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Rider Fitness Tip of the Month: Breast Cancer Challenge

An interview with an equestrian breast cancer survivor and exercises to build shoulder strength and improve range of motion.
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Heather Sansom is the author of rider fitness ebooks Complete Core Workout for Rider, and a regular columnist in several equestrian publications including Dressage Today. EquiFITT.com offers rider fitness clinics & workshops, Centered Riding instruction, and convenient distance eCoaching for riders anywhere. Subscribe to receive free monthly Equestrian Fittips, and download rider fitness eBooks at:www.equifitt.com/resources.html

Although I frequently work with riders recovering from injury or surgery, or living with an illness or disability, breast cancer is not something I have personally experienced or been very close to. While riders coming back from surgery or struggling with an illness do have similar needs and experiences, this one is special. It hits those affected in unexpected ways that are not usually talked about openly in fitness and riding literature.

For this month's piece, I was able to interview lifetime rider, Level III Centered Riding Instructor and breast cancer survivor, Mary Trafford.

Mary lives and practices in the Ottawa area in Canada. She was first certified as a Centered Riding Instructor in 1986, training under Sally Swift. Eventually, Mary worked her way to Level III which qualifies her to conduct Centered Riding clinics. She was also certified in 1989 by the Canadian Therapeutic Riding Association in therapeutic riding instruction. She balances her teaching and involvement with horses, with a full-time job as a speech-writer in the federal public service.

Heather Sansom:Tell me what happened when you found out about your diagnosis. What went through your mind?

Mary Trafford: It was 1998. I was riding at the time. When I heard the news, I was shocked. I was about to leave on vacation to go to Texas, and it was one of those situations where I had gone through a routine mammogram. They called me from the hospital and told me I needed to cancel the vacation. Then I knew it was pretty serious. It was ductal carcinoma in situ (DCIS). Luckily, as I went through the different levels of the diagnostic process, they discovered it was fairly localized. I only needed a mastectomy. It hadn't gone to the lymph nodes, so I did not need chemotherapy, radiation, or removal of part of the pectoralis muscle. I was very lucky!

The operation leaves you with a certain amount of tightness in the shoulder area. I wasn't riding that much at the time, but I did make a conscious effort to be with horses because I found it therapeutic. I got a lot of strength and comfort from the horses. I just felt better when I was with them, and it was really important to me to be with them.

Right after the operation, I had to rest. I also use crutches because I'm an amputee, and the doctor told me I couldn't use them because it put strain on the area. So I had to stay home for a couple of weeks.

HeatherSansom: How did you start getting back to your activities? What were some of the challenges?

Mary Trafford: I was able to start being more active after about two weeks. I had come through a hard time just before being diagnosed. My sister had died due to a brain tumor. I had been working really hard at my job. When I got the diagnosis, everything stopped. All of a sudden, I was off work. It took me five months before I felt well enough to go back to work. Part of it was physical, and part of it was emotional. During my time off, I participated in a Centered Riding update clinic, which really encouraged me.

The general anaesthetic really does strange things. I think it takes some time for your body to detoxify from it. You're tired. The actual surgery leaves you with tight-feeling skin. It hurts to move your arm, so a lot of women have problems with mobility of their arm afterwards. Those who have had lymph nodes removed may also have a problem with lymphedema, which is abnormal swelling of the tissues caused by stagnant lymph. After breast-cancer surgery, it can lead to uncomfortable and hard-to-control swelling of the arm. The lymphatic system works with the circulatory system to move fluid and infectious cells in your body, so when the nodes are removed, that system is interrupted. In these cases, the women have to wear a compression sleeve over the arm to keep the swelling under control. Too much swelling is not only uncomfortable, it can increase chances of infection in the arm. Exercise can help drain the lymphedema and help the process along.

When riding, there can be some discomfort because of surgery.

I gradually started to do some light exercises. I did some strength training with 2-5lb weights, using a strength-training program that included a range of exercises, such as overhead presses, light chest flies and bench presses. The program also included work with the legs and abs, and a lot of work for the upper body. I was doing it because I was interested in joining a dragon-boat team for breast cancer survivors and I needed to develop more upper body strength. After the surgery, just lifting my arm to the side hurt. It is really important to gradually nudge the range of motion because if you don't, your skin and the muscles stay tight. I also did a lot of stretching, as well as strengthening the whole shoulder-girdle area.

