Chemotherapy Recovery

Hi, and welcome to the second of our series, working with cancer, specifically breast cancer, and some movements designed to support the healing process. We're moving along the journey, where the surgery is a little bit in the rear view mirror, and now, where other treatments might be popping up for your clients, specifically, chemotherapy and radiation. Both Rebecca and Tiffany have dealt with chemotherapy. Tiffany is pretty much continual on low doses of chemotherapy due to her chronic condition. And I wanna say that Kristen over here, is going to be modeling some modifications because just five months ago, she had abdominal surgery for ovarian cancer.

So we have here, lots of variation for you and lots of opportunity to just see how movement can truly help and support the healing process. My name is Joy Puleo, thank you for joining us. And I am here with Rebecca Philipo, Tiffany D. Martin, and Kristen Bridey. All of us have worked together for a long time and we've worked on a project called Body Wise Connection, which originally started as a not-for-profit, designed to help women with breast cancer, and it's actually how I met Rebecca originally. And now, we've expanded really, to teacher training programs and opportunities to help teachers bring healing movement to clients everywhere.

All right, so we're starting here. Again, like I said, we got surgery in the rear view mirror. Something else I want you to think about, and it's something that we don't often talk about with, specifically, breast cancer, but cancer at large. And that is we've started the process, possibly with a mastectomy, which is part of who we are as females in terms of our shape, right? I actually spent a lot of time thinking about what do our breasts mean to us?

Well, certainly, it's fertility, but also it defines the shape of what we feel as feminine. Then we move into chemotherapy. Now, you'd never know Tiffany was on chemotherapy because the chemotherapy that she is on does not affect necessarily, her hair. But for most breast cancer chemotherapies, women will lose their hair. Your hair is an outward expression of who you are, your female self, right?

Try to watch TV today, and not see a shampoo commercial, where someone is like taking their luxurious hair and throwing it over their shoulders. It's very much a part of how we identify our female selves. So now, we've affected our breasts, we've affected our hair. For Kristen, she just had abdominal surgery for ovarian cancer; it's thrown her into menopause and she's had a complete hysterectomy, which is reproduction. It doesn't matter where you are on the continuum of your life as a woman, whether you're starting reproduction or your post reproduction, it's part of how we feel psychologically about ourselves.

So a lot of these movements are yes, designed to initiate shoulder range of motion or to engage the thorax, shoulder girdle complex and movement. They're also intended to continue to work on expanding through the rib cage, and to helping us feel ourselves and experience ourselves in movement, and empower ourselves through movement. This class will move a little faster than the prior class. So with that, shall we get started? Okay, you know, chemotherapy, one of the things about chemotherapy is there could be neuropathy in the hands and the feet.

So let's start by stimulating the hands, shall we? Can you guys just rub your hands together? Rub your hands together. Rub, rub, rub, rub, rub, rub, rub, rub rub. Now, I just wanna tell you, and wash your hands, we all are wearing mala beads from an organization called Malas for Tatas.

And they create mala beads for women with all good and positive energy behind them, and the proceeds go to support. I want you to just gently pull on your fingers, pull, pull, pull. Now, the proceeds go towards supporting women who are in treatment for breast cancer. So if you hear a little ching, ching, ching ching, as we warm up our hands, that's what that is, it's our mala beads sending out positive energy into the universe. Okay, now, take your hands and just make circles with your fingers.

And it's actually remarkably more challenging than you think. And now, circles with your wrists. And as you do that, really open your palms, open your palms, right? And then go the other direction. So now, you see we get the forearm involved with the hands.

Now, if you wanna get a little, you know, go for it, go for it, go for it. Is it Bollywood, right? I mean, a little music playing in the background. But as the forearms and the hands, and the wrist, really important to letting the shoulders go. So doing some of this work, and do both sides, ready?

Go down and out, and around. Doing this work before moving into some of the shoulder range of motion that we're going to move into, is hugely helpful. Now, take your right hand out in front, palm facing forward, and turn the dial so that your fingers are down, externally rotating at the humerus. Now, turn the dial so that the thumbs are down, and then turn the dial, and turn the dial. One more time, and turn, and turn.

Now, let that arm hang. Going to the other side, pump straight out. Let's turn the dial first, or the pinky. External rotation and internal rotation. So people ask me all the time, "Oh, where did you get these ideas?" And I just wanna tell you there are compilation of lots of work, of lots of sitting in the back of rooms, and just taking in and feeling, and expressing movement.

It's from gyrotonic through to the heritage training, through to Eve Gentry's fundamentals. You're gonna let the arms hang and through being in this really rich, wonderful movement environment that we live in. Okay, so we've did a little shaking. I want you to shake the upper body and I wanna hear your malas, ready? Out in front, out to the side, out in front, overhead, shake your malas, shake your malas, and then let them go silent, awesome.

So do you feel stimulation in your hands? Okay, we're ready to go. We're gonna start with a thigh stretch, and I'd like all of you to kneel, facing your chair if you would. Now, we're gonna use different prompts, depending on who they are and where they are right now, and what they need. We know Kristen has had a big scar from her belly button to her pubic bone.

