Stretch It Out
yoga
Yoga, a popular form of exercise focusing on breathwork through a series of postures or stretches, is gaining acceptance in western medicine as a way to relieve the mental, emotional and physical side effects of cancer treatment.

The World Health Organization defines yoga as exercise, while the National Health Institute considers yoga a healing, full-body practice that extends beyond the physical realm. And through scientific studies and research protocols, yoga continues to gain acceptance in western medicine as a way to mitigate side effects of cancer and its myriad treatments.

Kimberly Carson, MPH, C-IAYT, E-RYT, a mindfulness and yoga therapist at Oregon Health & Science University in Portland, has been developing research protocols for people with chronic conditions through the study of classical yoga since 1999. Classical yoga refers to a system of practices that includes postures, breathwork, meditation and philosophical teachings based on foundational and historical texts. Along with Carson’s husband, Jim, a clinical health psychologist and former swami (a spiritual teacher in the Hindu tradition), Carson created the first behavioral intervention protocol to demonstrate a decrease in pain in women with metastatic breast cancer.

In metastatic disease, pain is progressive and gets worse as the disease advances. Using the tools of a yogic trajectory, a combination of gentle asana (postures), pranayama (breath practices), meditation and mindfulness practices, we actually could reduce the baseline level.

Carson’s research in mindfulness and yoga therapies has been part of national professional trainings at Duke Integrative Medicine Center in Durham, North Carolina; Kripalu Center for Yoga & Health in Stockbridge, Massachusetts; and Veterans Affairs centers across the country. 

Most people facing cancer practice yoga to help manage their emotions while keeping the body mobile through gentle exercise. “Cancer patients and survivors are looking for some kind of grounding,” says Nancy Wang Gaeden, C-IAYT*, a California-based certified yoga therapist specializing in gentle yoga for chronic pain and cancer. “Even though they may come for the gentle stretching, they stay because of the impact it has for them on the mental and emotional level, as well as for the feeling of being in community.”

Indeed, getting on the mat has enormous healing implications. The day Michelle Stravitz received her diagnosis, she went straight to a yoga class before her mammogram. “That’s what I needed to do to settle my mind and get through it,” she says. Stravitz is a seven-year, triple-negative breast cancer survivor and the cofounder of 2Unstoppable, a nonprofit whose mission is to help women improve their cancer outcomes through exercise. 

Stravitz says yoga helped her feel normal, strong and present. “In a class, every minute I’m given instructions for the next 30 seconds, so I don’t have to think ahead, I don’t have to think behind, I’m right in the moment,” she says. Using the techniques of yoga while going through treatments and surgeries can significantly decrease the ensuing pain and negative emotional effects. “So much of our experience in difficulties has to do with our perspective — how the mind is reifying the dynamic energy,” says Carson. “When we can help patients work with that aspect of their experience, the suffering reduces dramatically.” 

For Steve Pinkiert, a Long Island accountant, water ski enthusiast and seven-time cancer survivor, yoga is daily medicine. After his first bout with testicular cancer in 1986, he explored chiropractic care, physical therapy and acupuncture, but he didn’t find relief until he got on a yoga mat. “Yoga is a neutralizer,” Pinkiert says. “It helps me with all of the issues of my life; it keeps me balanced with work and family — yoga puts me at rest and keeps me in place.”

How can you go about finding that peace and calm? Is it really accessible for all? Yes, with practice and mindfulness, says Wang Gaeden, who invites students into a gentle loving presence, offering a complete loving embrace for where they are. Her classes at Providence Medical Group in Santa Rosa, California, focus on moving with the breath, which more deeply connects students with their senses in the moment. “Yoga helped me feel more normal and in control during an out-of-control time of my life,” Stravitz recalls. Focusing on her breath continues to quell her anxiety. “It always reminds me that I’m here right now,” she says. “As far as I know, at this moment, I’m OK. Every lump is innocent until proven guilty.”

Yoga is a neutralizer. It helps me with all of the issues of my life; it keeps me balanced with work and family — yoga puts me at rest and keeps me in place.

