Pilates And Breast Cancer Recovery

Pilates Breast Cancer Recovery

Laura Rapuzzi

Pilates Breast Cancer Recovery

Laura Anna Rapuzzi

Dott.ssa Carol Pileggi

Photos

Fotostudio Rapuzzi Di Marco e Matteo Rapuzzi

Tradotto da Simona Casaccia

Via Bonomelli 92

25123 Brescia

info@fotostudiorapuzzi.com

© Copyright 2021 by Laura Rapuzzi MK PILATES – All rights reserved. You may not reproduce, duplicate or send any part of this document electronically or in print. Registration of this document is strictly prohibited.

INTRODUCTION

The creation of this manual is to give with Pilates method a practical guide that can help patients with breast cancer to achieve a complete psycho-physical recovery.

The benefits that you can get through the application of the Pilates method are many and valid. They guide each patient on the path to recovering their daily quality of life.

The improvement of the mobility of the part gone under surgery, the muscular rebalancing, the improvement of posture and breathing, are the main objectives that can be achieved with this planning.

The manual is aimed at everyone, even non-professionals, and will provide guidelines to optimize the benefits of the method. For this reason we will present the inventor Joseph Pilates and the Michael King school, recognized all over the world. Knowing the principles on which the method is based is very important to perform the exercises with precision, fluidity and effectiveness.

The interested parties will also be treated at an anatomical level by exposing the fundamental notions to better understand the reason for the choice of exercises. In the final part of the manual we will discuss how with the Pilates method diversified work phases can be organized, useful for achieving full recovery. Starting from simple exercises with the application of the principles of the method and developing, in the subsequent phases, motor challenges, we will improve all skills: control, stability, mobility, strength and balance.

The psychological, emotional side, as well as depression, will also benefit, thus offering a new, more positive, approach to life.

Laura Rapuzzi, ISEF graduate with 110 cum laude, for 40 years in the world of fitness; university teacher in sports science, she has perfected in recent years with Michael King’s MK Pilates school, with whom she collaborates as a referent in Italy for several courses. He will discuss the potential of the Pilates method as a recovery tool for those who have undergone breast surgery.

Simone Zanelli, Motor Sciences Brescia has been in the fitness and Pilates sector for years, collaborating with the MK school of which he is tutor, he will develop together with Laura, the rehabilitation and functional part of Pilates applied to this series.

In detail, Dr. Carol Pileggi, Emergency Doctor, specialist in Oncological Radiotherapy, as well as practitioner of the method and Pilates Instructor, will treat the clinical aspects of breast cancer, from the anatomical constitution of the district concerned to the diagnosis to the possible interventions based on the case and therapies, also touching the emotional as well as psychic sphere put to the test by the disease, whatever its evolution.

Thank you for taking the time and getting ready to read this manual.

PILATES METHOD

The Pilates method is an exercise system created by Joseph Hubertus Pilates in the 1920s. A program for the whole body, accentuating the mind / body relationship. The focus is on the movements that must be controlled, performed in a fluid and balanced way to have an improvement in strength, mobility, flexibility and coordination. The main difference between Pilates and other exercises is the approach to the method. Despite the multiple interpretations of the technique born since its creation, most Pilates lessons are performed in a way that allows professionals to approach the exercises with awareness.

JOSEPH HUBERTUS PILATES STORY

He was born in Mönchengladbach near Düsseldorf Germany in 1880. He was a frail and sickly child suffering from asthma, rickets and rheumatic fever. From the age of 14, he began to work so hard on his body that he became a model for an anatomical table. In 1912 he went to England. During this period he achieved some success as a boxer, gymnast, circus performer and self-defense coach for English detectives. During World War I in 1914 he was interned with other Germans in a “camp” of foreign enemies in Lancaster.

Later he was transferred to the Isle of Man where he became a nurse and worked with many inmates who suffered from infirmities and hardships left behind during wartime captivity. He became famous because when a terrible flu epidemic spread in 1918 killing millions of people around the world, thousands of them in England, none of Joseph’s followers died as they were in excellent physical shape. After the war Joseph returned to Germany where he began to train private clients and the Hamburg military police in self-defense and physical training.