I actually want her to take the ball and hold the ball right up in front of that scar. The scar is not tender, so we can put that there. And what she's always gonna do, she's gonna put a little gentle pressure into the ball. The elasticity of the ball is gonna spread out across the front of her abdomen. And Kristen, every time you exhale, I want you to imagine drawing that ball in, and it's as if it fills the pelvis.

And then as you exhale, it comes forward into the balls. That makes sense? Good, Tiffany we wanted to give you a band and have you hold on to a band. And the band, for you, as we move, is gonna go up overhead to your range. You have very nice and good range of motion, so we're gonna let Tiffany take the extended range of motion.

And Rebecca, we're gonna have you put the band behind your back so that as Rebecca goes into her thigh stretch, she's got this almost caressing and support happening through her back, yeah? Starting with a neutral size stretch, everybody's gonna hinge from the knees, back in space, and then lift up. Now, we're not going for range of motion to start. I want you to feel that hinge and that moment where you're hanging back and you feel yourself. And then as you come up, think of lifting up taller into your front body.

Good, come on back, hang back. You could feel the lengthening through the quads, and lift up. This is on purpose. As we go through chemotherapy, we're gonna deal with strength in terms of muscles and muscle metabolism. So we're eccentrically lengthening the quads and the whole front line of the body, particularly good for Kristen now, who's got that scar tissue happening.

Great, and come on up. We're gonna take this now, into bringing the arms up as much as you can comfortably, and Tiffany is gonna take this into a little extension. So you're gonna hinge back, and I'm gonna stop saying gonna. I would like for you to hinge back, bring the arms up, good. Lift up and get taller as you come on up, back to your neutral position.

Take a look at Kristen here. We're really taking this opportunity to hinge back at the knees. And for her, I want her to focus here, on the ball. And her extension is from the pubic bone, really up through her sternum, and then whatever reflection she has here, in her thorax, is perfect. Good, and here, for Tiffany, she can go into full extension, and while Rebecca, now, has this cradling where she could be lifted back up with the feet back of the band, and come on up, excellent.

Ladies, let's take this now, into a rotation, shall we? So let's start hinging back in neutral. Start your rotation to the left. And if you have the band, open your wingspan. Good, come back up and let's go now, to the right.

Now, again, here, for Kristen, I really like this 'cause she can actually put feet back into the ball to get the pelvis to initiate some of this rotation for her. For Tiffany and for Rebecca, they've got different bands here, and opportunities for Rebecca. Again, she's got this backward support that's gonna help lift her back up and give us a little more lift through the chest. Good, and last one. Now, look at Tiffany, she can get this band behind her; that's gonna stimulate now, her back line a little bit more, it's gonna make the frontline work harder as she comes up and forward.

And great. Now, go back to the extension for one second, I want everybody to do one extension. I'm gonna make you hold it. Okay, ready? And you guys out there, what I want you to do is come into the extension and I want you to hold it and feel it.

And for Rebecca, what I love about this band, Rebecca's had a double mastectomy here, and we can now, really get into that scar tissue and open her heart up. For Tiffany, again, that band is behind her. Now, where is your extension? What are you feeling and how do you lift yourself up? And Kristen push into that ball, and everybody come back up.

Now, come forward and release that extension. All of you back into child's pose, please, putting your bands down. So it's the same movement. It affects three different people in different ways, and it should affect you also. Don't judge it on where the extension is or how far back you go, it's really how long can you go for this one?

And then take it over to your range. Again, feeling that eccentric, a little bit of burning in those quads, right? (Joy chuckles) Rebecca is like, "Uh-huh." Here, just release your back, a little rock, a little left and right if that's comfortable for you. All right, we are gonna take this into kneeling cats. So can we have you guys on all fours?

So, cat, right? Cat, who doesn't love a good cat? And it's so much a part of everything that we do in our Pilates world. This is a nice place to take your clients if you're just starting the weight bearing on all fours. So the reason why I like this is you'll notice that the shoulders are little higher than the pelvis.

So I have them weight bearing, but I don't have quite as much as if they were really parallel to the floor. So it's a little gentler. The second reason why I like this is because we can get more flexibility into the spine here. All right, so everybody round your back for me. So Tiffany, you're gonna stay here, you're gonna round your back.

I want you to watch the rib cage. Now, let's take this into the extension. I want you to lengthen out. Start with the pelvis and lengthen out, come up through the spine, and let the head come up. And here, what I love about the forearms is you can feel the forearms down and that breastbone swinging through the arms.

Keep the breast bone swinging forward as you start to initiate with the pelvis, curling back. And it's like the breastbone, reluctantly comes back because it was so happy out there. I always think of the sternum as like a swing, and your arms as two ends, and you're gonna go into extension, guys. Two ends of a swing set. And as it swings forward, there's that pure moment of suspension and joy, and then you get pulled back in the other direction.