Heather Sansom: Was it easy to get active again? Why did you pick up exercise again so quickly?

Mary Trafford: It was a little uncomfortable at first, but I found it fairly easy. I have very good upper-body strength anyway, but this exerice regime gave me something concrete to aim for, and it gave me a sense of well-being. I felt that through the training, I was moving forward from the breast cancer to wellness.

They tell you to really take it easy for the first couple of weeks. But after that they suggest you get started. If I had been having radiation or chemo-therapy it would have been a slower process because those treatments have such a negative effect on your energy and sense of wellness. Coming out of a simple surgery, I found that it wasn't as complicated for me.

Heather Sansom: How long after your surgery did you ride?

Mary Trafford: It was probably about two to three months before I got on a horse. It was more of an access issue, since I didn't have my own horse at the time. I think I could have ridden about a month afterwards. It's important not to do anything too vigorously afterwards so that you don't damage the incision. And you need to have the energy for whatever activity you undertake. You don't want to get out there, and suddenly feel faint or overdo it. You should be able to do some good walking already and have some stamina before you get back in the saddle.

You shouldn't push yourself to the point of causing pain, but you do need to move your exercise program along in increments. It's not a good idea to tear muscle fibers from exercising too hard, especially early on.

If someone has had one breast removed and they had larger breasts, there may also be balance issues. The medical professionals generally recommend that you shouldn't get fitted for a breast prosthesis until six months after surgery, to permit full healing and to allow any swelling to disappear. So, for the interim period, you just basically stuff your bra with light-weight material you can get from the Canadian Cancer Society, and you are a bit unbalanced. You also don't look as good, cosmetically, because your breasts aren't even. That can throw you off in your riding, too. Besides creating an asymmetry in your body that you might compensate for on the horse, there is also the issue of feeling self-conscious.

A breast can weigh a couple of pounds. A couple of pounds in asymmetry is a lot of difference to a horse.

Heather Sansom:What are your thoughts from a Centered Riding perspective?

Mary Trafford: In Centered Riding, we help riders feel more comfortable in their bodies. We spend a lot of time teaching the rider to be grounded and aware of their body. This awareness can be a big plus for a rider going through something like breast cancer because the rider learns how to ?make friends' with their body. They learn how to feel the asymmetry, be aware of what is going on and find renewed balance. It's all about getting strength from your strong areas, and distributing it to the weaker areas. It's a riding technique that can really help people get comfortable again with their bodies and learn how their body is working in the saddle.

There is an emotional aspect, too, that helps a rider deal with their emotions and anxieties before they ride. Dealing with emotions and anxieties is especially important after a life-changing surgery like this.

Not everyone would be affected by the weight difference. Once you get your breast prosthesis, it hardly makes a difference.

Heather Sansom: Can you talk about how a rider can get back in the saddle after treatment or surgery?

I think just being around a horse is really important, even it's just going to watch an event. If you can be around a horse right from the start, you feel so much better. When the doctor allows riding again, starting off on a quiet horse is a good idea.

It's important to be honest with yourself and your instructor. If it's your first lesson post-surgery, it's important to be able to say so to your instructor so that they are aware you need to go gradually. Taking it slowly is really important. Don't push it until you are hurting, or begin feeling too emotional. Find that line and stay behind it. Go slowly.

It's not very comfortable to do exercises on your stomach after a mastectomy. Core strength is so important generally. After a surgery like this, it's even more important because it helps you feel more balanced and work from your center. Core includes your back of course, and back muscles help you maintain balance. The core is so important in keeping your head in alignment and making sure your movements are organized.

You can't expect the same performance as before treatment. You need to give yourself a bit of a break because your body just won't work quite the same way right away. With lymphedema, for example, you may have numbness in the arms or hands, which can affect your ability to hold the reins.