In 1926 he was invited to train the new German army, but because he disapproved of the political direction of Germany, he decided to leave for the United States. During the journey he met Clara who became his life partner. Arriving in New York in 1926 Pilates opened a gym on 939 Eight Avenue, in the same building as several dance studios and rehearsal rooms. Not much is known about the early years of his work. In 1940 he became famous in the dancers community. In February 1956 the newspaper “Dance” wrote: “Sooner or later, probably every dancer in New York and surely all the students of Jacob Pillow (American dance school) between 1939 and 1951 will humbly submit to Joe’s spirit of instruction. Pilates “. In 1960 Pilates had many New York dancers among its clients. George Balanchine trained “at Joe’s” (as J. Pilates called). Balanchine invited Pilates to instruct her young New York City Ballet dancers. At this point “Pilates” was taking over the world outside of New York. As the New York Herald Tribune wrote in 1964: “Hundreds of young students warm up daily with an exercise known to them as Pilates without knowing that it is actually the last name of a living man.” While Joe was still alive only 2 of his students Carola Trier and Bob Seed had opened their studios. Trier had a long experience as a dancer and came to the United States by escaping from the Nazi camp in France working as a contortionist. She met Joe Pilates in 1940 when an injury prevented her from continuing her career. Joe Pilates helped Trier open his studio in the 1950s. They remained friends until Joe and Clara died.

With Bob Seed, however, it was another story. A former hockey player became enthusiastic about “Pilates”, opened his studio across town and tried to steal some of Joe’s clients thanks to the morning opening. According to John Steel, one day Joe showed up in Seed’s study with a gun and ordered Seed to leave and Seed left.

PILATES” SECOND GENERATION

When Joe died he left no will or successor to his work. Despite this his work remained. Clara continued to manage the “Pilates” studio on Eighth Avenue in New York where Romana Kryzanowska became the director in 1970. Kryzanowska studied with Joe and Clara in the early 1940s and after a 15 year hiatus in Peru she resumed her studies of the method.

Other students of Joe and Clara opened their centers. Ron Fletcher was Martha Graham’s dancer who studied with Joe in the 1940s to recover from chronic knee pain. Fletcher opened his center in Los Angeles in 1970, which attracted many Hollywood stars.

Clara was very fond of Ron and gave his blessing to carry on the work “Pilates”. Like Carola Trier, Fletcher brought some innovations and improvements to the method. His variations and the evolution of “Pilates” were inspired both by his years as a Martha Graham dancer and by another mentor, Yeichi Nimura.

Kathy Grant and Lolita San Miguel were also direct students of Joe and Clara became teachers. Grant ran the Bendel studio in 1972, while San Miguel continued to teach Pilates at Ballet Concierto de Puerto Rico in San Juan, Puerto Rico. In 1967, shortly before Joe’s death, both Grant and San Miguel were certified by the State University of New York to teach “Pilates”.

EVE GENTRY AND JOE PILATES

Eve Gentry was a modern dancer born in the early 1900s. In 1917 she began studying ballet, folk and dance. In 1936 she moved to New York where she began her career as a dancer with the Hanya Holm Company. In 1938 he choreographed Tenant of the Street, his most famous dance piece. In 1940 Eva and 3 other dancers founded the Dance Notation Bureau. She was the first to teach Labanotation, a notation system, a graphic transposition of danced movements, for the recording and analysis of human movement. She married her childhood sweetheart Bruce Gentry in 1944 and chose the professional name Eve Gentry, formerly Henrietta Greenhood. Eve headed her dance company from 1944 to 1968. She also worked as a lecturer for the High School for the Performing Arts and New York University School of the Arts. Chronic back and knee problems led her to Joseph Pilates’ studio where she worked as a teacher from 1938 to 1968. In 1955, Eva had a radical mastectomy, and turned to Joe for help in his functional recovery. The surgery removed so much muscle that he could not lift his arms. With Joe’s help she was able to get back to dancing within a year. Eve and Joe made an amazing video of her rehab. His recovery through the Pilates method was so incredible that when Joe introduced him to the doctors, hoping to form an alliance, they didn’t believe the video was real. In addition to the disbelief and amazement at the results achieved, they could not make this collaboration because Joseph was a self-taught without medical qualifications. Only in the future was its value also demonstrated on a scientific level. In 1968 Eve moved to Santa Fe, New Mexico, where she founded a dance studio and a Pilates studio with the equipment Joe had given her. He choreographed and danced in Stravinsky’s La Rossignol with the Santa Fe Opera and at the age of 63 he danced in Jose Limon’s Villa Lobos Yerma. In 1991 he co-founded The Institute for Pilates Method. With a career spanning more than 50 years, Eve was a dancer, teacher and choreographer for the stage, film and television. She was honored in 1979 by Bennington College (Vermont) with the Pioneer of Modern Dance Award and was named Santa Fe Living Treasure. She was an incredible woman who lived an incredible life. In 1994 he died at the age of 84..