Good, so this is a lovely place to do that. Look at how the rib cage rotates around the head of that humerus. Great, okay, I love this, but I want it to be no more dynamic. So everyone can be around, cat-back, sit yourself back into child's pose, and straighten out through the tail, extend to come forward. Good, curl back, pull back, lengthen and forward.

Curl back, pull back, lengthen and forward. One more, curl back, pull back, lengthen and forward. How do you like those? Now, just a precaution here. Tiffany, will you sit back into that child's pose with your tush back.

There's a tremendous amount of range of motion here, in the shoulder. Each of these three have different ranges of motion. Please, your client only goes back as far as a range of motion in the shoulder will allow. Number one, number two, don't be satisfied with sagittal. We're gonna take the same movement and move it on diagonal.

So everybody on all fours, your first diagonal is to the right. So it's curl back, and to the right sit bone, to the right heel, go forward. Now, onto the left. Curl back, circle back. So I don't know if you can see this, but now, their orientation is diagonal with the chair.

So a whole different feeling through the ribcage, through the lats, through the thoracolumbar fascia. And I dare, I say, probably through the core, and also this really nice nourishing movements in the hips as they go into that deep hip crease. Good, go to the other side. So let's have the left. Sit back, lengthen out, send it forward.

And curl back, lengthen, and forward. Two more. I love this moment right here, for the pelvis, as you lengthen out. Yeah, last one. Super, okay.

So we now did diagonals. Can we play with circles? And here, I'm not gonna tell you what I want you to do. I want your body to do what it's comfortable doing. So the best way to start this is as you sit back into your child's pose on one side, you're gonna circle around to the other and let your rib cage move in relationship to your pelvis that is natural for your body.

Your head even replies, right? If you guys play with this... Don't hold your head back, let the three centers of weight move; the pelvis, the rib cage, and the head. And let the movement of one reflect through the other two. And let it be easy and natural.

Please don't put judgment on this for your client. One of the hallmarks of mind-body... Go the other direction, guys, if you haven't already. One of the hallmarks of mind-body fitness is to take the judgment out and let them experience their bodies. Hugely important when anybody is dealing with any medical condition, especially something as big as cancer.

Awesome, and then just come to all fours. Great, how does that feel? I really wanna be doing that too. (Joy laughs) So we'll take this now, into like another progression of this, which is called thread the needle, adding rotation. So we will start with forearm is down on the chair.

And yes, if a client needs to come up higher and be with their hands flat on the chair, they are more than welcome to. Let's start with your left arm, straight out to the side, okay. Now, you will sit back into your cat, take the left arm underneath, look to the fingertips on that side. Notice all three of them are in a different position here. Good, now, as you come up, open the left arm out, and you could even open the hips.

And then come on back. Rebecca and Kristen are keeping a straight hand or a straight arm. Tiffany is keeping the forearm on the chair. All of these are wonderful, nice. So this is a rotation.

I'm not pulling or pushing them into this rotation, which often we see when we do the thread the needle, which is a great assist, but I'm letting the movement do the work for them. Nice, let's switch to the other side. Now, as they come through on the other side, what I like about being in child's pose is by really anchoring the lumbar here, we can keep the spine very central. So that as they come up into their extension, they're not overly shifting to one side or the other, nice. And on this last one, I want you to hold, good, and feel the opposition of one hand, down into the chair while the other reaches, and then come on out of there.

Nice, awesome. Okay, so that's the forearms. We did some cat, we did thread the needle. We're gonna take this into a downward dog. Before I do that, I wanna just sort of let some of that tension in the arms go, that you just had.

So again, if you could put your forearms on top of the chair. Let your left arm just hang. Just let it hang, just let it hang, good. And sweep it side to side. Good, and now, take that sweep, sit back into your child's pose, and your final thread the needle underneath you.

Just take that as your final moment. Good, come on out of that, let's put you back onto all fours. Let's take the other arm off and let it just hang, let it just hang, let it just hang. And now, take it underneath for your final. Okay, all right.

Forearms are back on, and here's our task. I wanna get us all up to standing so that we can then progress on to some standing work. A lovely thing to do here with the chair is to take this kneeling position. And first, let's just unweight your knees. Now, I know for Kristen, I wanna be really careful about unweighting the knees because she's got this surgery, and abdominal strength is still a consideration as is some lumbar restriction.

I'm gonna put her on this ball. And Kristen, your whole task here, is just for that ball... Right now, it's like full because you're kneeling on it. It's just for that ball to just look a little like this little less air in it. Rebecca, if you wanna do the same, you can do the same.

And what that should ideally do is take some weight off of the upper body. So this is the first time now, we're introducing this concept of weeding the upper body. So everyone exhale, hover your knees up a little bit, and then lower down. A lot of core work here. On the ball, it's really nice 'cause that instability really triggers the core without really putting too much work, either in the upper body or having Kristen work too much into that scar tissue.

Great, now, we'll take it one step further into a downward dog. So as you start to hover, drop your heels and send your sit bones back. Your arms can straighten or you can keep the forearms on the chair. Bend your knees and slowly lower all the way down. Now, let's add a spinal articulation to this.