Yoga can help cancer patients stay limber and at ease with their bodies. “Yoga is a great tool to regain and maintain mobility and stability and also to help people return to function,” says Diana Tjaden, clinical director and founder of Full Circle Physical Therapy – Ivy Rehab, an exclusive breast cancer recovery center in Garden City, New York. She endorses gentle stretching as a great way to begin rehabilitation, post-surgery and treatment. “Once a patient gets their range of motion, they can slowly add weight bearing movements,” she says. She recommends starting slowly, breaking up physical activity into shorter durations, alternating muscle groups, modifying postures and holding them for shorter periods of time to build endurance. 

Carson recommends slow transitions, especially when starting out, and Wang Gaeden suggests beginning with a three-part breath — bring breath into the belly, ribs and chest — and gentle warmups, with movement following the breath. Both Carson and Wang Gaeden (who was a student of Carson’s Therapeutic Yoga for Seniors at Duke Integrative Medicine), believe in finding the lowest common denominator to make the yoga practice accessible to everyone, no matter what phase of cancer they are facing. “The training really informed me in meeting students where they’re at,” says Wang Gaeden. “We want them to not only be able to do the class, but [to also] feel really good during and after.” The two give options and modifications, as well as permission to simply rest or opt out at any time. “Professional athletes use visualization when they are in recuperation because it lights up the same part of the brain,” Wang Gaeden says. “So there are many ways to participate, and we welcome the whole spectrum.” 

Although yoga and exercise are an excellent prescription during a cancer journey, patients need to remember that their internal reserves may be lower than their norm, and could persist in that way for decades after treatment. “We recommend that those going through treatment maintain 25 percent in their proverbial gas tank,” Carson says. “You don’t want to work so hard that at the end of class you are tanked. You want to keep that reserve of energy in your system.” 

Ultimately, yoga is the connection between you and yourself. “Even if you are doing shoulder shrugs, it’s the inner asana, the inner movement that is the most important part,” Wang Gaeden says. “Coming into class with a self-kindness presence is the biggest opening into that relationship with the self.”

Take heart in a cancer diagnosis: it offers an opportunity for a new relationship with the body and with the self, and does not mean that you have to live with excessive restraint. “Things might be different,” says Tjaden, “but the quality of life after a diagnosis might actually be enhanced in some ways, with new understandings, new activities. Live your life with no limitations.”

yoga

Carson offers this simple sequence to incorporate during any part of a cancer journey. Speak with your healthcare practitioner first regarding any personal recommendations for your practice, and modify if your range of motion is compromised.

  1. Begin supine, lying on your back, with your knees bent.
  2. Inhale; stretch your arms over your head, resting by your ears. Exhale; bring your arms down by your hips. Repeat five times.
  3. Inhale; bring your arms over your head while tilting the pelvis forward, creating an arch in your lower back. Exhale your arms down, nestling low back into the ground. Repeat five times.
  4. Bend your right leg and hold your knee close toward the belly. Inhale, moving your knee away from the belly, and extend your arms. Exhale, coaxing the knee toward the belly again. Repeat five times on your right side, then five times on your left.
  5. Inhale; extend your right leg straight up toward the ceiling. Exhale, bending the knee. Repeat five times on your right side, then five times on your left. 
  6. Bring your right leg up toward the ceiling. Inhale, slowly lowering the extended leg to hover above the ground. Exhale to lift. Repeat five times on your right side, then five times on your left. On each of the last rounds, stay with the release of the leg to ground. Receive the depth of release.
  7. Conclude with Shavasana, or supine relaxation pose, lying on your back with arms and legs comfortably extended, resting on the ground.

To learn more about incorporating yoga into your life, reach out to our sources:

Kimberly Carson: www.MindfulYogaWorks.com

Nancy Wang Gaeden: www.LoveGentleYoga.com

Diana Tjaden: www.FullCircleBreastCancerPT.com

Michelle Stravitz: www.2Unstoppable.org

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