Pilates and Breast Cancer

Here's a question I recently answered on AllExperts.com. I share this with everyone because the information is important -

Hi Lynda,
I am an occupational therapist with mat based and reformer based Pilates training through Sara City Workouts (more of a general fitness genre) as well as attending classes and instruction through 2 "Romana" trained Pilates instructors and physical therapists in Milwaukee. I have also attended some general Pilates for Rehab Professional type courses over the past 4 years. I am an NSCA personal trainer as well. I have a client, 34 years of age, 4 kids, stage 2 breast CA and stage 4 mestastasis to the bone. She has always been physically fit. She is interested in reformer training, she did an intro to Pilates class a few years ago and found it boring as she is the type that needs convincing that pain and heavy sweating are not always necessary for an effective exercise program. Since these diagnoses she is more open to more gentle movements. What exercises would you think would be contraindicated on the reformer? Typically I would avoid movements that would involve thoracic flexion and rounded back positions like "hug," roll downs, stomach massage with rounded back, into the sternum. Do you know of any risks associated with legs in straps? Her MD has given her the o.k. for exercise after reviewing her bone scans. Thank you so much for your feedback. In my mind I tend to think of it as a client with osteoporosis and the best methods to modify. I have not attended the Pilates for Osteoporosis but would like to. Thanks again, Sincerely,

Answer -
Dear Tiffany,

Thank you so much for this question!

You have given me enough info to think that you are correct in treating this as you would osteoporosis. No thoracic flexion, lots of spinal extension, and as much kneeling & standing & balance work as you can.

Legs in straps should be fine, except of course short spine & long spine stretches.

I'm not sure what the curriculum of SCW covers on the reformer. Do you know any of the standing side split work? Eve's lunge? The long box, pull straps & T? Seated arm work on the box?

If you would respond and just let me know what series you've been taught on the equipment I could be more specific.

Anything side lying, on all fours, or prone on the mat would be great.

If you want a continuing ed course with more standing/kneeling/extension variations on the equipment and mat try PhysicalMind's Initiation 201 & Concentration 201.

Please get back to me with the reformer info and I will give you some more specific recommendations.



Name: Tiffany

Subject: Pilates and Cancer

Question: Thank you Lynda--all great suggestions and I will look at the Institute's concentration 201. I have a number of Stott videos that I often look to for variations of exercises and should focus more on the standing lunges on the reformer. I recall hearing the name Eve's lunge but not certain what it is exactly. I do use the long box and agree the T, pulling straps would be appropriate. I believe one of my Pilates Coach/ Leslee Bender DVD's demonstrates using the box for upper body exercises so I will review that too. I met with the client the first time Monday and although she did well I am not sure if she will follow-up for future sessions. I do like the long stretch series, typically do knee stretch, stomach massage and elephant with my general clients and may be able to modify those if she chooses to continue. I agree so much of the matwork and standing series could be beneficial as well. One additional question--we use the Stott reformer at the studio where I work--I was trained on a much cheaper version--the stamina products and when I take private lessons the Romana trained instructor uses I beieve the "Grott" model--that might not be the right name but it is the very traditional $6000 model. I am looking to attend the Chicago Stott reformer certification so I am better versed in our equipment. Any opinions on pursuing - Stott certifications versus Power Pilates or The Pilates Method alliance etc? Thanks again for your feedback--take your time on my question. Your studio is beautiful!--------

Dear Tiffany,

Thanks for the follow up. Lots of questions!

Regarding certifications & Pilates education, the PMA does not train you, they simply offer a certification exam that supposedly gives all Pilates teachers and consumers common ground. Stott is good, but know that they are expensive and require tons of expensive continuing education workshops to maintain certification. They have tons of continuing ed materials that anyone can buy, and it can be worth it to get as much as you can. Power Pilates is also good, but when you are out of the NY home studio the quality can vary (I do not know this directly but have been told by others). I teach for PhysicalMind, and what you might like about PMind is that the focus is on biomechanics and what the point is of each exercise (for example, footwork is about pelvic stability with differentiated movement at the hip; so is the frog; so is the knee stretch; so are the leg circles...). And the courses are broken down such that you learn new information and exercise modifications/variations, learn how to be creative yourself, AND you learn how to use any reformer, cadillac/pole, or chair so you're not locked into one equipment line.

Regarding equipment, I have to say that I'm a little horrified at the thought of training teachers on a stamina machine. But I'll get over it :-). However, there really is not that much difference machine to machine (your Romana lady uses Gratz equipment). Just break it down into straps, springs, and bar angle.

Unless your client can extend her spine in stomach massage & knee stretches (and you know how hard that can be at the best of times), do NOT go there. Too much flexion. And elephant is completely contraindicated for osteoporosis--if you shouldn't bend over to tie your shoes or pick something up off the floor, why would you do that on the reformer?

Long stretch series can be OK if she can stay extended through the thoracic spine. Long spine stretch is a flexion exercise with legs in straps which would be bad for this client.

Don't separate what you know as an OT from your Pilates!

Feel free to follow up. Good luck!