Can you look up? Everybody, look up and come into your extension. Now, let your chin drop down. Let that start to move the thorax, let the thorax go into the lumbar, and then let that lift you up and send your sit bones out. Great, and then the knees are gonna bend, curl the tail, slowly, lower down, and the head comes up.

So the eye gaze starts up. Now, the eye gaze is gonna lead. The thorax is gonna follow, the lumbar, and then send the energy of the sit bones, starting with the tail. As soon as the knees bend, curl that tail and find that articulation, and come on down. And then the very last one is about finding your downward dog.

And then if you want to, you can step forward and come to standing. All right, now, that we have you standing, let's take this and start to work on the strength and the metabolism in the legs. Let's turn the chair around, shall we? So that you have the back of the chair to use for balance. Listen, with chemotherapy and neuropathy, client's sense of balance can often be an issue for you to consider.

So whenever you're doing this standing work or anything that requires a balance challenge, highly recommend that there's some way to create stability for your client. Now, I'm gonna bring a roller in for Kristen. I'm actually gonna bring a half arch in for Rebecca. Rebecca is just recovering from a broken foot, and some of the lunging work might be more challenging and really contraindicated for that foot at this present time. So she's gonna use the arch underneath her shin.

The reason why we have the roller here, for Kristen, is just for an added balance support for these lunges. It's an example of what you can do or give your client if they need a little extra. And if you want even more, certainly, something like a dowel or a gondola pole, would be really helpful here. So let's do this. You're standing with your right hand on the chair.

Can you step back with your right foot and put your left foot in front. Good, so here's where we're gonna start with some lunging work. I wanna start with a 90-90 lunge, and that means the back knee is bent and you're gonna descend down and come on up. Now, you'll notice with this 90-90 lunge that the back knee is directly underneath the pelvis and that the torso stays upright. This is not about going down, this is about lifting up.

Yah, good. And that little difference is really meaningful for your clients 'cause everybody is so busy trying to go down as far as they can go, that they forget that the full expression of this exercise is the down and the up. Now, we'll have you come down. We're gonna go down, repetitions pulse, and then all the way up, good. So I want you to think about this for me: this is a lunge, this is for the leg muscles, but it's also for the pelvic floor.

So you're gonna go down again, and you're gonna hold, and you're gonna pulse. Good, and then stand up. Okay, so why don't I say that you guys rest for one second? This is a kind of a moment, a pelvic floor moment. I've been doing a ton of pelvic floor workshops, and what I've really come to understand through all the pelvic floor literature is that the co-contractors and the supporting muscles of the pelvic floor are really important, and the pelvic floor makes a lot of its attachments through fascia, through the legs.

So the leg strength is very important here. Pelvic floor is affected by chemotherapy. Number two reason why this is important is chemotherapy can affect muscle wasting and muscle metabolism. We wanna tap in to the strength of the muscles. How do we do that?

Repetitions, one. We work a bit on eccentric control, which is the descent down, two. We hold, three, and then we pulse, four. Okay, so we're gonna do those lunges again, same side. I'm gonna back out of here.

I'm going to ask you to do five, coming down and up. When I say eccentric control, look at the back leg. Come on down, we're getting a nice eccentric lengthening of the back quad. And then as you come up, come fully up, one. Go down again, and up, two.

Go down again, up, three, four. On this last one, I want you to come down and I want you to hold it. For a count of five, four, three, two, one. I'm gonna change your pulsing. I want the energy out into the abductors, out, out, out, two, and one, and come on up.

So let me say that again in case I wasn't clear, and you guys are gonna shake your legs out 'cause you're gonna do that one more time. We wanna support the pelvic floor, we wanna get into the metabolism of the legs. So holding the eccentric control, holding isometrically is gonna really heat those muscles up. And then we wanna pulse into those muscles, creating buoyancy in there, ready? We're going to go down and up for five, back like directly underneath you, four.

You're gonna keep your three centers of weight: head rib, cage, pelvis, nice and aligned. And on the fifth one, which I think this is, you're gonna hold. And now, this time, you're gonna focus your pulsing inward, in, in, in, in. Great, and stand up, shake your legs out. Okay, change your stance, change your legs.

This is where Rebecca is going to use the arc to protect that foot. So chemotherapy is a tricky bugger. Everybody is affected by it differently. In trying to deal with chemotherapy, you also always have to keep in mind where your client is in terms of their side effects. Sometimes, powerful exercises such as these can trigger nausea.

That's an indication of back off and you come back at this at different day or at a different point in their cycle. So let's have you go down and up for five, shall we? Down and up. I'm really looking at where that back knee lands in relationship to the pelvis. Good, and then you're gonna come down and you're gonna hold.

And the first pulsing is just an up and down, small little bouncing pulse there, just like the thigh stretch. There's this lovely lengthening that happens in the elasticity of the quad underneath you. And then you're gonna stand all the way up. Good, now, we're gonna change that orientation and of the pulse. So let's have you come down and up.

