In April 2010, Diana Mann was diagnosed with breast cancer. She was just one of approximately 13,000 Australian women diagnosed that year. She also represented the one out of four who seek complementary therapies, having enlisted the nurturing guidance of her yoga therapist, Annette Loudon, during chemotherapy and radiotherapy treatments that left her with third-degree burns.
“When I first attended a yoga class with Annette, I was feeling sick, isolated, weak and depressed. I was full of fear and doubt as to whether my life and body would ever be normal again, but even after the first session I started to feel that cloud lift,” says Mann.
A significant rise in the survival rate in recent years, perhaps partially due to the emerging field of integrated medicine has given hope amid the increasing number of women being diagnosed with breast cancer. Numerous studies have mirrored Mann’s testimony, confirming yoga complements modern mainstream medicine by addressing the physical, psychological and emotional responses to breast cancer diagnosis and treatment. Reported benefits include stimulation of lymph flow, reduced fatigue and nausea, and enhanced sense of wellbeing through application of restorative practices such as movement (asana), meditation, chanting, visualisation and breathing techniques.
A study conducted by Vivekananda Yoga Research in India also showed that the degree of depression, anxiety and recovery time following treatment lessened as a result of yogic techniques. This mass of scientific evidence triggered public endorsement from respected health systems, including the Cancer Support Alliance, which says “yoga benefits cancer patients on many levels, including stress and pain management”.
“The therapeutic application of yoga is predicated on the philosophy that the body has a natural tendency towards health and gently works to facilitate the removal of obstacles—one of those being sickness—by treating the whole person rather than just the symptoms of disease,” says yoga therapist Susan Cosgrave.
Cosgrave herself has endured two mastectomies, eleven years apart. As well as experiencing the immense therapeutic benefits of yoga first hand, her research during studies at the Australian Institute of Yoga Therapy (AIYT) in 2008 discovered pleasing results on yoga’s benefits for women being treated for breast cancer.
According to Satyananda Yoga teacher and exercise physiologist Dr Maarten Immink, not only does moderate physical activity reduce fatigue and promote healthy functioning of the heart, blood vessels, lungs and blood sugar regulation, but evidence also suggests it may support immune and cognitive function during such treatments as chemotherapy. Dr Immink believes not all women with breast cancer are limited to practising slow, low-intensity types of yoga, however numerous factors must be considered to adopt a practice appropriate for their condition and desired outcomes, including: stage of cancer; type and side-effects of treatment; level of fatigue; cardiorespiratory function; and other chronic conditions and risk factors such as high blood pressure.
“Practitioners should always be aware of the risks and benefits in relation to their yoga sadhana [practice] and their condition, and self-monitor to determine suitability of continuing their practice or the need to alert their medical professional or accredited exercise physiologist of any changes,” he advises.
This reinforces why there can be no generic one-size-fits-all when applying asana in the instance of chronic illness, as each scenario presents a unique set of contraindications.
“Some women having chemotherapy may not be able to do much physically, maybe only wrist, neck or ankle rotations. Radiotherapy involves deep internal burning, which means women undergoing that treatment wouldn’t want too much movement in the tissue by overstretching the upper body,” explains Loudon, who has more than 16 years’ experience teaching yoga for special needs and is currently completing her Masters in the effects of yoga on women with secondary arm lymphoedema from breast cancer at University of Tasmania.
“Women on aromatase inhibitors or tamoxifen often get hot flushes, so they wouldn’t want additional heating from a dynamic practice,” she adds.
Radiation oncologist at the Breast Cancer Institute at Westmead Hospital and author of The Little Pink Book (Finch Publishing, 2011), Dr Phillip Yuile cites secondary breast cancer as another major contraindication. “This is when cancer is in the bones, which is called metastatic disease. In this case, you wouldn’t want to subject the bones, hips, pelvis or back to any excessive activity that risks breaking or fracturing the bone.”
Erring on the side of caution, many professionals advise a restorative practice for most patients. “Yoga therapy generally involves posture modifications to stimulate the flow of prana, or vital energy. It’s about the connection of body, breath and mind, which you can do simply lying in Savasana (Corpse Pose) or standing in Tadasana (Mountain Pose) and connecting your feet to the earth to experience that sense of grounding,” says Susan Cosgrave.
Living With Lymphoedema
Dr Yuile warns that women receiving treatment for breast cancer may need to be careful of arm movement so as not to aggravate any lymphoedema, an inflammatory response to treatment that results in heaviness, aching, tingling, weakness and limited range of motion in the affected arm.
“Having a lot of surgery in the axilla beneath the armpit can make it hard to lift the arm, but it’s important to try and move it gently to your ability so you don’t end up with freezing of the muscles,” he says.
“Yoga benefits cancer patients on many levels, including stress and pain management.”
Like many women with breast cancer, Mann suffered severely with lymphoedema, which resulted in limited movement in her left arm. “Specialists said there wasn’t much I could do, but to their surprise I now have complete mobility in both arms thanks to the targeted movements Annette gave me,” she says.
These impressive results were shared by many of the participants in a study conducted through University of South Australia and the Lymphoedema Assessment Clinic at Flinders Medical Centre by Dr Immink and lymphoedema therapist Jan Douglass. The study investigated the benefits of Satyananda Yoga for women with breast cancer-related lymphoedema. While no adverse effects were recorded by participants in the yoga program, Douglass does acknowledge lymphoedema presents certain considerations.
