This class is designed for anyone with breast cancer, anyone who is still feeling the effects of treatment, or the stress of the experience. There is a lot of emphasis on relaxation and awareness.

In addition to basic yoga postures and stretches, exercises and stretches that are given after surgery are incorporated into this practice. We work to increase mobility and range of movement and to include awareness of the physical and psychological effects of treatment.

One main concept to remember is that practicing regularly is key. It's better to do short bits of exercise often rather than infrequent long sessions. Do only as much as you can but as often as you can. As a reminder, don't push or over-do at the beginning. If you feel any strain or twinge, simply back off until you can relax and breathe deeply.

Some themes to focus on during this practice:

• Awareness of the breath(prana): Focus the attention on the breath and the connection to your nervous system. Try to practice smooth, quiet and calm breathing.
• Awareness of being supported by the earth/ground/floor.

1. Introductory Relaxation
   Rest on your back. Make sure you are warm and comfortable. Take this time to heal, to rebuild, to come back to yourself while you focus on your breath. Bring your attention to the sensations in your mouth, jaw, throat, tongue. Focus on expansion on your inhalation and relaxation on the exhalation. Relax your arms, shoulders, back. Focus your awareness on the chest, breasts. Notice areas of tension and sensitivity. Observe feelings, letting the breath feel the feeling. Acknowledge any anger, fear, sadness. Drop attention to belly, pelvis. Feel the rise and fall of the inhale and exhale. Feel stable, grounded, centered, connected. Rest back more. Sink into the floor. Let your legs relax. Thighs, knees, calves, shins, ankles, heels. Feel relaxation into the soles of your feet and toes. Feel yourwhole body more at ease, more settled, your attention more focused. Care for yourself. Commit to your own healing. When you're ready, slowly stretch.
2. Warm-up Stretches
   From this reclining position, we'll stretch the upper body, reducing stiffness after surgery, chemotherapy, or menopause after chemo. There are alternative stretches that can be done from a chair if you are uncomfortable resting back. Remove covers.

   Hug knees to chest. Feel the stretch in yourlower back and pelvis. Rock gently side-to-side. On the exhale you can pull your knees in closer to your chest and on the inhale, press knees further away from chest.

   Move knees to the side in a twist on the exhale, find the arm position that allows for a stretch across the chest. Be sure to adopt the pose to your needs. Relax your waist, side ribs, your armpit, and shoulders. Repeat on the other side.

   Pelvic tilt, which is the counter pose after knees to chest. Gently exhale and tilt the pelvis. On the inhale, relax. This will help stabilize your lower back and stretch your hips. If you're feeling comfortable, you can come up farther into desk or bridge to stretch the top of the chest. Keep your lower back long, moving in and out of the pose. This time, inhale and peel your spine up and away from the earth. On the exhale, lower down one vertebra at a time. Feel the length of your spine.

   Hug knees to chest again.

3. Arm Stretches Lying Down
   These stretches are given after surgery. They will help with lymph circulation, range of motion, reestablish mobility, reduce stiffness after surgery or radiation.

   Snow Angel: Start with your arms by your sides, palms facing up. Watch for uncomfortable sensations as you move through this exercise. Slide your arms up as far as you're comfortable, moving in this direction on the inhale. On your exhale, slide yourarms back down. If you're more comfortable, hold the stretch in various positions.

   Bring your arms up toward the sky, toward over head as far as is comfortable. This drains the fluid and circulates the lymph fluid. Note any stiffness or tenderness in the tissue. Wait until any fear passes to go further. You can move up and down or hold the stretch. Keep your arms as even as possible. Rediscover easy, free movement of the shoulders. You can rest your arms on a pillow overhead to help drain the lymph fluid. Breathe slowly and smoothly as you stretch.

   Lie on your non-surgical side. You can place a pillow under your head and curl your knees. Make circles with your free arm, in one direction. Start small and spiral to larger. Feel the tissue. Feel for strain in your chest or collar bone. Keep your elbows, wrists, and hands relaxed. Reverse the direction of the circles, noticing the differences. Try to move smoothly. Rest your hand on your hip and breathe. Stay on this side or move to the other side if you'd like to observe how normal tissue moves (this assumes you didn't have surgery on both sides). Learn how to redevelop your muscle and tissue.

4. Shoulder Stretches Sitting
   These stretches can be done by anyone at anytime, in the car (when you are not driving or are at a complete stop), in front of the computer. Create a stable foundation from the waist down.

   Roll your shoulders in circles forward and backwards. Squirm or move in any way that feels good to you.

   Relax shoulders, begin to turn head from side-to-side moving with the rhythm of your breath.

   Drop one ear toward one shoulder. Relax for a few breaths and move to other side. Observe any tension from scar tissue - move slowly and with awareness.

   Make circles with your head remembering not to go too far to the back - no compression in the back of the neck.

   Place fingertips on shoulders, circle the elbows, forwards and backwards (spiral from small to larger). This promotes good lymph circulation in the arms and increases range of motion. Don't go past your range of comfort - no strain.

   "Washing Machine" spinal twists. Place your hands on your shoulders so that your fingertips fan out in front of your shoulders. Twist to one side on the exhalation, inhaling come back to center, and exhaling, turn to the other side. Be careful not to overstretch the top of the chest.