Real fast, down and up for five, four, three, two. Now, hold, and then give me a little outward pulse. Feel those abductors getting a little bit involved in that pulse. Posterior pelvic floor is involved here, and then come on up. Great, and now, the last one, let's do five, sorry.

Down and up for five. They're gonna have earned their dinner. Good, and then you're gonna hold, and now, feel the abductors. Yeah, two and one, and come on up. Legs come together, you're gonna shake out your legs.

So you know, you guys, I drink a lot of water on my car ride, and I was really grateful for having done this work because I had to stop and I had to find a ladies room, and this is how I ran into the ladies room. I internally rotated, I flexed up my hips and I ran. And you know what? I made it. So this stuff works. (Joy laughs)

Now, can we go back to the first stance with your legs staggered? Really important to work on balance and control, and the ankles become really super important here. So now, in this staggered stance, and you could have thrown this in between each of those lunges. I want you to bend your knees just a little bit, and then rise up onto the balls of your feet, and then come down. Now, you can go up and down with this, go up and down.

So go up and down. Kristen's staying low and she's moving her knees out underneath her; that's great as well. And now, hold it there, and now, bouncing that, right? Three, two, and one, and stand up. And Tiffany's got this really...

I could see out of the corner of my eye, this smile, and it's saying, "Are we done yet?" (Joy laughs) Now, switch your switch sides for me. There's a number of ways in which you should do these heel raises. I do like to do in this staggered stance position, but I wanna do something different on this side and I'm throwing this out, you guys. What I'd like you to do is bend your knees slightly, lift your heels up, and we're gonna change this a little. Bend your knees slightly.

And now, can you shift forward and back? Forward and back. So this is a unique challenge, and this really mimics propulsion forward and back. And eventually, when a client gets really good at this, they can bounce between the front leg and the back leg. This is great for now.

And then stand up and drop the heels, legs come together. We're gonna get rid of that roller, and Rebecca, you're gonna move that arch. And we're gonna turn you, facing your chair for squats. Okay, all right, so squats, squats. What's there left to say about squats?

Here's what I have to say about squats. Descend your tush. So often I see a squat in a Pilates studio... Bend your knees a little bit, Tiffany, and dump forward. Where our client does this for their squat.

Or I will see a situation where they come down and let your pelvis curl under, and they're here. So this is not about the knees or the toes. The orientation there, is really important. But I promise you if you can descend your bums... So you're gonna flex at the hips and the knees, and the ankles.

And in this case, I do want the torso to balance over your thighs, hold it. Now, if she lets that bum go down a little farther, and then come on up to return, it's descending the tush, not tipping the torso, okay? And I think that's an important distinction to make for us. I am using the chair because I want the chair there for extra balance. We're probably gonna play a little bit with the balance and coordination, possibly adding some ankle work.

So as you lower down into your squat, can you put your arms out in front and find the edge of the chair? And then stand up all the way. So this is as much about how far down you go to send your tush. And it's also now, about finding your posture as you come all the way up. Find it, find it, find it, find it, find it all the way at the top, good.

Reach the arms out. Now, can you add an arm? Press back as you stand up, press the arm back and engage the back line. Go forward and up. And if you need the chair, you use the chair.

If you don't need the chair, that's fine too. We can be narrow parallel as Kristen. We could be a little wider as Tiffany. We could be wider still and you could even turn out as Rebecca. All is good, all is slightly different.

Everybody come down and hold. Now, when you pulse.... Tiffany, come up a little bit 'cause you have this range of motion. When you pulse, it's about this tush; it goes down and up, down and up, down and up, yeah. Three, two, one, stand up all the way.

Shake out your legs. Okay, so I wanna do this differently than the lunges. Can we pulse little more abduction? Yes, can you pulse a little more adduction? Absolutely, we're gonna add though, some torso rotation to this.

So we're gonna add our thread the needle in here. So let's have you come into your lunge. Everybody take your left arm and it goes underneath you. Left arm underneath for thread the needle. That's your starting position.

Ready? Stand up, open out for one, go down and thread. Up, open, two, go down and thread. Up, open, three, go down and thread. Up, open, four. Now, come into your thread the needle, hold it for your rotation.

I'm gonna lift you up off your thoughts a little bit, Tiffany. I want you to bounce your tush a little bit. Now, can you bounce your tush and add a little more of that rotation in. Three, two, one, stand up. And then we're going to do the other side.

Feel okay? All right, it's gonna be the right arm underneath for you thread the needle. Let's start in the position with your arm under. So everybody's got the timing. Good, let's open up and out, look at the beautiful scenery, and then go down and under.

Open up, and then go down and under. Open up, really open the body, and then close the body. Open the body, close the body. Last one, open and close. Hold it there.

Now, it's tush. Tush and spine, spine, spine, yeah? Two, one, stand up, okay. (Joy sighs) So many opportunities here, to do so many different things. What I love about that is this concept of closing the body, opening the body, right?

Closing the body to open the body. That's like what we do best in our world, yeah? Okay, I'm very, very excited. (Joy laughs) And I am paying for dinner tonight. So we're going into the curtsy lunge.

