Question: Dear Matt, I recently had a mastectomy and 5 lymph nodes removed. I have 5 questions:
- How soon after surgery is it safe to return to my Yoga practice?
- What poses should I avoid and for how long?
- I guess, more importantly, what poses I should practice to encourage healing and range of motion to that side of my body?
- What other avenues of support should I seek?
- Will Yoga alone help me with this loss?
How soon after surgery is it safe to return to yoga? What poses should I avoid and for how long?
Your first two questions must be answered by your surgeon. Only they know what tissues were involved, other complications/concerns, and the healing times pre-mobility. For our readers, it is a good idea to insist on post-operative physical therapy to not only manage mobility, but safeguard for swelling and to work in communication with your Yoga therapist. All of this applies to asana practice, but we know Yoga is far more than just poses.
You can and should work on your breathing until the moment you go under anesthesia and again the moment you awaken. Bhavana (guided imagery) is also powerful both pre and post-op for healing rates and pain control. The many long hours on either side make a wonderful time to delve deeply into the Yamas and Niyamas. Yoga therapy views illness as an opportunity for spiritual reassessment and development. Cancer shines a bright light on all of these ancient precepts and can be a source of comfort.
What poses encourage healing and range of motion?
As you are cleared for movement and weight bearing on the arm by your physician and physical therapist, you will want to restore mobility not only in your shoulder, but also your chest wall, to include your upper back. Restoration of a full 3-part breath is critical and should happen in the first week. Full restoration may require subtle work to include prana vidya by your own hands or someone else to fully ventilate the involved area both mechanically and pranic-ly. Restorative postures to include chest openers and side-lying rib openers can be very helpful in small, progressive doses.
What other avenues of support should I seek?
Part of non-harming self care is to closely follow guidelines regarding swelling, elevating your hand, and safety regarding skin integrity of the involved side hand and forearm. If you have been given a support garment, stick to your schedule. The discomfort of the garment or any post-operative pain provides an excellent opportunity to practice pratyahara, the withdrawal of senses. This non-reactivity to stimulus accompanied with slow, full breathing quite literally builds new connections in your brain to facilitate stability between the worrying/planning portion and the emotional and fear centers. If you have access to Yoga nidra tapes or class, that practice is very helpful in that regard as well.
Will Yoga alone help me with this loss?
You should also know that you can share with your cancer team the proven benefits of Yoga in cancer care that include improved sense of well-being, decreased pain, decreased mood disturbance, improvement of sleep quality, cognitive disorganization (chemo-fog) and overall improved quality of life. [See references below you can share with them.] Locally in Arizona I have served as a professional advisor and the Yoga therapy expert to Cancer Support Community of Arizona in Phoenix, www.cscaz.org, a free cancer support center that offers free evidence-based programming in Yoga, Tai Chi and mindfulness-base stress reduction.
A key principle to bear in mind as you move through your cancer experience with your Yoga is to provide yourself with stability of mind, peace of heart, and healing in all of your relationships, most especially with yourself. There is no reason for guilt, there is no shame or regret….only this moment to act with compassion and awareness. Go gently, go inward, and remember the peace that is our true nature.
Duncan MD, Leis A, Taylor-Brown JW. Impact and outcomes of an Iyengar yoga program in a cancer centre. Curr Oncol. 2008 Aug;15 Suppl 2:s109.es72-8.
Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, DHEAS, and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004 May;29(4):448-74.
Galantino ML, Brown D, Sticker C, Farrar JT. Development and Testing of a Cancer Cognition Questionnaire. Rehabilitation Oncology, 24(2), 2006.
Gopinath KS. Evaluation of yoga therapy as a psychotherapeutic intervention in breast cancer patients on conventional combined modality of treatment. Proceedings of the American Society of Clinical Oncology. 2003; 22: 26.
Groenvold, M et al. Breast cancer patients on adjuvant chemotherapy report a wide range of problems not identified by health-care staff. Breast Cancer Research and Treatment, Oct 13, 2006 (published online).
Galantino ML, Cannon N, Hoelker T, Quinn L, Greene L Effects of Iyengar Yoga on Measures of Cognition, Fatigue, Quality of Life, Flexibility and Balance in Breast Cancer Survivors: A Case Series. Oncology Rehabilitation. 2008.
For a more recent summary of the research click here.
Special note of appreciation for the references from my dear friend and colleague, Dr. Mary Lou Galantino, PT, PhD, breast cancer survivor and thrive-er!