The study was done by researchers in Germany, and examined groups of women in the USA, India, Brazil, China, South Korea and Germany. What is really interesting about the breadth of the study groups is that the women would have had vastly different lifestyle and diet habits. So, the observed positive effect must come from something outside of existing diet and lifestyle. In this case, the researchers conclude that yoga helps specifically with night sweats and hot flashes.
I worked for twelve years in rehabilitation of women who have had breast cancer. As you may know, many breast cancers are sensitive to oestrogen, so one of the therapeutic strategies is to provoke a chemical menopause. This may sound harsh, and it is, for the ladies. Later, the woman may take a hormone disruptor (aromatase inhibitor or similar) like Tamoxifen for a period of five to ten years. So, I have seen my share of ladies going through the menopause, believe me. The hot flashes and night sweats are very disruptive.
I myself have been crossing this particular juncture in the past two years and the night sweats thing comes and goes. But, as a practising yogi, I will say that my transition has been smooth, and I am not overly bothered by the symptoms. If anything, I feel lighter in my body and more stable in my mind. I did not expect to have a relatively early menopause (I am only 45), but I did expect that my symptoms should be bearable. And in fact, yes, they are.
So, let’s just sum up, shall we? Yoga seems to be effective at easing symptoms of menopause, even adjusting for diet and lifestyle difference. Yoga is a safe and practical solution. Viniyoga, which adapts the practice to the individual, not the individual to the practice, is a style that can help women who might have co-pathologies like osteoporosis/osteopenia,overweight/obesity, arthritis, and so on.
Have I convinced you yet? Don’t worry, I will keep trying if not. Why? Because I care about your health, even if I don’t know you (yet).
Among breast cancer patients, a common complaint is numbness or tingling in the upper-inner arm. This is called neuropathy and is often down to damage to one particular nerve: the intercostobrachial nerve.
The intercostobrachial nerve (ICBN) is connected to the brachial plexus and innervates the axilla, medial arm and anterior chest wall. The brachial plexus is a group of nerves that originate in the neck and whose basic function is to move the arms. (plexus definition: a network of nerves or vessels in the body. an intricate network or web-like formation.)
It is well known that many breast cancer survivors have problems with mobility, strength and sensation in the arm of the affected side. Today, we are going to talk about the specific complaint of tingling, numbness, pain and loss of sensation in the armpit and the inner arm. Here is an image, lifted from the pdf whose link is in the references section, that illustrates perfectly the areas of skin that are innervated by the ICBN.
Intercostobrachial neuralgia, also known as Post-mastectomy Pain Syndrome (PMPS) is estimated to occur in about 33% of breast cancer survivors. I can’t find reference to whether these are 5-year remissions, or longer or shorter intervals, but 33% seems to be the agreed upon figure, and this is for PMPS that persists for longer than three months after the breast surgery. There are other nerves involved in PMPS, but it appears that the the ICBN is the main nerve affected in most cases. Thus, some people say it is more correct to refer to Intercostobrachial neuralgia. However, as that doesn’t exactly roll off the tongue, let’s stick to PMPS and try not to think about PMS (ouch!).
Why does it hurt?
The origin of the pain is either:
nerve damage during surgery, or
scar tissue around the nerve.
Surgery in the axilla is usually to remove lymph nodes, and these are deep to the ICBN. Here is an image of the technique that is used to remove lymph nodes. I lifted it from the medscape article that is cited in the references section. Radiation therapy (RT) tends to damage nerve tissue and promote the formation of fibrosis, is also a cause of the PMPS.
Here is a wonderfully concise description of the surgical reasons for PMPS:
“The most commonly cited theory of chronic postoperative pain in breast cancer patients is the intentional sacrificing of the intercostobrachial nerves. These sensory nerves exit through the muscles of the chest wall, and provide sensation predominantly to the shoulder and upper arm. Because these nerves usually run through the packet of lymph nodes in the armpit, they are commonly cut by the surgeon in the process of removing the lymph nodes.” (http://www.cancersupportivecare.com/surgerypain.html)
I tried to understand what a “lymph node packet” might be, as this isn’t a term that we use in MLD speak. I think that it is a surgical term for the bundle of lymph nodes that is excised. [An article unrelated to PMPS and ICBN contained this phrase “We prospectively assessed 61 pelvic lymph node dissection specimens (packets) in 14 consecutive patients undergoing radical cystectomy.” ]
What to do?
