A Breast Cancer survivors’ path to renewal
Posted on Oct 15, 2015 1:10:00 PM
 
 
My first experience with breast cancer was witnessing my aunt Maggie’s losing battle with the disease that sadly took her at 49 years old.  Her cancer was very advanced, by the time it was diagnosed she didn't have a chance of survival.  
 
Back in those days (1991) it was more common for one to be taken by the disease than to survive.  Fortunately with the advancements in cancer research and cancer treatments survivorship is the norm.  Those of us in the rehab and post rehabilitative world, that choose to work with breast cancer survivors, had to advance our knowledge of the appropriate protocols for each and every survivor.  That is a huge undertaking – there are so many types of cancers and treatments that it can be a bit overwhelming.  
 
As a dedicated and passionate trainer I sought out the advice from one of the pioneers in breast cancer survivorship – Dr. Carolyn Kaelin. Twenty years ago Dr. Kaelin was the founding director of the Comprehensive Breast Health Center at Brigham and Women’s Hospital.  She was also a breast cancer survivor.  Dr. Kaelin was committed to treatment and ongoing care for survivors – she believed fitness to be a critical component in both the physical and emotional patient care during and after treatment.  
 
My work with her and her patients was some of the most rewarding in my career.  Sadly Dr. Kaelin passed away in August of this year, 2015 from her second struggle with cancer, brain cancer.  She will always be remembered for her strength and compassion.  
 
Dr. Kaelin advised me on the five seminal points all fitness trainers should know and understand when working with breast cancer survivors:
•Lymphedema
•Rotator cuff issues
•Sarcopenia
•Premature osteoporosis
•Physiological imbalances (implant, TRAM, and lat) 
 
With her guidance and advice I developed a STOTT PILATES program for Breast Cancer Survivors and am now working on the development of this program using the TRX Suspension Trainer. 
 
The foundations of this program are as follows.
 
Phase One:
The first phase is focused on tissue mobility – the soft tissue of the body, namely the fascia, is restricted with the various surgical and systemic treatments.  Adhesions in the fascia often restrict range of motion in the joints and create postural dysfunction and movement impairment.  It’s critical to restore this tissue through both proper diaphragmatic breathing and selective movement.  Careful attention must be maid to stay in a pain free range.  
 
Phase Two:
The second phase is dedicated to regaining strength in both the core and the posterior chain (back side of the body).  The core is hierarchical in posture and support – its essential for dynamic stability and effortless movement. The posterior chain is our endurance line – it is what brought us out of the fetal position.  It helps keep us maintain an upright position and enables us to manage both gravitational and ground reaction forces .
 
When don't the exercises included here I encourage you to be mindful of what is happening during the movement.  Whether you are a trainer or a breast cancer survivor yourself please pay careful attention to how the movements feel – if something doesn’t feel right – it most likely isn’t right and warrants attention from a either a qualified fitness professional or physical therapist.  
Remember, keep it simple, keep it safe, and enjoy the road to recovery.  When it comes to renewal – look for the pleasure in the movement and be sure to breath.  
 
 
 
 
Phase One - Mobility
 
Name: TRX Neck Stretch
Adjustment: Long / SHM
Position: Standing Sideways to the anchor with working arm is behind the back with the elbow bent
Movement: Use free hand to apply gentle pressure to the head and lean the head toward the anchor
Stay in position and breath in and out fully 3 – 5 times 
Return: bring neck back to vertical
Repeat on opposite side
 
Name: TRX Forearm Pec Minor Stretch
Adjustment: Long / SHM
Position: Standing facing away from anchor, one arm bent and placed inside the foot strap, feet in offset stance - the same foot as working arm is behind
Movement: externally rotate the suspended arm simultaneously lean body away from anchor until a slight stretch is felt in the front of the shoulder of suspended arm.  Keep the working elbow bent throughout.  Use free hand to feel and guide the working arm into rotation.  
Return: internally rotate arm lowering it back to the start position
Repeat on opposite side
 
