Janna received a referral for a client with early stage breast cancer. She recently became a Cancer Exercise Specialist and asked if she could hire me to help her with and teach her how to put together Luci’s exercise program. She completed her initial assessment and health history and shared the following information with me:
- Luci is 47 years old and exercised 5-6x a week in a variety of group exercise classes prior to her diagnoses
- Luci is 5’1 and currently 118 lbs. She has 20% bodyfat
- She was diagnosed with stage one breast cancer in July 2015.
- She underwent a lumpectomy with immediate implant reconstruction on July 18, 2015. She has been participating in her exercise classes for the past few years, but is complaining of neck and low back pain.
- She is on hormonal ablation therapy
- Her BP is 120/75 and her RHR is 68
- Head rotated toward left shoulder
- Elevated left shoulder
- Mild upper-crossed syndrome
- Moderate winged scapula both sides
- Left knee/foot laterally rotated
- Forward hip flexion during squat test
- She meets the 90% requirement in all planes of motion so there is no reason she can’t begin upper-body weight training, however, will continue to work towards improvements in ROM
- She has unusually tight quadriceps on both legs
- Tight ITB on left side
- Hyperextended knees on both sides
- She has a moderate anterior tilt (she wears high-heels 80% of the time)
I started by compiling my own notes and breaking everything down for Janna one step at a time.
- Because Luci is not at risk for lymphedema, Janna does not have to give her the lymphatic drainage exercises or list of ways to prevent it. She also has no limitations on upper body workouts.
- Because she has a breast implant on the right side it will be important to avoid putting excessive pressure on that area during exercise. Close attention should also be paid to controlled range of motion in exercises like chest flys. There is always a slight chance that the implant could move out of it’s “pocket.”
- Janna will incorporate upper-body strength training to help increase her bone density; she is at a higher risk for osteoporosis since she is now menopausal from hormonal therapy.
- Because of the upper-crossed syndrome, Luci needs to stretch both her pecs and lats. She should focus on shoulder retraction and depression to stabilize her shoulder girdle. That will also help with the winged scapula, but Janna is going to have her do ceiling punches in a supine position to help strengthen her serratus muscles.
- Janna will instruct Luci on some neck and upper trapezius stretches and will perform AIS when they are together.
- After Janna completed the Modified Thomas Test on Luci, she was able to determine that her left abductors and calves are tight. Therefore, she would need to focus on hip adduction and avoid hip abduction-type exercises on the left leg. She will also give her a series of calf and achilles stretches.
- She believes that her tight quads are contributing to the knee hyperextension and gives her a series of quad stretches instructing her to hold each one for 20-30 seconds and performing AIS or PNF stretches when they are together.
- The anterior tilt is not attributable to tight hip flexors as they appeared perfectly normal during Modified Thomas Test. Luci does very little to strengthen her abs/core and has extremely tight erectors.
Once I gathered my thoughts, I was able to come up with the following workout routine for Janna to facilitate with Luci for her initial 6-8 weeks.
DAILY Luci can continue to go to her group classes as long as she follows through with her stretching and strengthening program. She wants to improve her body composition so high-intensity cardio will help her to rev-up her metabolism and burn calories. She will be training at 85% of MHR. As an alternative do group classes she may chose to ride her stationary bike. I also recommended that she she an R.D. specialized in oncology to create a customized menue for her. Every day she will take 10 minutes to perform her neck, low back, chest, lat, quad, and calf stretches.
2 x PER WEEK if she does not get her strength training during her group classes, she will perform 3 sets of low rows and 3 sets of external rotation with her palms facing the ceiling. These will both help with scapular retraction as well as stretching the chest through reciprocal inhibition.
On two of the non-weight days she will go to a beginning yoga class. This will help her to strengthen her core and should help to minimize her low back pain.
Janna will also suggest minimizing the amount of time she walks in high-heels in any give week as that is most likely a contributing factor in her lordosis.
Janna will re-assess Luci in 8 weeks and either continue with this routine, or progress to a few more strength training exercises and/or more weight.
If you are in need of assistance with a special-needs or physically-challenged client, you can get Andrea Leonard’s help in with custom exercise programming