The experience also shakes up your perspective on life, which can affect your riding. You start to re-evaluate things and approach things differently. You really need to spend some time on mental and emotional rehabilitation. You may wish to change your riding priorities and goals. Someone who was very competitive might find themselves with different priorities afterwards, and this will cause a change in your riding and training plan. It's important to focus on enjoying the process.

Heather Sansom: As a riding instructor, how has your experience with breast cancer had an impact on your practice?

Mary Trafford: I think it's made me more empathetic and less goal-oriented. I'm a little more easygoing. It's easier for me to go with the time a process takes, whereas before I would feel more highs and lows. I'm more aware that people have to find their own path, and that I'm there to assist their journey, but I can't control it.

Cancer touches just about everybody, and breast cancer is pretty common. After the surgery, I found that many people seemed to share a common ground with me.

It's also important to consider that some women who have had a mastectomy go on to have breast reconstruction surgery afterward. This can be a very invasive procedure, sometimes requiring multiple surgeries. It can leave the individual with decreased abdominal strength, depending on the type of procedure. A good website for information on breast reconstruction is www.breastreconstruction.ca As an instructor, I would want to know if my student had had such a procedure and if she has any residual weakness, pain and/or tightness, as a result.

There are also interesting posts on this site: http://community.breastcancer.org/forum/91/topic/752038 . On this site, some women talk quite candidly about their experiences and concerns after breast cancer surgery and treatment, and in some cases, reconstruction. At some point out, getting physiotherapy can be helpful in regaining range of motion in the arm and shoulder. I have read stories that indicate that one month after surgery, some women still find basic tasks difficult, like putting on a halter.

The experience of breast cancer and recovery is a very individual journey, but we can all benefit from the insights and advice of others.

Heather Sansom: Thank you for sharing from your experience Mary.

Mary Trafford will be conducting a Centered Riding afternoon workshop in April 2011, as a fundraiser for a breast-cancer support organization in the Ottawa area (www.skylinefarm.ca for Breast Cancer Action www.bcaott.ca ).

Click "Next" to learn some exercises to build shoulder strength and improve range of motion.

Exercises to Build Shoulder Strength / Improve Range of Motion

When a rider has to carry their arm in a fixed position for a period of time, such as during the recovery weeks after a mastectomy, the skin, muscle and ligament tissue in the shoulder area can tighten and have a tendency to remain short, especially if pectoral tissue was also removed. During the rest period, the muscles that mobilize the shoulder area also atrophy a little through lack of use. It is important to follow your physiotherapist's advice on stretches to improve range of motion and allow movement, and also start to strengthen important should muscles.

Lateral and forward raises help strengthen your shoulders. These exercises isolate the deltoids (muscles at the top of your arm). Improving strength in your deltoids can help reduce overall load and tension in your trapezius muscles (neck/shoulder area), while improving your strength for lifting and carrying your arms. As a rider, strength in this area can translate to an ability to maintain your posture without tension in your biceps/on the reins. Building strength in your upper body can help you retake control and ownership of your upper body, both in a real physical way as well as emotionally.

LATERAL RAISE:

Simple-Lateral-Raise
  1. Start with light weights or no weight, and gradually increase the number of lifts you can do.
  2. Count to three on the way up, and three on the way down. Keeping a steady rhythm improves muscle memory and muscle fibre acquisition.
  3. If you can do 20 or more repetitions in a row before you need to rest, you are ready to add weight. As a rider, watch carefully that you do not scrunch up your shoulders at the same time. Doing so would mean you are relying on your trapezius, instead of isolating your deltoids.
  4. The picture shows a very advanced use of lateral raise, combined with stability and balance element from the balance cushion, and core stabilization. You can start out seated on a chair, and progress to standing variations or sitting on an exercise ball. Generally, use less of your body to start, and incorporate more muscle groups as you become stronger.

FORWARD RAISE

Complexe-Forward-Raise
  1. Raise your arm forward to shoulder height. You can start off with no weights, and add weight as you are ready. Keeping your rhythm is important. When you are much fitter, you can add complex variations that incorporate your core, and separation of body-parts into different activities. Doing different exercises with different parts of your body at the same time really helps your brain prepare for the many simultaneous signals you give to and receive from your horse.

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