As usual, when we use yoga therapy for breast cancer rehabilitation, we must respect limitations. Firstly, PMPS won’t be cured by practising yoga. But, it can be helped. Secondly, there is variability in the extent and severity of pain and impairment to range of motion. So, adopt a personalised approach and be patient. Use simple, slow movements with breath synchronisation to achieve optimum results. If you are a yoga teacher, you probably believe in prana. I certainly do, and no matter how scientific the tone of my posts, I will absolutely vouch for the healing effects of good prana circulation. So, when teaching, keep your students focused on the practice, not on the results. Also, use your own healing energy and direct it towards them. Wish them well. Ask for guidance and the blessing of whatever guiding energy you believe in.
Here are a few suggestions for sequences that you can integrate into your own practice and bring some flexibility and mobility to the chest and inner arm region. Note that all sequences mobilise the brachial plexus in general.
It is well and good to analyse the physiological and anatomical reasons for practising hatha yoga. It is well and good to tell you why you ought to practise and what you ought to do. Yet, there is another way to saying the same thing and it is much simpler.
Dear reader, happened upon this blog, you should practise yoga just because. Just because yoga makes your body sing. Because when you become very very still and very, very quiet, you can hear that miracle of your own song, your very own vibration. You can connect with a timeless quality that is nonexistent in practically every other sphere of your existence.
You should start practising yoga right now, even if it’s nothing more than sitting in a straight-backed chair, breathing in and raising your arms to shoulder height, then breathing out to lower them slowly down again. Even this simple movement, isolated from any other posture, breath or sequence, repeated with enough intention and presence will bring you into a place of peace that you cannot know under different circumstances. It is as simple as being quiet enough to listen, quiet enough to hear, your own song.
Why, you may ask, ought I listen to my song? There is music on the radio, on the TV, on Spotify…there are so many things to listen to, surely it’s not that important. You err, I will reply. You don’t know what you don’t know until you know it. You are deaf to the chorus of your bodysoul and if you choose not to even look, then you are cowed and craven, too. This is not to insult, not to chivvy, but yes, I would like you to wake up. No matter how hard I try to detach from my longing to awaken each and every one of the beautiful human souls on this planet, no matter how unrealistic and even juvenile this deeply held longing may appear, it is there, it is real. I want you to wake up and the best tool I can offer you is yoga.
Why hear your song? Why listen? Because then you can hear all the messages from within and without. You can then hear your body tell you which foods give life and which foods burden you. You can then hear your soul’s messages about which company to keep, and for how long, and which relationships are toxic and which are good. You can hear the live-giving messages from Nature, the chant of the wind and the whisper of the trees.
And why might this be important for breast cancer survivors? Well, because your song is your life singing. And your life – so rudely threatened by disease – is pretty darn important to you, I will wager. Yoga integrates movement, breath and mind/thought to bring about harmony in all three spheres. I do not say this it should be practised to the exclusion of all other sports or creative activities. But, it complements so well anything else you do that it should be practised alongside your other activities, and not left until last but given priority and done with constancy.
Why practise? Because you can. Because you are here. Because you are alive. Because yoga makes you feel more alive. Because yoga has been around forever and keeps coming out tops from practically every angle. I yog just to know that I am alive. Om. Peace out.
I hear this question a lot.As a yoga teacher, I am naturally inclined to say yoga.However, I recognise the usefulness and appropriateness of both systems, depending on the person and their circumstances.
Let’s explore the similarities and differences between Yoga and Pilates.
Yoga is an ancient system of healthcare and spiritual inquiry.What most of us consider yoga is really only a fraction of the entire body of Ayurvedic medicine.Hatha yoga consists of specifically applied breathing and postures.There are many branches of hatha yoga, includingAstanga and flow styles (vigourous, stimulating), Kundalini and tantric lineages (spiritual),and everything in between. The objective of yoga is to heal the physical body and prepare body and mind to sit in contemplation and, eventually,meditate profoundly.The stilling of the mind is paramount in yoga.