5. Cat Pose & Dog Pose
   Focus on mobility in your spine, strengthening your arms. If you have wrist issues, use the fist/knuckles on floor or forearms on floor. Start on all fours, hands underneath shoulders and knees underneath hips. Round your back as you exhale, come back to neutral position or gently arch your back as you inhale. Be careful not to compress your neck or lower back. Pay attention to the upper back which can be stiff after surgery. We focus so much on the front of the body, sometimes we need to be aware of the back too. Keep the spine long all the way through the neck. Make the movements smooth and sinuous.

   From table, walk your hands to the side curving the spine into a "C". Continue to round and arch your back as you exhale and inhale. For a more intense stretch, dip your chest toward the floor. Go slowly and carefully at the beginning. The chest becomes more flexible and open. Feel the stretch through the side ribs. Feel your strength.

   Rest in child's pose. Drop your hips back on to your heels and fold forward. If you do not reach the ground comfortably, make a pillow with your hands or place a pillow in front of you and rest. Spread your knees far enough apart so that your chest can drop between your thighs. If there's pain in your knees, place a blanket between your calves and thighs.

   If you're ready, we'll work into downward facing dog pose to build strength in your arms and to stretch your back body and legs. From Cat Pose, turn your toes under and straighten your legs. Bring as much attention as possible into the heels. Stretch the arms, shoulders, spine, hips and legs.

   Rest in child's pose.

6. Standing Stretches and Warrior Pose
   These are basic standing stretches given after surgery.

   Stand facing the wall with your feet hip width apart. Place hands on the wall and slowly crawl your hands up the wall, as far as you can comfortably. Then walk them slowly down. Keep the shoulders relaxed, dropped. Explore the range of movement in your arms and shoulders. Rest your arms by your side when you're finished.

   Turn your right side to the wall. Align. Your distance from the wall will depend on your flexibility and stiffness. If you're stiff move further away from the wall. Walk your hand/fingers backwards as far as your can without strain. Keep your body straight (don't turn the body), keep shoulders dropped. Feel the stretch across your chest. When you've come back as far as you can, drop the arm to the side and repeat 2-3 times. Turn and try the other side. Adjust your distance from the wall accordingly. Notice the difference on this side.

   For a wider range of arm motion and stretch, you can use a belt. Hold the belt with your hands about three feet apart. Stretch your arms in any direction. For example, inhale and bring arms up overhead, move arms side-to-side, twist - feel what's best. As you become more flexible, bring your hands closer together. You can also try this from the back, bringing the belt behind you, holding it and stretching in all directions.

   Warrior I Pose. Stand with your feet about hip width apart. Focus on reestablishing stability, strength and security. Bring your arms to your hips or overhead. Step one foot forward and bend your front knee. Focus on the feeling of stability of your legs underneath you as you breathe.

   Stand in mountain pose.

   Standing Forward Bend. To relax after the Warrior Pose, exhale and bend forward. If your lower back is weak or sore, bend your knees and place your hands on your knees to support the weight of your body. Breathe.

   Mountain Pose. Stand with your feet hip width apart. Focus on your breathing. Feel as if you have roots growing into the earth and that you are centered, grounded and stable. Feel yourself growing upward like a tall tree.

7. Sitting Meditation
   Reestablish your sense of stable center. Feel grounded. The ground supports you. Your spine is grounded. Your arms, neck and shoulders relax. Sense the sky above and the space around you. As you inhale, draw from the space around you, let it fill and expand you. Let it heal you. As you exhale, draw your attention inward so that you're more grounded, more connected to yourself, more stable and secure.

   With each breath feel expansion and deepening, a sense of wholeness.

   Feel in this moment that you are whole and complete. It's a very gradual process that lets you feel good in your body, that this powerful vehicle for healing is awareness of your breath. Know that when you feel lost or scattered, that your breath is there even when you can't find it.

   Take a few minutes each day to sit or lie quietly and pay attention to your breath. Draw your strength from the breath, that prana, the life force.

8. Final Relaxation
   Get as comfortable as possible, supporting the arms, neck, knees if you need it. Bring your attention to your breath. Inhaling and expanding, exhaling and relaxing. Feel relief in the exhalation. Sink, melt into the earth. Feel yourself being completely supported by the earth. Remind yourself that sometimes relaxation makes us calmer, steadier. Sometimes it makes us more vulnerable. Whatever you feel is ok, it's normal. Give yourself permission to really feel what you're feeling. Sense the inner resource of your breath. This is your time. Feel the relief in allowing yourself to just be.

   Let your head rest back, heavier. Eyes soft. Forehead relaxed, face relaxed, softening tension in the mouth, jaw, throat. Let your neck relax, shoulders drop, arms rest fully on the floor. Feel relaxation carry through into the palms of your hands, thumbs, fingers. Let your arms rest, feel easing in the armpits, sides of ribcage, across your chest, through your breasts, relaxing through your scars and through any places that are wounded. Allow yourself to heal. Give yourself over to the movement of your breath. Feel the rise and fall of your belly. On your next exhale, feel your back rest into the earth, as if the earth were made of clay and your body sinks further and further, leaving your impression in this place. Pelvis relaxed, legs, knees, calves, shins, ankles, heels. Feel as if the movement of your breath penetrates into the soles of your feet and toes. Give your body to your breath.

   And now let's all remind ourselves that we are alive. Each breath is an expression of the gifts in our lives. Be grateful for this time....this practice. Your inhalation expands you, fills you, gives you energy. Your exhalation draws you more deeply inward, to your inner source, your re-source. Tap into this place when you need. Be gentle and caring of yourself and with yourself.

   Namaste

Mary Esther Middleton

Contact Yoga Sense