Polestar Educator Amy Dixon has an extensive fitness background spanning over 20 years, including experience working with breast cancer survivors. Through classes and private sessions, she helps survivors rehabilitate and reexperience positive movement experiences. Amy shares her experiences working with Cancer clients along with useful insights on what to expect teaching this population and how to make the sessions the best they can be.
23 years ago, I was working as a personal trainer while working through issues resulting from 2 herniated discs. I began working with a Pilates teacher and was amazed to discover that this practice alleviated my pain. Because of this, I was inspired to train to become a Pilates instructor myself and after a few years, I found Polestar and completed their Transition program. It was after Polestar that I was drawn to work with more complex clients, using Polestar’s principles to navigate their varying needs. Throughout my career, I have had the opportunity to work with a lot of people with breast cancer diagnoses. I have seen the full range of symptoms breast cancer sufferers experience, from diagnosis to post mastectomy. These symptoms include:
- Decreased shoulder range of motion and strength
- Fatigue
- Pain
- Poor posture
- Peripheral neuropathy
- Increased risk of premature osteoporosis
- Increased risk of lymphedema and sarcopenia
- Impaired ability to perform daily tasks
These issues are compounded with emotional stress and varying frames of mind, which can irritate the symptoms further. Post-surgery breast cancer patients tend to limit their movement to the point that they set back their recovery. Many also develop guarding habits, such as raising the arm on the affected side to protect against being touched or jostled, which can cause further mobility problems in the shoulder area. This is where Pilates can retrain some of these potentially adverse compensations to expedite recovery and avoid the adverse movement patterns from becoming habitual. For example, it is more difficult to restore shoulder mobility in patients who stay guarded in a sling for six to eight weeks than it is to begin the mobility process as soon as lesions are healed.
Clients with a positive outlook and a willingness to progress tend to have better results with this kind of focused movement. It can be scary for the client to move, so much encouragement and compassion are needed! Private sessions are ideal for this type of client in the beginning in order for them to feel more comfortable and to participate in Pilates without feeling self-conscious.
To reintroduce patients to everyday movement, it’s best to start with low-intensity Pilates routines that focus on the upper body. During cancer rehabilitation, the concepts of breathing, pelvic and lumbar spine alignment, rib cage placement, shoulder mobility and stability, and head and neck alignment can be applied to any Pilates movement. Bringing awareness to posture can be the first step in improving daily activities. Putting the body in a position where it moves and reacts more efficiently can take away unwanted stress and strain. Developing proper movement patterns will also allow the body to heal in a way that reduces the likelihood of compensatory injuries.
When dealing with cancer patients, you must be aware of their progress as well as keep in close communication with their physical therapist. It is important to know the types of issues they are dealing with, and by keeping good communication with their PT, you can ensure the proper contraindications are noted before creating a program for these clients. Watch for fatigue, swelling, limited range of motion, and pain while working with these clients.
Ultimately, our Pilates practice can greatly improve the mobility, range, and posture of survivors. Creating a positive movement experience is key.
For more information on Amy and her studio, click here.
Workshop Objectives:
The process of planning this mat class involved adopting a filter of empathy and sensitivity towards domestic trauma abuse victims. As one of my clients who is an MD said, “We all have suffered our own trauma at some point in our lives.” Although this is true, I have never personally experienced the level of trauma as that of a CORA client. I reached out to a few friends and colleagues who have, as well as to Pilates teachers on “The Contemporary Pilates Haven” Facebook group who have had experience working with victims of domestic abuse. Excellent advice came from all of these sources.
One member of this Facebook group recommended the book, The Body Keeps The Score, by Bessel Van der Kolk M.D. This excellent read was particularly helpful in understanding the current neuroscience research involving trauma and pointed towards the successful use of Yoga and Pilates as tools whereby the individual can experience the self as finally being seen and heard, a state of being that often disappears from the psyche of the abused.
In other words, just to be, as opposed to not be, (think Shakespeare), is an essential step for the individual to experience as she/he negotiates a path towards freedom.
I had to design a Pilates Mat class that delayed supine, prone and quadruped positions on the mat as these positions would likely be triggers that could land the participant in a real moment of re-lived trauma crisis. These positions would need to be introduced in a manner where the participant felt an organic sequencing that got them there with a sense of self efficacy and power.
