating the scapula.
• Exhale: slide shoulders away from ears, lightly pressing hands down on the balls, depressing the scapula.
• Repeat 8-10 times.

Beneficial Cues:

• Allow the balls to roll up and down, which will help keep the movement smooth and steady.
• Watch that the arms do not round forward as they roll down away from ears.

2. Hip Release
Benefits: This exercise mobilizes the hip joint and strengthens the abdominals and spinal muscles to help hold the spine in neutral. The goal is to use the abdominals to maintain symmetry while moving the leg away from the midline of the body. While appropriate for all breast cancer clients, this is especially beneficial for those who have had TRAM flap surgery and experience core weakness as well as inflexibility in the hip joint.

Start Position: Lie supine on the mat with spine neutral, knees flexed, legs hip-distance apart, arms long by sides (place pillow under arm of affected side).

Exercise and Breath Pattern:

• Inhale, rotate one leg laterally, allowing it to drop out away from the midline of the body. Extend the knee and slide the foot down along the mat.
• Exhale, medially rotate the leg and slide the foot back up. Bend the knee and return to the start position.
• Repeat 3 times on each leg.

Beneficial Cues:

• Keep core muscles engaged when the leg drops out to the side, think small range of motion first.
• As you exhale visualize the core musculature wrapping around you like a gentle corset.
• Keep leg relaxed and hip socket tension free; avoid rigidity.

3. Butterflies with Toning Balls
Benefits: This exercise focuses on scapulohumeral rhythm, which is often compromised with breast cancer surgeries. You want to mobilize the shoulder, but not at the expense of dynamic stability. The balls are a perfect prop to assist in controlling range of motion and aiding dynamic stability.

Start Position: Lie supine on the mat with spine neutral, knees flexed, legs hip-distance apart. Arms are bent and hands hold toning balls on the tops of the shoulders. If the client needs arm support on the affected side, place a cushion under the elbow.

Perform this exercise in two parts. Do not add part two until client can do part one without pain. Keep the range of motion small at first.

Exercise and Breath Pattern:

• Part one: Inhale, lift elbows off the mat straight up to the ceiling. Exhale, lower them back down to the mat.
• Repeat 5 times.
• Part two: Inhale, lift elbows straight up to the ceiling. Exhale, open the elbows out to the sides. Inhale, lift elbows back up straight over shoulders. Exhale, lower them back down to the start position.
• Repeat 3-5 times

Beneficial Cues:

• Let the arms feel as though they are floating. Avoid tensing hands or forearms and do not grip the balls.
• Only open arms as wide as you can while maintaining pain-free control.
• Use your exhalation to maintain core stability as you open the elbows. The breath precedes the movement.

4. Supine Spinal Rotation
Benefits: Rotation of the axial skeleton is a necessary and functional movement that may have been compromised during treatment. Abdominal tightness and spinal rigidity are common side effects of certain breast cancer surgeries. This exercise will help mobilize the spine and core musculature as well as provide a nice stretch to the upper body.

Start Position: Lie supine on the mat with spine neutral (may imprint the lumbar spine for additional support), knees flexed, legs together, arms out to sides just below shoulder level with palms facing up.

Exercise and Breath Pattern:

• Inhale to prepare. Exhale, rotate lower torso allowing both legs to lower toward the mat, keeping legs together. Inhale to stay. Exhale, rotate back to the start position.
• Repeat going in both directions 3-5 times.

Beneficial Cues:

• Keep the inner thighs engaged as you lower legs to one side—this will help with abdominal connection.
• Do not let your upper body rotate with the lower body.
• Maintain a lifted sensation in your pelvic floor muscles as you rotate your spine.

Look for the next installment of phase one Pilates exercises for breast cancer in the June issue of Inner IDEA Body-Mind-Spirit Review.

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