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

According to the National Cancer Institute, approximately 2.4 million women living in the United States in 2004 had been treated for breast cancer (American Cancer Society 2007). Fortunately, thanks to early detection and advancements in treatment, many more women will survive breast cancer and go on to live out their natural life expectancy. Despite this good news, cancer treatments take an enormous toll: in just a year of treatment, the body can age a decade. Between the inherent weight gain, muscle atrophy and premature bone loss, women are left weak and physically challenged even by normal day-to-day activities.

Pilates is a gentle restorative exercise regimen perfectly suited for women as they recover and work to rebuild their bodies. (The benefits also extend to the very small minority of breast cancer patients who are men.) Many people considered Joseph Pilates a master of rehabilitation during his lifetime. His approach emphasized precision and control. Combine those qualities with current exercise science and you have a recipe for success.

For a cancer survivor who is re-building her foundation of physical strength—flexibility, endurance and self-esteem are priorities. Once the client’s medical team has given the okay to begin a gentle exercise program, the process begins.

Phase One
In the first session, be sure to review the client’s overall health history as well as the types of treatments and surgeries she may have undergone. This information is instrumental in developing an effective and safe Pilates program. Remember that you are not here to diagnose, but to help with her rehabilitation. Therefore, it is imperative that you prepare by gathering all of the facts before beginning.

Keep in mind that the usual stages for tissue healing and exercise progression for a client who has had cancer differs greatly from a client who has an acute or chronic injury. Symptoms like muscle tightness and joint stiffness are present in both instances. However, while the symptomology may appear similar, you cannot treat a mastectomy or a lumpectomy like you do a rotator cuff or joint injury. Treatments such as chemotherapy and radiation coupled with surgery greatly affect the time it takes to heal and fully recover. Also keep in mind there are ongoing side effects this client may experience that are unlike those an injured client might have.

The phase one exercises focus on developing the clients’ kinesthetic awareness and teach very basic biomechanical movement principles. These principles are foundational and can be part of the client’s daily exercise regimen forever.

In this first of three installments we will cover three principles:

  1. Breathing
  2. Pelvic Rocking – Imprint and Release
  3. Scapula Protraction and Retraction

1. Breathing Flexed Forward
Benefits: 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—all important for restoring posture and functional strength.

STOTT PILATES®  photography © Merrithew Corporation.

Start Position: Seated with knees bent, pelvis vertical, spine neutral, arms resting long by sides.

Exercise and Breath Pattern:
Inhale to prepare, exhale, initiate from the top of the head and articulate the spine into forward flexion (position shown in photo). Maintain a vertical upright pelvis, relax arms over shins, inhale through the nose and expand the entire rib cage. Exhale through the mouth, allowing the ribs cage to soften.

Complete three to five full breaths while flexed forward. On the last exhale, initiate from the tail and articulate the spine, rolling up to the start position.

Beneficial Cues:
• On the inhalation, allow the ribs to expand like an accordion.
• On the exhalation, feel a gentle wrapping sensation around the torso.
• Focus on full breath patterns and relax; get centered.

2. Pelvic Rocking – Imprint and Release
Benefits: This move helps mobilize the lumbar spine and strengthen the abdominals, especially the obliques, which are essential in the case of TRAM flap surgeries where the rectus abdominus is used for breast reconstruction.

STOTT PILATES®  photography © Merrithew Corporation.

Start Position: Supine on the mat with spine neutral, knees flexed, legs hip-distance apart, arms long by sides (place pillow under arm of affected side). Note: photo shows arms in the air so that the reader can see the neutral shape of the spine, but the arms should be kept long by sides, supported with props if necessary on the affected side).

Exercise and Breath Pattern:
Inhale to prepare, exhale, contract the abdominals and imprint spine toward the mat. Inhale to release back to neutral.

Beneficial Cues:
• Gently rock the hips toward the ribs.
• Visualize a fossil imprint of your spine in sand; avoid pressing the lower back into the mat.

STOTT PILATES®  photography © Merrithew Corporation.

3. Scapula Protraction and Retraction
Benefits: This exercise focuses on scapulohumeral rhythm, which is often compromised with breast cancer surgeries. Strengthens the middle and lower fibers of the trapezius, the serratus anterior and the rhomboids, which are all are extremely important for shoulder girdle mobilization and dynamic stability.

Start Position: Supine on the mat with spine neutral, knees flexed, legs hip-distance apart. Arms are long to ceiling (may have to do one arm at a time and use the strong arm to help hold the affected arm up). Note: photo shows exercise seated upright so reader can see the scapula movement. However, this exercise should be performed on the mat in the supine position with the arms straight over the chest reaching toward the ceiling. See photo #2 for reference.

Exercise and Breath Pattern:
Protract: Inhale to protract the scapula, reaching arms toward the ceiling, exhale to come back to neutral. Repeat 3-5 times.
Retract: Inhale to retract the scapula, bring them closer to the spine; exhale go back to neutral. Repeat 3-5 times.

Beneficial Cues:
• Feel the gliding of the shoulder blades along the ribs. They glide toward the spine and away.
• Visualize holding a roll of paper towels in your hands so that arms don’t go wider or narrower.
• Minimize the range of motion and pay attention that movement occurs just with the shoulder blades and not the spine.

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

PJ O’Clair is the owner of Northeast Pilates Certification Centers and Master Intructor Trainer, STOTT PILATES®.


American Cancer Society. 2007. Breast cancer facts & figures 2007-2008. www.cancer.org/downloads/STT/BCFF-Final.pdf; retrieved Feb. 14, 2008.

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