And the curtsy, I will ask you to find your curtsy, what you're comfortable with here, yeah? Let's take the right leg back and lower into your curtsy; you've just met the queen, right? Stand up and let's go to the other side. Just take these slow to feel them. Stand up, this is really where it's very helpful to have the chair, and up.

Now, pick up the pace, and down. Good, down. Good. Last one, each side. And great, okay.

So I love these, but I'm not satisfied there. So let's have you take your right leg back and come into your curtsy, and rotate to your left. Left, yeah. Now, stand up and transitioned, and rotate to your right, and up. Now, it's rotate to the left.

Ready? Go. Up, switch, up, switch, up, switch, up. Now, switch and hold. Now, pulse. Good, now, pulse out in the rotation.

Boom, yeah. Three, two, one, up. Let's just have you curtsy to the other side and hold, shall we? Let's have you pulse, really feel again the descending of the pelvis. Good, and then let's add the rotation piece.

Rotate, rotate, rotate. Good, and up, nice. Great, okay. One last thing, I really do like these cross body stretches. When you do this curtsy, you can also bring the arms, one up on back, and just cross the midline, and then come up, and then go the other side, and cross the midline.

It's a bit of a different stretch, but it really helps to ring the spine out in a really lovely way, okay. Can you put your hands on the back end of the chair? Take a big step back. Don't pull on your chair, but send yourself back into a tabletop. Good, curl your tail just like we've been doing with curt, and then lengthen out.

Good, and one more time, curl your tail, and lengthen out. Great, you can also take the right arm off and let it swing. You can take it and swing it underneath into a thread the needle. Good, and then put the right arm back. Left arm comes down.

We're just trying to come out of all the work you just did in nice, easy way. Hands around the edge of the chair. Take a big step forward. If you don't mind, bend your knees for me. Bend your knees, curl your back, and take that up to standing.

Arms come up overhead. Hands together to bring all of that down through your center, and we'll move on to some supine work. Okay, you guys just worked really hard, shake that out. So let's just come together for a second. That's a lot of hard work and it might not be right for everyone, especially as they're going through cancer treatment.

So please modify this as needed. The reason why we were doing squats and lunges is as I said earlier, is really to start to work into standing balance, standing strength, ankle balance and control, and also to start to work a little bit on the pelvic floor. Do not throw all of these at your client at once. Just give them little bits and really play with how far down they go into as far as the range of motion. But remember, range, a certain number of repetitions, a hold, and a pulse, and that really, will take you pretty far here.

Okay, so we're gonna move on. And what I would like to do is take you on the downward slope of this workout and lie you supine. So let's move your chairs. I'm gonna take your chairs to the edge of your mat. And then let's have you lie supine.

We're gonna use the ball, and I would like the ball to be behind your pelvis. So we talked about the squat and the lunge, and really, completing the phrase by coming all the way upright and finding that length if you will, in the body. We've found lots of opportunity for openness across the chest and the shoulder girdle. So finding length in the long bones if you will, and finding width, particularly across the shoulder girdle. But now, we're gonna focus a little bit on finding width across the pelvic girdle, and the ball happens to be an excellent, excellent place to do this.

So I like the ball. The ball is gonna put a little fire underneath the core, just because of the instability. We only have these balls inflated to roughly about 25%, and they're going to breathe. And we have the pelvis slightly higher than the shoulders. It's gonna really help for relaxation across the back of the thoracolumbar fascia, through the lats, through the upper back, and into the back of the neck.

It's also gonna allow the shoulder girdle to relax, and it gives us an opportunity on the exhalation to really feel the softening of the sternum. Okay, so that feels really nice, and I will tell you, this is a really great place where clients like to just close their eyes, fall back into that meditative state, and occasionally fall asleep. So just keep your eyes open for that one. Now, here's a great place to refocus on breathing. And because you're lying on your back, I do like to feel the back or the width of the back body as you inhale.

And because you have that ball underneath, you feel really sort of that hollowness, that softness of the front body as it drops down toward that ball. Good, and it's an inhale. In my mind's eye, as they exhale, all of that energy goes in through the pelvis and out around, through the back wall of the pelvis. And so it's just like a wash with breath. Tiffany is putting her hands on her first few ribs so that she can really feel that softness of the sternum.

Another nice thing to do is just put your hands right up alongside the sternum, just below your clavicle. Great, super. Here's a great opportunity now, to integrate the arms into the breathing. So let's have you put your arms alongside your body. As you inhale, let your arms float up with the breath as they come up overhead, and then bring those arms down.

This is so much a part and a rich part of our Pilates tradition and heritage in the fundamentals of Eve Gentry, in the fundamentals of Kathy Grant. And these are such fabulous preparatory movements, and also they really help to dial down the sympathetic nervous system and allow the tone of the parasympathetic nervous system to come into place. Good, now, let's alternate arms, let's have one arm overhead, one arm is down. And as you breathe, ride the return of one arm as the other goes overhead. And again, try to synchronize that as best you can with the breathing.