As opposed to a list of exercises to teach, here is where the six Polestar Pilates Principles of Movement helped me to design an appropriate class. Breath, Axial Elongation and Core Control, Spine Articulation and Mobility, Head Neck and Shoulder Organization, Alignment and Weight Bearing of the Extremities, and Movement Integration.
The class started sitting on stools where we mobilized the feet using blue mini balls, and breath and spine movement exploration using Therabands. We progressed to standing for mobility and balance exercises in the spine and extremities using the wall and the floor for support, followed by supine, prone and quadruped exercises with feet against the wall. We returned to standing in a circle with some group movement, folk dance style. In one of the groups we also did an improvisation using the mirror exercise where, working in partners with palms held up and facing each other but without touching palms, the duo moves together as if looking in a mirror. Many of us movement teachers may have done this sometime in our past, but none of the CORA staff members had ever done this exercise before. They loved it!
Aside from the stools, blue mini balls and Therabands, the only other small props I used were partially inflated squishy balls for proprioceptive feedback through the hands, and upper and lower back while doing exercises standing at the wall and in supine. The use of balls for the wall exercises was important because it brought an element of play to the experience and would hopefully avoid a trigger experience of abuse.
We addressed all of the Polestar Principles during this class, and as is so often the case, each exercise hit on many Principles simultaneously.
During the discussion afterwards, I asked the staff members for feedback as to how, or even if, they thought what they had just experienced might be beneficial for their clients. They all commented on the awareness of breath as a huge benefit for bringing the self into the present. I had introduced the statement, “breath is a tool, not a rule” to the group as we explored mobility through all the movement planes, changing where to inhale and exhale. They found this particularly on point as it facilitated each of them to feel positive change in their movement where there had initially been some discomfort. They commented that this might be a first concrete step for many of their clients to feel less invisible. After all, the successful change was generated by the self and not an outside force. Not surprisingly, they also saw the value for their clients in the group and partner generated movement at the end of class as it provided community support.
As of this writing, the CORA Safe House Curriculum Director has indicated that she would like to find a way to incorporate Pilates into the early evening programming. Some of the therapists are considering ways to bring Pilates into their group sessions. These are a group of dedicated, underpaid non-profit organization employees working to improve the lives of their clients. Although no ongoing relationship between myself and CORA has been established, and it may take awhile to solidify some plans, I believe that we will find a way to make something work. Stay tuned!
I will be brief since this is a whole course in itself! We know that Idiopathic (no known cause) Scoliosis (IS) is a 3 dimensional spinal disorder that begins with anterior vertebral wedging due to RASO (relative anterior spinal overgrowth) during bone development. We also know that the rotational component of scoliosis exists as
both inter-vertebral torsion (rotation of one vertebra relative to another) and intravertebral torsion (an internal rotational distortion within each vertebra), most notably at the apical vertebra (the vertebra most deviated laterally from the vertical axis that passes through the sacrum).1
This distortion contributes to less joint motion at the apex of the curve and more at the transition points of the curve.
We see this to a greater degree in adults and to a lesser degree in adolescents who have a more flexible curve before bone maturity. This is apparent in a supine lateral flexion X-ray that assesses curve flexibility.
Better posture can be achieved by emphasizing the most fundamental principles of all intelligent movement disciplines: axial elongation and breathing. Scoliosis curve concavities are constantly under compression by gravity. Axial elongation encourages a natural re-alignment of the spine by using neuromuscular activity to reduce multi-plane compression and collapse of the concave side of the scoliosis curves.
Once the concavities (which include the ribs) are expanded, then breath can be used to further open the collapse through:
A research article was published in 2014 claiming that scoliosis curves can be reduced by doing side planks on the convex side of the curve, and was sensationalized in a WSJ article.2 But the research had many flaws3 and while interesting, it cannot make that claim. Muscular activity on both the concave and convex side of a scoliosis curve is inefficient and exercises that address each side are optimal for IS, including the Side Plank. Consider benefits of the Side Plank based on curve type:
Life takes us out of neutral spine…shouldn’t we train our scoliosis clients how to move their spine effectively out of neutral? The answer is of course yes…. but which movements and how much? This depends on your assessment of the client: Are they in pain? How much movement does the apex of each curve have? What is the curve type? What other muscle imbalances or injuries exist? What are their goals? Considering that the scoliosis spine tends to move more at the transition points and less at the apices, we may want to limit end range movements and emphasize elongation in postural shapes that minimize compression of the curve concavities. This will be more difficult for those with a double curve. So it is important to make critical decisions with your client based on your evaluation and their goals.