Pilates, is a system of exercise developed in Germany by Josef Pilates. Setting out to align and strengthen the body, Mr. Pilates believed that the mind, when properly oriented towards the physical endeavour, could completely dominate the body, bringing it into harmony through force of will, as it were.Thus, as in yoga, there is mental focus required, but the objectives are quite different.In our modern world, we tend to believe the the intellect reigns supreme and human ingenuity can solve any problem.For this reason, the Pilates philosophy may be more comprehensible for the beginner.It is hard to imagine what “stilling the mind” might entail until we have experienced it.When choosing between Yoga and Pilates, review your belief system:are you more materially or spiritually oriented?While yoga doesn’t have to be spiritual, I could not deny the spiritual underpinnings of the practice.
Yoga can be both dynamic or static, depending on the style.Dynamic yoga places poses in a sequence and one moves smoothly from one to the other.This can be used for warming up – the famous Sun Salutation, for example – or the whole series can be built around flowing vinyasa-s. More static styles work on holding poses.The time can be measured in number of breaths or in seconds/minutes.Yin yoga, for example, holds poses for five minutes or more, allowing deep work into the connective tissue.Some styles combine the two:Viniyoga usually takes each pose through a dynamic phase before holding the pose for a certain number of breaths.The idea behind yoga is that the subtle energy needs to flow in all parts of the body, so a practice could focus on one area (hips, chest) or indeed a whole season could be dedicated to working slowly towards a certain key pose.Again, depending on the style, because the flow styles are more “full body” and some systems work with a set series of poses that work the entire body.
PIlates is always a full body workout, but you may use certain props such as balls, stretchy bands and magic rings to focus a class.There is also simply mat Pilates which perhaps looks more like yoga.Notwithstanding, some yoga styles, such as Iyengar, use props.Pilates is focused on aligning the joints, toning the muscles and strengthening the core abdominal musculature.
Correct breathing is important in both systems.In Yoga, breath and movement are co-ordinated and interdependent.Inhaling for opening movements (extensions, lifts), we exhale to close (flexions, lowering).The breath brackets the movement.That is, the breath is longer than the movement, beginning before and finishing after.Most Yoga classes involve a component of “pranayama” or breathwork.This can be done during the practice, or in special gentle sequences. More often, we close the class by sitting with a straight back and breathing through one or both nostrils following a pattern and rhythm designed by the teacher.
Pilates also has specific breathing patterns, but they are distinct.Inhaling to open and exhaling the close is usually observed, but this pattern is reversed in some exercises.In strength work, we are taught to exhale when applying force (think of a weightlifter’s grunt when squatting).Pilates uses this technique for its strength component.In Pilates,the navel is usually held in.However, with tensed abs, we can produce “paradoxical breathing” as we draw breath, .Paradoxical breathing is a breathing pattern in which the pressure in the lungs increases due to intake of air, but the lung volume does not increase (the lungs can’t expand because the tensed abs limit diaphragm movement).Paradoxical breathing is the hallmark of anxiety and even trying it for a few seconds brings on quite a nervous feeling.Try it yourself:pull your abs in then breathe deeply a few times. That heady feeling?The brain’s response the the increased lung pressure.So, while Pilates will produce more toning and strengthening than yoga might, it can have undesired secondary effects due to the breathing.When deciding between Yoga and Pilates, review your personality and challenges:are you nervous, anxious and looking for mental peace?Or are you more interested in toning and firming?
Adaptations for Breast Cancer Survivors
A yoga teacher with a good training will know how to adapt yoga poses (and flows) to minimise their potential harmfulness to irradiated and/or post-operative areas.Bear in mind that this somewhat eliminates styles in which a set of poses “has to” be practised as a sequence. If these sequence is what the teacher CAN teach – and many 200-hour trainings teach their teachers only set sequences, not how to sequence postures – then a practitioner who “cannot” do the equence will put pressure on herself, the teacher and the class.We need a therapeutic style for breast cancer work, so make sure your teacher knows how to adapt both postures and sequences.Bear in mind that yoga teaching is economically unrewarding and some teachers will be under pressure to fill their classes at any cost.Bear in mind, also, that some teachers might be unaware of their limitations.By reading this post, you are gaining the knowledge necessary to assess your potential teacher and decide.