I understand, here, it gets a little less obvious where the breath should be, but you can inhale and switch with one breath or you can switch, and then breathe. And as you change your breath, change your arms. And all of those are really good options here. And if you can add a spiral of the arms, that would be great here as well. So as the one arm goes overhead, the thumb is facing the floor and the other arm spirals internally.

So one is spiraling external rotation, one is spiraling internal rotation. And you'll notice Tiffany is keeping the arms directly overhead. Kristen is taking her arms into a little more of a Y position. And we have Rebecca here, who's really just opening the arms more out to the side. So depending on your client's range of motion, how far post-surgery they are, and how well the shoulder range of motion is coming into play, these are three lovely options for you.

Super, let's have you bring your arms down now, alongside your body, and let's play a little bit with bridging. So everybody's gonna do what Tiffany is doing, which is to move your feet probably about an inch to two inches from the edge of the chair. You're gonna feel your heels into the chair. Now, I particularly like bridging at this stage of recovery because these deep hip muscles tend to go quiet under the influence of chemotherapy. By the way, as does the diaphragm, and by the way, the organs tend to get kind of sluggish.

All of this work right here, is fabulous at addressing those issues in particular. So we'll go into a bridge, but not a full bridge. They're gonna stay relatively neutral in their pelvis, and they're just going to press down on the chair to unweight the pelvis. And you're gonna see the ball is gonna give a little, and then they're gonna sink their weight back into the pelvis. And again, go wide into the ball.

Press into the chair and unweight, and then come on down into the ball. Good, and one last time, you're gonna come up in that relatively neutral pelvis, and then sink down into the ball. So this is with parallel legs. Now, I'd like to really work those little external rotators a little bit. If you could bring your heels together and allow the outside, either of your heel or the side of your foot to find the chair.

But I want you to not just flunk open your legs because you have that ability to do that. So you're gonna keep a little activation in the adductors, keep your legs roughly in and around the width of your mat. And again, on weight, lift up, and then sink down into the ball. On weight, lift up, and sink down into the ball. You should be feeling that now, a little less hamstringing and a little more, really truly around the back wall of the pelvis.

Good, now, if we were to follow our rule before, I'd have you unweight and hold it, and a little pulses. And then sink back into the ball. Great, legs are gonna come parallel. Now, as I spend saying over and over, and over, do not be satisfied with sagittal. I need to make that a song.

We're gonna take your knees over to a diagonal. Now, when your knees are on the diagonal, on this right side, you're on the outside of your heel, on the left side, you're on the inside of the heel. Unweight here, and what we're getting is a little more of the lateral side of the body in the hamstring, and then sink down. And on the left side, we're getting a little more of the medial hamstring. And I want you to put your attention into that left side of that medial hamstring 'cause that medial hamstring is usually not as strong or as comfortable doing this work as the lateral is.

Great, and now, you're gonna go to the other side. So I'm not sure if you could see their faces, but there's an awful lot of concentration happening right now. (Joy laughs) So again, you're gonna feel on the left side now, more of the lateral leg. And on the right side, you're gonna feel the inside of your heel, more of the medial. Please put your thoughts into that medial side 'cause it's very easy to make the lateral side, do the work here.

Good, and I'm not gonna make you hold at impulse, but you get the idea 'cause that's certainly an option here. Great, come back center and just recenter yourselves. And now, go for a full bridge if you wouldn't mind. Take the ball out from underneath, put your hands now, by your sternum. As you roll down, soften the back ribs to the mats.

Slowly, roll through the lumbar spine. Let the pelvis find the mat and roll into the pelvis. Now, does your pelvis feel a little lower than your shoulders? Does your pelvis feel wider? Yeah, so I hate to tell you this: in your mind's eye, you wanna see and feel them almost sink into the mat, and it's like as if they widen themselves into the mat.

But never say to a client, "Oh my God, "your pelvis looks so nice and wide," because it makes them a little nervous. (Joy laughs) But when they feel the release and the relaxation, they'll know exactly why you were going for this. Yeah, so your whole back body should feel a bit more relaxed here. Super, we're gonna get them out of here by doing a roll up. I'm gonna ask Kristen to put her legs on the inside of the chair, gently pressing out against the legs.

I'm gonna ask Tiffany to port her legs slightly to the outside of the chair, gently pressing into the legs here, of the chair. And for Rebecca, we're gonna have her bend her knees with her feet also just gently pressing out. Arms will go up overhead. Big inhale, exhale. Let's have you follow your hands, ride your breath, and your hands are gonna go up and over that chair, and reach forward, wherever your reach is today.

Yeah, and Rebecca, you might need to scooch and get comfortable. Now, here, Tiffany can really straighten out her spine, but all of you, if you can give me some extension here, and then lift yourself up to sitting upright. Starting with your pelvis, turn the pelvis back and hold it. You've rocked off your sit bones. Let's turn the pelvis a little more, and I want you on the backside of your sacrum.