Name: TRX Walking Shoulder Extension 
Adjustment: Short
Position: Stand facing away from anchor, hands holding handles, palms facing body
Movement: walk away from anchor allowing arms to float up behind into shoulder extension
Return: walk back toward anchor allowing arms to lower down to start position
Repeat 4 – 5 times
 
Name: TRX Reverse Forearm I Fly Stretch
Adjustment: Long
Position: Stand facing away, offset foot position, elbows bent with forearms in foot straps
Movement: lean into forward leg allow arms to raise up, the leaning into the forward foot will help support the shoulder stretch
Return: press forearms into straps to lower arms back down to shoulder height
Repeat 3 times with one leg forward then 3 times with other leg forward
 
Phase Two – Core & Posterior Chain Activation
 
Name: TRX Forearm Plank into Chest Flys
Adjustment: Long
Position: Stand facing away, offset foot position, elbows bent with forearms in foot straps
Part One Movement: This is an isometric (static) exercise.  However pressure into the forearms will activate the core
Note: may change leg position to progress exercise 
Part Two Movement: lean the body into the forward leg and open the arms out to side
Return: Press the arms back to start position
Repeat with other foot in front (offset stance) 
 
Name: TRX Hip Hinge with spinal mobility
Adjustment: Long
Position: Stand facing the anchor, feet in wide symmetrical stance with leg bones turned inward from the hip joint, hands on handles with palms down
Part One Movement: hinge forward from the hip simultaneously pressing the hands in to the handles to activate the shoulder girdle and core
Return: hinge back to vertical maintaining plank position
Repeat 3 – 5 times
Part Two Movement: hinge forward from the hip simultaneously pressing the hands in to the handles to activate the shoulder girdle and core
Return: mobilize the spine by rolling spine from bottom to top coming back to the start position
Repeat 3 – 5 times
 
Name: TRX Half Kneeling Hip Flexor Stretch with T-Spine Mobilizer
Adjustment: Long or Mid Calf
Position: Kneeling lunge facing away from anchor, arms lengthened out straight in front of chest, both hands placed stacked inside the foot strap with palms down 
Movement: rotate upper body toward forward leg, apply gentle pressure into hands to activate shoulder girdle and core
Return: rotate back to face front
Repeat on opposite side
 
Name: Horseback Sitting Protraction / Retraction
Adjustment: Long
Position: Sit on Ball (or heels) facing the anchor with hands holding handles, hinge body from knees on a diagonal with arms long, palms facing in
Movement: Squeeze shoulder blades together and down in to retraction 
Return: release and allow shoulder blades to hug the ribs into protraction
Repeat  8 – 10 times
 
Name: TRX Low Row
Adjustment: Short
Position: Stand facing anchor, legs in offset stance, elbows under shoulders and lean back, off loading body weight in to back leg
Movement:  Squeeze shoulder blades together and down, bend elbows and pull body toward the anchor
Return:  lengthen arms back out to start position
Repeat 8 – 10 times
 
Name: TRX Hip Press
Adjustment: Mid Calf
Position: Ground facing the anchor, heels in straps, knees bent and hip at a 90 degree angle
Movement: press down into straps activate glutes and lift hips 
Return: fold at hips and lower body back to start position
Repeat 8 – 10 times
 
Name: TRX Hamstring Curl
Adjustment: Mid Calf
Position: Ground facing the anchor, heels in straps, legs extended out long
Movement: press into straps and lift hips up to a low hover, bend knees and bring heels toward hips
Return: press legs back to long position, keeping hips up
Note:  to modify, keep hips down
Repeat 8 – 10 times
 
 
Name: TRX Abduction / Adduction
Adjustment: Mid Calf
Position: Ground facing the anchor, heels in straps, legs extended out long
Movement: press into heels, lift hips, open legs out to sides
Return: close legs keeping hip up
Note:  to modify, keep hips down
Repeat 8 – 10 times
 
 
 
For more information on programming for breast cancer contact PJ OClair
Facebook: Pjoclair 
 

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