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.
Protective Phase exercises should be done with 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 above) 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:
- Lie on your back with both knees bent and feet on the ground, hip distance apart.
- Pelvis is level with the floor or slightly tilted toward your nose if you have back problems.
- Arms and fingertips are reaching toward the ceiling only to shoulder height.
- Optional: Squeeze ball between your knees.
Exercise:
- Inhale, and reach fingers tips toward the ceiling (shoulder blades will lift off the mat). This is protraction.
- Exhale, and bring your shoulder blades together (not too hard) as you imagine you are gently cracking a walnut between your shoulder blades. This is retraction.
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:
- Lie on your back with both knees bent and feet on the ground, hip distance apart.
- Pelvis is level with the floor or slightly tilted toward your nose if you have back problems.
- Arms are long at your sides.
- Optional: Squeeze ball between your knees.
Exercise:
- Inhale to start, and then exhale as you tilt your pelvis toward your nose to imprint your spine.
- Then push off through your heels, and lift your spine off the mat one vertebrae at a time. You will start moving the lower back, middle back, and then upper back off the mat.
- Inhale as you hold this position at the point where you can remain still, without any movement of your pelvis. Both the upper part of your shoulder blades should remain on the mat.
- Exhale as you return to the start position by gradually bringing the upper back, middle back, and lower back gently down to the mat, vertebrae by vertebrae to your neutral or imprinted pelvis. Think of rolling the spine slowly down to the floor.
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.
This article has been adapted from Pilates for Breast Cancer Survivors, by Naomi Aaronson and Ann Marie Turo.