Astanga-style flows are awesome for the fit body, but tend to include quite a few arm balances.Bear in mind that even the ever-famous Downward Dog (Adho-mukha-svanâsana) is an arm balance.This seemingly simple pose puts pressure on wrists and arms, requires full range of motion in the shoulder joint and requires that Serratus anterior be stretched.All of these factors make Downward dog a tough pose for breast cancer patients.I am not saying “Don’t do it”.I am saying – assess carefully just how important this pose is to the final objective of yoga – stilling the mind through body and breath work – and decide if a class that involves a lot of Downward dog is the BEST option.
Kundalini classes also tend to work set kriyas – sequences – but are probably easier on the breast cancer survivor as the âsana element is less important.There tend to be poses that work pretty intensly the abdominal region, so those with shoulder drop might find this imbalance makes some kundalini poses more challenging.
Bikram is out because of the heat.Too dangerous for lymphedema.
I practice and teach Viniyoga.It covers all the bases when it comes to adaptation of postures and sequences.The therapeutic aspect of Viniyoga also makes it more useful when working with the very personal journey each breast cancer survivor is coursing.
Pilates is subject to the same general contra-indications I mentioned about Astanga and flow styles.It may be difficult for a teacher to adapt a class to one single student.Arm balances for core work may be unavoidable.It may be left to the student to adapt the poses, rather than receive specific instructions about how to do so.Pilates will be great for bringing the shoulders back into alignment and keeping the shoulders joint stable, but again, interview your teacher and decide if they are the person best able to help you.
Gentle physical exercise is a must for breast cancer patients. How tough you want to go is up to you, but it also depends on where you were when you were diagnosed.Did you have a good level of physical fitness, or had you been making excuses for too long?How old are you?Have you any extenuating circumstances like injuries or co-pathologies? Answering these questions helps you to decide what your goal is.But, really, I urge you to go slow at first, and keep a steady pace over time.This will bring greater rewards, over time, than plunging in and risking injury and setbacks.Either yoga or Pilates will do you a great service.Find a teacher who knows and inspires confidence, a class that is nearby and at a time that you can manage. Consider taking a private class, just to give the teacher time to know your history, your limitations, and to teach you how to modify the postures that you will find in the group class.Most important of all is to stick with it!
If you can’t find a group class in your area, why not start one yourself?Find three other breast cancer patients – not too hard, sadly – and contact a teacher.Be pro-active and believe that this is a fundamental part of your healing journey.Om.
We usually think of child’s pose, sometimes known as bheki, as a relaxation pose. It figures in yin yoga and restorative sequences and is generally used as a counter-pose after more strenuous work. However, what seems an easy pose actually represents certain challenges to the breast cancer patient.
Firstly, the classic arm positions in child’s pose – arms alongside the legs or extended and next to the ears – can be challenging for these students. To lay the arms alongside the legs suggests that the person is low enough into the pose (ie: backside is sitting on the heels) so that the upper arm is on the floor. My ladies aren’t all able to do this. Also, anyone with serratus-flap reconstruction is going to find the required rounding of the shoulders hard on the affected side. The extend the arms taxes both serratus anterior and trapezius. There are some people who just can’t lift the extended arm that high. This calls for a modification! Read on…
The ankles can present a problem in ladies of a certain age. If there is undue strain on the front of the ankles, the pose becomes unstable. A simple solution is the prop the ankles on a tubular prop, or simply roll up the end of your mat and use that.
If there is a bit of belly – and let’s face it, with all the cortisone administered in chemo, most students arrive a bit on the heavy side – we need to make room for it. Simply separating the legs helps the body settle comfortably into the deep forward bend.
In people who carry neck tension – and most mastectomized and reconstructed ladies do – you will see that the cervical curve persists in this pose. Do your best to bring attention to the dorsal zone, instructing students to separate the shoulder blades on the inhale. Tell students to pull the chin down towards the sternum. (For those who are comfortable on the pose, you can suggest a little breath retention after each exhale.)
Take the arms out to the side, just above shoulder height, with the elbows bent. Keep a slight pressure between the forearms and the floor. Splay the fingers and keep a slight pressure on the fingertips. Keep awareness at the fingertips.