Supporting Your Pilates Clients Through Breast Cancer and Recovery

The program is based on Joy Puleo’s work with Body Wise Connection, the not-for-profit she founded for women newly diagnosed with breast cancer. Body Wise Connection reminds women that even in the throes of a diagnosis and treatment for cancer, the body can heal and strengthen. This post looks at the ways that a Pilates practice can benefit breast cancer patients and survivors, both physically and mentally, and how a Pilates instructor can support her clients during this challenging time.

“Physical activity improves both function and mental well being,” says Kathy Corey , a master teacher of Pilates and founder of Kathy Corey Pilates . “Even modest activity can improve inner strength and decrease the risk of recurrence. Pilates helps restore ease of movement and strength needed for daily activities and helps rebuild endurance and regain energy to fight fatigue.”

Pilates instructors are known for their perfectionism. Working with a client during diagnosis, treatment, and recovery from breast cancer, however, requires a broader definition of what it means to “do Pilates.” According to Puleo, who is based in Sacramento, California, and is the education program manager for Balanced Body, “Pilates instructors like to fix and we like to have the answers. With cancer, we don’t have an answer, but we do have a space.”

A diagnosis of cancer brings with it an array of doctor visits, tests, treatments, as well as a great deal of uncertainty about the future. That stress can impact daily life and self-esteem. To calm the nervous system, Puleo highly recommends meditation. She notes that you can also cultivate mindfulness by simply sitting with your feet planted firmly on the floor and breathing deeply into the lungs. Not only is this calming, but expanding the ribs also helps to release tightness through the chest wall post-surgery.

From there, Puleo moves on to gentle, rhythmic, Pilates-based movements that help restore physical self-awareness. “What is the experience of cancer?” Puleo asks. “How does a client who has to now give themself to the medical world still feel and empower their own body?”

In her work with post-mastectomy clients, Puleo focuses on mobilizing the ribcage and thorax. There’s no pulling on or stretching of delicate tissue. Puleo recommends leaving shoulder range of motion work to physical therapists and occupational therapists, especially in the early days following surgery.

So what can the Pilates instructor do? “We can create subtle rhythms that can help or assist in the healing process,” Puleo explains. “Think: breathing leading to sensation, and sensation leading to movement.”

For Debora Kolwey, working with Pilates “elder” Eve Gentry informed her own experience when she underwent a double mastectomy. “Eve was clear that our task in working with people in pain was to support them in moving again, and not focus on the pain,” she says. This meant getting the rest of the body moving in order to support the area that is in pain, an approach that is quite different from the physical therapist’s laser focus on an injured body part.

The advantage to working this way is that you can start where you are. “Just show up, and we can always do something,” she remembers Gentry saying.

Kolwey, a former professional dancer, remembers lying on the floor after her own cancer surgery and struggling to perform the physical therapy exercises she had been given. Then she remembered some of Gentry’s pole exercises, shown in the photo above. “You actually know what to do right now,” she told herself. “It cut through my self-pity.”

This experience led to a powerful shift in her sense of self. As an instructor, she had often worked with people dealing with injuries and illness, but she hadn’t identified as one of them. “Now I was one of ‘those people,’” says Kolwey. “It was the biggest gift.”

Puleo's work with breast cancer patients and survivors (as well as those who have dealt with other types of cancer) has three pillars:

1. Set an intention: For Puleo, this meant asking herself, “What in my sphere could I do for others, given that I’m not a doctor, not a physical therapist?”
2. Create the space: Simply being with someone without having to talk can be helpful, especially during a time when your client may feel overwhelmed by people trying to help or find the right thing to say. As Pilates instructors, we’re good at tactile cueing to elicit more efficient movement, but the action of placing a hand on someone is also a form of communication that says, “I’m here for you. I’m seeing you.”
3. Acknowledge the experience: “Allow your client to feel what they need to feel in the discontent, in the discord, and in the tension that is cancer,” says Puleo. Include movements and exercises that celebrate each phase of someone’s experience. That includes post-treatment, when there’s some anxiety around the question, “Can I trust the physical body to do what it needs to do in the future?”

“Feel what you feel” is a powerful piece of advice for all of us. After all, there’s not one of us who doesn’t have their own story of cancer, whether directly or indirectly.

If you work with clients during or after a cancer diagnosis, does this approach resonate with you? Let us know in the comments below.