PRINCIPLES OF PILATES METHOD

The Pilates method is one of the few methods that gives the possibility to train the deep muscles before the superficial ones, with a synergy. This allows for a more complete and effective result. The principles of the method used universally:

Concentration - while in many methods and programs you can “turn off the mind”, in Pilates exercises every movement is controlled by the mind. “The mind body” “mind body” is the fundamental connection to perform the movements of the method with awareness and quality.

Respiration - is one of the pillars of the technique and the part that requires the most application to learn and automate. With a slight activation of the transverse abdomen (30%), lateral thoracic breathing is exploited. Joseph Pilates, suffering from asthma, gave great importance to correct breathing, emphasizing inhalation to fill the lungs and exhalation to empty them, in order to rid the body of toxins and purify the blood..

Centre - It represents the center of strength and control for the rest of the body. Also referred to as core (diaphragm, transverse abdomen, pelvic floor and multifidus) or girdle of strength or powerhouse. Many people train without paying attention to how a movement is initiated. This can lead to pain and strains. Pilates teaches us to activate the core before starting a movement, starting each movement from the center. As a result our body will be strengthened and protected in every movement. The body works as a whole, like an orchestra rather than individual instruments.

Control - When control becomes automatic, complete mastery has been achieved. Before being called the Pilates method, when Joseph was still alive, he called it “contrology”, the title of his first book, because every movement performed requires full awareness and precisely the control of every single movement.

Precision - This principle is the basis of a correct approach to making the movement. It requires complete muscle integration which can be followed by the isolation of certain muscles or muscle groups. If each movement is performed with precision to the smallest detail, the work will be felt more deeply. Accuracy is the basis of a correct approach to perform movements. The routine of the Pilates technique leads to acquiring control of the body and thus the precise execution of the exercise.

Fluidity - Pilates exercises are a continuous movement, as if it were a wheel that turns with the same speed by performing a cycle and a set of movements. In this way, the body is able to take advantage of the eccentric and concentric phase and the training is balanced and functional. Flow can be understood from a physiological point of view, as the perfect timing of muscle recruitment. In every movement there is an optimal muscle recruitment sequence. When this sequence is correct and executed with the right timing, it manages to generate a natural flow. Observing two people who perform the same movement, we often detect the difference between their executions, a difference attributable to the flow or the total absence of this. As well as looking at a professional athlete of any discipline, the natural fluidity and precision of movement is observed.

EXTRA PRINCIPLES OF THE METHOD

Isolation - This principle identifies the realization of an action with a segment of the body that stabilizes and another part that carries out the movement (for example in Spine Twist, the pelvis is stable while rotating the spine). It is a work in synergy that involves isolating the movement without using unnecessary energy to be able to perform it correctly.

The routine - the movement is repeated several times and continued over time. “Little movement that is well planned and executed with precision in a balanced sequence, has the same value of hours of forced and loosely done contortions.”

Coordination - Capacity that allows you to perform movements in space effectively without wasting unnecessary forces. It represents the driving force of the method. In each exercise we find the balance of body and mind. Achieving this balance, according to what Pilates wrote in Return to life through contrology, guarantees perfect posture. If this principle is not adopted and realized, the body lacks its life force. By practicing Pilates we become aware of the relationship between body and mind.

Alignments -This principle is closely linked to the principle of precision, it is a constant search to find the correct position before making a movement. Posture and alignments are also widely treated in physiotherapy even if there is no standard system of measures. Each of the alignment points correspond to bone points and it is crucial to maintain them correctly as the lines of force and gravity will act so perfectly. If the tension of the tissue does not allow the points to be in this orientation, there could be a problem with neurological, lymphatic, and blood flow.

Relaxation - Ability to relax the muscles not involved in movement, a principle linked to isolation.

VERTEBRAL COLUMN IN NEUTRAL.

The column in neutral is a fundamental part of the Pilates technique in the recent teaching. The concept is based on the use of the body for how the spine is specifically constructed and its original design. Strengthening the body in the neutral position of the spine gives you more strength with which to carry out daily activities with less risk of causing accidental back pain or postular deterioration. You can search for the neutral position of the spine in an upright position, supine in a sitting position. Any movement in the supine position can be used to re-educate or resume the correct setting of the neutral position.