Good, hold it. Good, now, let's go for the lumbar. Let's get the lumbar down, the back ribs, and all the way over. Inhale, exhale, circle the arms around, chin to your chest, ride the wave of your breath as you send your arms over the front of the chair. Good, find this length and the spine.

Lift up, nice. And now, start to turn the pelvis back. Good, good, so they're rolling back slowly. The width we found in the back of their body should be really helpful for these roll-ups. Circle the arms around one last time, and you're gonna come up and forward, and reach over the chair.

Super, all right. So finding the width of the body, the way we did by lying down is really super helpful for finding the roll up. Very often, clients who can't do the roll-up, once they really can relax into that ball, the roll-up has a different level of ease to it. It's not like you're pulling yourself up, but instead you're truly rolling through the spine and the movement. Let's take you into a mermaid, shall we?

So everyone is gonna side-sit for me. Good, you're facing... Perfect, you're all facing the right direction. (Joy laughs) What I would like to do is I'd like to give you a couple of different options here, in terms of sitting position. Rebecca, you have this arch here, so let's have you up on the arch.

Kristen, I have over here, Moon Box Lite, which is probably just the right height for lots of clients. Let's have you sit on that. And when you sit on that, you can be anywhere you need to be for your hips to be relaxed. So Rebecca, you can just like that, let your hips open out. Kristen's in a little bit of a modified Z-sit where she's up a little higher, and Tiffany is in the full Z-sit.

Everybody put your right hand on the chair, lift up with the left arm, and take your mermaid right now. Just side bend toward that chair. Good, now, lift up and let's take you over into the other direction. Now, I'm gonna come over here by Rebecca. Rebecca's had a double mastectomy, and let's have your right hand come down onto the chair.

The reason why I like the chair, particularly for breast cancer patients or clients, is because as we go into that side bend, I can encourage or control as much range of motion as I would need in this shoulder. And then lift up, and let's go to the other side. So if I wanna encourage more range of motion as the hand finds the chair, I could ask that hand to slide out as far as she's comfortable with this right shoulder. And now, everybody lift up. One last time.

And now, we're gonna add a rotation here. So the right hand comes to the chair, left arm comes up, side bend and rotate. And please notice that they all have different levels of rotation here. I like to watch the rotation from the back to see the spiraling up from the sacrum, all the way through the lats into the arm, and to see where each of them are. Now, unrotate or derotate, and then lift up, beautiful.

And let's go to the other side one more time. Great, Tiffany's adding a rotation, awesome. Awesome, awesome, awesome. Okay, so let's turn you around. Left hand is gonna be on the chair, right arm is going to be up.

(Joy chuckles) And let's have you side bend. So again, I like to look at these from behind. And really, the first few, and come on up and go to the other side. All right, just let them move, let them feel this. Take the technicality out, and again, take the judgment out.

In terms of the arm or the shoulder, if they have a lack of a range of motion, they certainly can put the forearm on the chair. They can hold the arm closer to them, and not slide the arm on the base of the chair or the seat of the chair. Great, and then come on up. And for this next one, we add the rotation. And everyone, take this into your rotation.

And again, looking from the sacrum, up through the lats, through the ribs. Great, you can even rotate the head if you want it to look over your shoulder. And then derotate and come on up and out. Good, and if you can see this, you've got three different rotations. Let's have you do that rotation one more time.

You have three different ranges in the shoulder that's on the chair. Three different rotations, and all are beautiful. And then come on out, and up. Super, so I wanna take you now, from here to standing. Tiffany, you're in your Z-sit, can you come up onto your knees and come standing from there?

Everyone's gonna turn and face the camera, and let's have you stand right on the edge of your mats. Take your arms in front, cross the midline. Open the arms out to the side, open up. Good, take the arms down again. Now, let's do this...

I'm throwing this at them again, guys, so hang on there with me. Cross your hands in front, so we cross the midline. Drop your head down as if you're looking into your hands. And then as you open the arms out, send your palms out and away from you. Arms come up, and then let your eye gaze look up, and really let your head tilt back as you look up at the ceiling.

Sweep the arms around, look at your palms. Good, and then come on up. Cervical movement is really important and I feel that we don't really pay enough attention to just that bowing forward and that looking up overhead. Last one. Arms are gonna come up.

Now, keep looking up. Now, imagine you see something up there, you're trying to reach. So it's like climbing a rope; reach with your right arm, and then your left, and then your right, and your left. And as you are watching this, notice the movement through the rib cage. Good, notice the translation.

Take it through your hips and through your feet. Good, if you wanna get up on your tippy toes and try and reach it. (Joy laughs) Good, ground your legs, bring your arms down, bend your knees. Bend your knees, bring your arms in front. Now, grow up and reach, big inhale.

Sweep the arms around, come on down, and up. Again, it's that folding and opening. Come on down, fold and open. Come on down, fold and open. And now, last one, come on down, and now, open.

Big inhale, bring the hands together up overhead. Bring all of that energy down through your center. And there you go. Shoulder mobility, thoracic mobility, strengthening the legs, balancing coordination, and just a whole lot of feeling good.