Phase-One Exercises for Breast Cancer, 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 principles focus on restoring joint mobility with gentle range-of-motion exercises intended to break down residual scar tissue from surgery and various treatments. The work of increasing overall body awareness with slow, controlled, concentrated movements also persists. These simple exercises in the phase-one work are designed to prepare the client for the strength and endurance exercises that will be added in phase two.

While Pilates is a wonderful practice 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 slowly and progress according to the client’s ability—a little goes a long way in rebuilding the foundation. Remember to work closely with the client’s medical team; don’t begin without a physician’s clearance.

Phase-One Movements, Part Two

The following exercises are not meant to replace the foundational exercises from part one of this series (see the April issue), but rather to serve as an adjunct to those exercises. Use the moves below to progress the client in a conservative yet effective fashion. By introducing no more than one or two new exercises at a time, you will avoid overload and more easily be able to determine which exercises are successful and which are potentially problematic. If you add too many moves at a time and the client does not respond favorably, you may not know which exercise was premature. Consistency combined with quality movements is the key to success with this population.

To avoid stressing the affected areas, include both upper- and lower-body moves from the repertoire and allow adequate rest between exercises. Work with the client 1–3 times per week for 30 minutes. This may prove more beneficial than working with her once per week for an hour.

You will note that a couple of the exercises incorporate STOTT PILATES® Toning Balls. The weight of the balls is not relevant, as you will be using them, not for resistance, but rather to support the limbs and assist in the movements.

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 function 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 abdominis, internal obliques, pelvic floor and multifidus.

Benefits. Like the scapula protraction and retraction shown in part one, this exercise creates awareness of how the scapulae glide along the rib cage. The 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 balls. You may support weight of affected arm with cushion, as shown.

Exercise and Breath Pattern

• On inhalation, slide shoulders up toward ears, elevating the scapulae.
• On exhalation, slide shoulders away from ears, lightly pressing hands down on balls, depressing scapulae.
• Repeat 8–10 times.

Beneficial Cues

• Allow the balls to roll up and down. This will help keep the movement smooth and steady.
• Make sure the arms do not round forward as they roll down away from the ears.

2. Hip Release

Benefits. This exercise mobilizes the hip joint and strengthens the abdominals and spinal muscles, helping them to hold the spine in neutral position. 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, hip release is especially beneficial for those who have had TRAM (transverse rectus abdominis myocutaneous) flap surgery and are experiencing core weakness as well as inflexibility in the hip joint.

Start Position. Lie supine on 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

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

Beneficial Cues

• Keep the 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 your 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 mat with spine neutral, knees flexed, legs hip distance apart. Arms are bent, and hands hold toning balls on tops of shoulders. Place cushion under elbow if necessary.

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

Exercise and Breath Pattern

• Part one: On inhalation, lift elbows off mat straight up to ceiling. On exhalation, lower them back down to mat.
• Repeat 5 times.
• Part two: On inhalation, lift elbows straight up to ceiling. On exhalation, open elbows out to sides. On inhalation, lift elbows back up straight over shoulders. On exhalation, lower them back down to start position.
• Repeat 3–5 times.

Beneficial Cues

• Let the arms feel as though they were floating. Avoid tensing the hands or forearms and do not grip the balls.
• Open arms only 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 mobilize the spine and core musculature while providing a nice stretch to the upper body.

Start Position. Lie supine on mat with spine neutral (may imprint 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. On exhalation, rotate lower torso, allowing both legs to lower toward mat (keep legs together). Inhale to stay. On exhalation, rotate back to start position.
• Repeat, rotating in each direction 3–5 times.

Beneficial Cues

• Keep the inner thighs engaged as you lower the 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 final installment of “Phase-One Pilates Exercises for Breast Cancer” in the September issue of IDEA Pilates Today.