When you are seated, before starting a movement, look for the neutral position, with all the natural curves of the spine. If you are unable to maintain this position, the cause may be due to inelastic hamstrings and a contracted psoas, so you can sit on blocks or any rise to allow you to be able to keep the neutral position keeping the ischium higher than at the feet. The advice to improve and stretch the hamstrings (hamstring) with stretching and mobility exercises. The column is in neutral if the pelvis is in neutral. It is essential to be able to find this position even if some exercises do not involve always working in neutral (for example those in which they bring the flexion of the spine). In the paragraph on alignments and posture, this position will be dealt with more specifically.

MICHAEL KING METHOD

The Pilates method was initially taught by keeping the lumbar spine in imprinting, that is, with the lumbar curve flattened (a famous phrase of Pilates is “keep the spine flat, straight like that of a child”) But the latest research has shown that this position it is not the most effective for the spine, for a postural attitude that has changed in the present day and for those people with lumbar problems. It therefore becomes important to know the difference and when to use the work in neutral or imprinting, shoulders lifted from the mat or in support. This knowledge and this change of version from the original distinguishes the MK Pilates method from others.

Michael King

ADVANTAGES OF NEUTRAL REQUALIFICATION

The neutral of the spine provides a balance of muscle forces between opposite muscles. It allows the ‘optimal’ function of the stabilizing muscle unit of the transverse abdomen and pelvic floor. Allows for the best muscle maintenance and development essential for short and long term function of the spine and daily movement. Helps prevent the rectus abdominis from shortening and becoming a dominant abdominal muscle. Reduces stress on vertebrae and discs.

Criteria required for the preparation phase:

 Posture control - body alignment Shoulders - Soft ‘V’ (open the chest)

 Breathing - latero thoracic

 Neutral position - lumbar, thoracic and cervical area

 Center / Isolation - 25-30% contraction of the transverse abdomen T.A. or pelvic floor P.P.

 Joint mobilization - focus on the spine

 Balance - non-advanced functional focuses on concentrating on the stability of the center.

 Concentration - use of the environment, surface and voice to reduce distractions.

 Fluidity - can be implemented already in the preparation phase.

 MK Pilates Principles - Introduce the concept of all principles including routine and precision.

There is no specific order but it can be followed as listed above. It is important that the teacher promotes awareness of the principles.

It is important to listen and ask, never take anything for granted. Above all, you must not try to “fix” people. Not all problems are caused by a physical problem. Stress, anger, insomnia can create serious somatic effects. So there are many reasons why a person may have problems - not making a diagnosis, but knowing and understanding why a certain movement is made by applying the method or principle.

Respiration

Breathing in addition to being vital, has numerous physiological advantages for the human being.

(“Breathing is the first vital act and it is also the last. Our very life depends on it. Lazy breathing makes the lungs, figuratively speaking, a cemetery for the deposition of sick germs.” Pilates 1945)

 Bring oxygen to the blood

 Releases toxins

 Improves circulation

 Calm the mind and body

 Facilitates concentration

 Gives rhythm to the movement

 Contributes to the activation of the muscles responsible for movement

For all these reasons it becomes essential to correct breathing in Pilates and in rehabilitation to obtain optimal results.

Natural or diaphragmatic breathing induces relaxation of the abdominal muscles during inhalation. In Pilates, lateral or intercostal breathing is used. During inhalation, the lateral and posterior expansion of the rib cage is emphasized, favoring an inward movement of the abdominal wall. The abdominals contract more during this phase to help the diaphragm and the intercostal muscles in expelling air. In lateral breathing, the maintenance of abdominal muscle contraction is facilitated during the entire respiratory cycle, which, in turn, contributes to the stabilization of the trunk.

Centre

“In Pilates, centering yourself means more than finding your own center of gravity; it means to merge body, mind and spirit. (Isacowitz, 2014, 9) “

In the Pilates Method, the center or core is the point of origin of all movements, defining it as a powerhouse. It is made up of deep intrinsic muscles of the trunk: the transverse abdominis, the multifidus, the pelvic floor and the diaphragm. They provide stability to the spine. These muscles are located deep and are not developed like other skeletal muscles such as biceps or quadriceps. For this reason, the mind-body connection of Pilates becomes fundamental to facilitate the stabilization of the spine and allow it to penetrate deeper with the neuromuscular connection.

