Using Pilates to find mobility and more after breast cancer surgery

Another inspiring story on how Pilates helps us in our daily lives!

By Jessica Yadegaran
Contra Costa Times

THERESE BREWITZ was 37 when she was diagnosed with Stage 1 breast cancer. Five years ago, she underwent a lumpectomy followed by five weeks of radiation. It was a grave time for the Oakland Pilates instructor, but she felt blessed to be cancer-free.  Six months following her treatment, however, the pain set in.

“I started to have neck pain,” says Brewitz, now 41. “My chest muscles were very tight. It took me by surprise.”

Brewitz experimented with various Pilates conditioning techniques, but it wasn’t until she discovered and became certified in the Pink Ribbon Program that she began to feel relief.

Founded by Doreen Puglisi, a New Jersey exercise physiologist and breast cancer survivor, Pink Ribbon is a Pilates-based program for postoperative breast cancer patients. It helps survivors regain mobility and range of motion through gentle movements of the chest, back, shoulders and abdominal muscles.

According to a 2005 Harvard-led study in the Journal of the American Medical Association, breast cancer patients who do moderate exercise for three to five hours a week are 50 percent less likely to die from the disease than women who are sedentary.

But, getting moving can be difficult. Scar tissue as a result of lumpectomy, mastectomy, or breast cancer reconstructive surgeries can cause pain, stiffness, muscle weakness and general deconditioning, says Irina Nosova, a San Francisco physical therapist who is certified in the Pink Ribbon Program and Polestar Pilates, another rehabilitative approach to Pilates.

According to Nosova, the entire body can react to postoperative pain, developing poor postures and breathing. Typically, both result in more pain and loss of mobility.

“It’s amazing after surgery how we subconsciously have guarded movements,” she says. “So you can see how you compensate when you stand or sit. The very first step is to make a client aware of it.”

Because Pilates emphasizes a mind-body connection focused on posture and breath work, the arm circles, side bends, and other gentle movements can also restore energy, confidence and self-esteem, she says.

“I think even without realizing it, women are seeking some kind of positive movement experience when they pursue this because they can’t return to their normal physical activity or exercise routine,” Nosova says.

Pink Ribbon is a four-phase program that begins six weeks after surgery or when a doctor approves gentle exercise, says Lori Watson, a San Jose Pilates instructor who was certified in Pink Ribbon three years ago.

In phase one, shoulder stabilization and chest expansion help prevent swelling and tightness and increase blood flow and oxygen to the body.

By phases three and four, the focus is on spine and core strength and resistance training to strengthen the muscles of the back, shoulder and trunk.

“The idea of the program is to reeducate them on how to move,” Watson says. “Think about everyday movements. Lifting your arms to wash your hair can be difficult.”

Watson says many breast cancer survivors don’t pursue this kind of rehabilitation for up to one year following surgery. In some cases, they don’t know it is an option. In others, the general exhaustion and emotional toll of cancer keeps them at home.

“They’re uncomfortable or perhaps they thought, ‘I was in shape before. I’ll recover.’ But posture and breathing? These are things they need to get back.”

Elna Adams of Oakland got them back — and more. Two years ago, Adams, a former anatomy instructor, underwent a double mastectomy and radiation to remove three tumors. Following the surgery, she had a tendency to curl inward to protect her chest, says Adams.

As a longtime practitioner of Pilates and Trager, a form of somatic movement, she was keenly aware of the tightness in her muscles. Adams, 69, did conventional physical therapy until she started working with Barbara Hoffer, an Oakland Pilates instructor who specializes in postoperative rehabilitation, including Pink Ribbon.

“She was very committed to getting stronger,” says

Hoffer, who is also a breast cancer survivor. “When she first came in, she was only able to raise her hands up to shoulder height. She was very tight.”

Hoffer worked with Adams to open her chest, strengthen her back, and isolate the muscles in her arms and shoulders. In some cases, Hoffer visits clients’ homes, placing index cards in areas such as the bathroom sink where a mirror makes it easier to perform these exercises.

“That way, they see themselves getting stronger in normal day-to-day activities,” she says. “The real key is self esteem. Not only strength and flexibility, but finding that woman again. The woman they were before the cancer.”

Hoffer is certainly pleased with her progress.

“I might be in better shape than I was before the surgery,” she says.