“It’s advisable for anyone with established lymphoedema to begin by restricting loading of the affected arm or postures which are held in a static way in the early stages of developing yoga practice,” she says. “Women at risk of developing lymphoedema should monitor themselves in the early stages to ensure they don’t overdo any activity with the affected arm, but progressively build strength and tolerance to all postures.”
Participants kept a journal of their experiences to report subjective life improvements that were not formally measured, such as enhanced confidence, improvements in arthritic symptoms and ability to carry out daily activities such as child care and hobbies. Stress reduction was also notable due to the program’s inclusion of the Satyananda Yoga Nidra meditation, which was incorporated with the notion that relaxation can reduce levels of inflammation.
According to Loudon, an area that most women can work on post-surgery is the core, or abdominal region, which upon strengthening can evoke a multifaceted response.
“If women are ill after surgery and can’t walk or move their arms, working on their core brings back a little bit of power. Strengthening and stabilising the core also creates pressure changes that keep the lymph and blood flowing, and facilitates movement of the upper body when it is able,” explains Loudon.
This region also marks the home of Manipura chakra, one of the seven main energy centres that are located from the base of the spine to the crown of the head. Loudon uses three chakras as the centre of her work: Manipura, located at the navel, represents courage and resilience; Anahata, the heart chakra, symbolises love and compassion; and Visuddha, in the throat, signifies discernment in decision-making and communication. “It’s a flow-on effect, manifesting power and self-love, and then trusting in that power and self-love to make appropriate decisions,” says Loudon, whose work inspired Mann to reconnect with her mind and body after a long period of feeling as though the two were worlds apart.
“To their surprise, I now have complete mobility in both arms.”This enhanced sense of mind-body connection acquired through such techniques are imperative throughout a woman’s journey with breast cancer, as they provide the platform for soul-searching and self-study (svadhyaya) to take place.
“Coming back to the practices and philosophies as outlined in ancient texts like the Yoga Sutras and Bhagavad Gita gives women a reference point for svadhyaya,” says Cosgrave.
“A lot of women will ask questions of ‘self’ surrounding what has happened, what they want to do about it, what it means for their family and their life, what it means for the level of who they are, what things in life bring them pleasure. Asking those sorts of questions empowers them with a greater sense of control to navigate life.”
Acclaimed yoga therapist Shirley Telles, who’s been instrumental in the Vivikenanda research, claims mantra repetition is the most powerful healing practice of all. Loudon often implements this technique in her classes, with the use of the chakras’ accompanying mantras to help remove self-defeating thoughts; namely “ram” (pronounced rum) for Manipura, “yam” (yum) for Anahata and “ham” (hum) to stimulate Visuddha.
“Mantra is a prana-enriching practice. It changes where our brainwaves are—from the fear centre at the back of the brain to the frontal area, which is calmer. So mantra repetition is an easy way to relax when you’re doing things that create fear, like waiting for an appointment or treatment,” explains Loudon.
Such calming effects of yoga comforted Mann during her darkest days, and to this day remind her how to breathe easy when the anticipation of quarterly check-ups makes her momentarily hold her breath. “Because of my yoga practice, I’d go into my appointments without so much fear and despair, knowing it was a journey and I would come out the other end. Looking back on it, I think ‘how did I survive that journey?’, and I wouldn’t have without yoga. It made me come alive again,” declares Mann.
The full yoga breath has the power to calm the mind and help relieve anxiety. Yoga therapist Annette Loudon suggests the following exercise:
Breathe in from the lower, middle and then upper ribcage. Feel the ribs moving outwards from the front, sides and back, and the tummy expand slightly. Breathe out from the upper, middle and then lower ribcage. Allow the breath to become long and slow; simply focus on the breath, nothing else. If possible, allow the exhalation to become longer than the inhalation. Experienced yoga practitioners may include Nadi Shodana (Alternate Nostril Breath) and Brahmari (Bee Breath).
To learn more exercises like this, view Loudon’s DVD, Yoga for Women after Breast Cancer, available from YWCA Encore’s online shop at ywcansw.com.au
Yoga and exercise classes, retreats and events are offered at discounted or no cost to breast cancer patients. Find one near you:
Anahata Healing offers free yoga classes around Australia for those affected by cancer; anahatahealing.com.au
Breast Cancer Network Australia and National Breast Cancer Foundation host events to inform, support and fundraise for women affected by breast cancer; bcna.org.au, nbcf.org.au
The Otis Foundation provides retreats for women and men living with breast cancer at no accommodation charge; otisfoundation.org.au
YWCA Encore offers post-surgery exercise programs including a floor-based regimen and hydrotherapy pool access; ywcaencore.org.au
Specialised yoga for breast cancer classes run in Canberra by qualified instructor, Katrina Hansen; yogaforyou.net.au
Cancer Services of Northern Sydney Central Coast Health offers a range of support groups and workshops; cancercare.org.au
The Quest for Life Foundation in Bundanoon, southern NSW, hosts a range of workshops and retreats that address the challenges of cancer; questforlife.com.au
Mater Private Breast Cancer Centre in Brisbane offers free yoga classes to its patients; breastcancer.mater.org.au
The Gawler Foundation hosts a range of cancer healing programs and retreats in the Yarra Valley; gawler.org
Urban Yoga in Wellington offers yoga classes for women in various stages of recovery; urbanyoga.co.nz
Diana Timmins is a freelance writer and hatha vinyasa yoga teacher.