Alignments

Good alignment results in less strain on the spine and joints and more efficient muscle activity. In biomechanics it is an established factor that a position that maintains the natural curves of the spine is the most energy efficient, allowing the body to resist erect against the force of gravity and against further forces on the spine. If the column is neutral, the pelvis must also be neutral, but not vice versa. For example, if from the supine position with the pelvis and spine in neutral, we raise the head and shoulders (as in a crunch), the spine is in flexion while the pelvis remains in neutral. So it is essential to know and find this position even if it does not mean that all the movements will be carried out with these alignments. The neutral position of the pelvis occurs when supine, the anterior superior iliac spine on both sides of the pelvis and the pubic symphysis are on the same horizontal plane, and the superior iliac spines on the same transverse plane. Anterversion is referred to when the superior iliac spines are higher (or anteriorly if the position is erect) than the pubic symphysis. Resulting in a more pronounced lumbar curve. We speak of retroversion when the pubic symphysis is higher (or anteriorly, if the position is erect) than the anterior superior iliac spines, resulting in a less pronounced lumbar curve.

The neutral position allows you to generate force more efficiently, it is the safest to protect the body from injuries, it promotes the correct recruitment of both the core muscles and all the muscles that act on the limbs. It is very important to strengthen an efficient posture, the ideal alignment for the benefit of functional and positive motor patterns. Once this pelvis-column relationship is learned, other areas of the body will be observed. (Head cervical spine, Shoulder girdle, Rib cage, Thoracic spine, knees, feet).

4 DIAPHRAGMS

In classic Pilates (first generation) the diaphragm muscle was considered the main engine for reaching elongation, center activation and breathing. In the current evolution of the method, the visualization of the 4 diaphragms is used to achieve the same goal with more precision, thanks to the synergistic involvement of the whole body and not just a muscle, following the principle of muscle chains. It is very important to focus on this image that from the feet to the head brings strength and elongation upwards. These imaginary diaphragms are precisely 4 are:

 Palate: imagine the tongue pushing the soft part of the palate upwards

 Chest: imagine a hot air balloon rising upwards

 Pelvis: pelvis, imagine an elastic trampoline that pushes you upwards

 Feet: arch of the foot, imagine a peanut under the foot that brings you upwards, without moving your toes..

POSTURE

More than 120 postures are known in medicine. The most common that we can find are:

 The correct posture: It has all the natural physiological curves that are optimal for a correct distribution of forces.

 Sway back: o fatigue posture The physical characteristics of this posture are: head in front, low shoulders and in closing, accentuated kyphosis, pelvis in retroversion and antepulse

 Flat back: it is a postural deformation of the spinal column: the normal dorsal curve of the spine is diminished or canceled.

 Hyperciphotic: the dorsal kyphotic curve is accentuated creating a thoracic flexion. Great dorsal, great pectoral, great teres and subscapularis are hypertonic, basically muscles that rotate the humerus. The muscles that extrarotate, such as the infraspinatus, teres minor, posterior deltoid and trapezius, will be strengthened.

 Hyperlordotic: the characteristics of this posture are the increase in the lumbar lordotic curve (lumbar hyperlordosis), the anteroverse pelvis (rotated anteriorly) and the tendency to flexion of the hips

 Scoliotic: is a permanent lateral deviation of the vertebral column associated with the rotation of the vertebral bodies.

 Military: rectification of the spine, a protruding and expanded thorax is highlighted, giving the idea of a rigid body, a situation opposite to the hyperlordotic one. In this case we have the compartment of the retroversors of the pelvis to be hypertonic, ie hamstring, buttocks, piriformis which must therefore be lengthened; the anteroversori are hypotonic, paraspinal of the lumbar spine, square of the loins and hip flexors including the iliopsoas, will be reinforced.

 Head drooping: The ears are further forward than the hip line, with a tendency to bring the shoulders forward and closed. With every inch of advancement, the head increases its weight on the cervical spine by about two kilos.

“Generally, posture is defined as the arrangement of the parts of the body” Kendall reports this concise but exhaustive definition to define posture, included in a report by the Posture Committee of the American Academy of Orthopedic Surgeon.

Posture is the position that the body assumes in space and the spatial relationship between the various parts of the body (e.g. limbs, back, neck, head) in order to guarantee the upright position and movement (static and dynamic anti-gravity function ). Correct posture is important in order to allow a good balance while standing, walking and any movement of daily life, preventing muscles and joints from working disproportionately to their abilities. This results in a slowing down of wear on the stressed parts, a reduction in inflammatory processes and therefore pain, as well as a slowing down of arthritic-degenerative phenomena.