An Online Zine for Cancer Patients and Professionals Breathing and Exercise For Pain Relief Francine Manuel, RPT, Isadora Rosenbaum, MA, Ernest H. Rosenbaum, MD Breathing Range Of Motion Exercises Arm, Shoulder, Chest and Wrist Exercises Hip, Knee and Ankle Exercises Breathing Back to the Table of Contents Breathing properly is a key factor in all exercise programs. By itself, breathing is a good exercise. Its benefits are twofold: therapeutic and relaxing. Breathing exercises can be used to improve the habits of those who breathe lightly, expanding only the upper chest. They are also a good way to rest between exercises. Urge your patient to let go of all the muscles in his neck and shoulders and fill his lungs all the way. This will break the cycle of shallow tension breathing. Breathing Guidelines: Breathe in through your nose and blow out through your mouth, if this is comfortable for you (this will avoid drying out the throat and mouth). If you can only breathe in through your mouth, go ahead, but keep a glass of water handy. Never hold your breath while doing an exercise. This will exert pressure on your heart and could even cause you to faint. Either blow out or in while performing any of the exercises. You will want to be sure that you are breathing with the lower part of your lungs as well as the upper to increase your lung capacity. To do this, - a. Place a hand on your stomach. - b. If you are using your diaphragm and correctly expanding your lungs, your hand will rise as you breathe in and fall as you blow out. Range Of Motion Exercises Back to the Table of Contents If the patient is immobile for long periods of time, the joints will start to stiffen. They are then painful when the patient tries to move. The family can be taught to support limbs while doing ROM exercises, if the patient is unable to do it himself. The limbs should go through each motion ten times daily at minimum. Here is a series of range of motion exercises that can be done daily by your patients. If the patient cannot move the limb on his own the family should gently support the limb and instruct the patient to tell them if it hurts while you move it. Arm, Shoulder, Chest and Wrist Exercises Back to the Table of Contents Exercises 1, 2, and 3 work the shoulder joints and strengthen the chest muscles. Begin by having the patient take ten deep, relaxing breaths. You can do this along with your patient. Remind the patient not to hold his breath while he is exercising. Encourage him to breathe rhythmically in and out. Give the following instructions to our patient. As he does the movements, watch him. Make sure he is doing the exercise correctly. Also, make sure he is remembering to breathe as deeply and regularly as possible. You can quote these directions to your patient or rephrase them if you like. Straight Arm Lifts - a. Lying on your back, place your arms down by your side. - b. Keeping your elbows straight, lift your arms up and as far back over your head as you can. - c. Now,still keeping your elbows straight, lower your arms down to your side. Elbow Touches - a. Lying on your back, place your hands behind your head, elbows flat on your bed. - b. Bring your elbows together in front of your body. - c. Lower your elbows back down to the bed. Straight Arm Crosses - a. Lying on your back, put your right arm straight out to the side. It should be at a right angle to your body. - b. Keeping your elbows straight, bring your arm across your chest to your left side. - c. Still keeping your elbow straight, return your arm to its original position. - d. Repeat this exercise with your left arm. Elbow Bends (This exercise preserves elbow mobility) - a. Lying on your back, place your arms down by your sides. Make a fist with each hand. - b. Bring your fists up to your shoulders, bending your elbows. - c. Lower your fists to their original positions. Wrist Rotation - a. Lying on your back, hold your arms out in front of you. Make a fist with each hand. - b. Make small inward circles with your fists. - c. Reverse directions and make small outward circles. Hip, Knee, and Ankle Exercises Back to the Table of Contents Hip, Knee and Ankles - a. Lying on your back, place your legs together flat on the bed. - b. Bend your left leg and bring your knee up toward your chest. - c. Straighten your knee while lowering your leg slowly to the bed. - d. Repeat this exercise with your right leg. Straight Leg Lifts - a. Lying on your back, place your legs together flat on the bed. - b. Keeping your knee straight, lift your left leg as high as you can. - c. Still keeping you knee straight, lower your leg slowly to the bed. - d. Repeat this exercise with your right leg. Knee Touches - a. Lying on your back, bend both knees, keeping your feet flat on the bed. - b. Relax and let your knees fall outward as far as they will comfortably go. - c. Bring your knees back up together. Ankle Rotation - a. Lying on your back, bend your left knee and place your left foot flat on the bed to brace yourself - b. Lift your right heel a little off the bed and make small inward circles with your foot. - c. Reverse the directions and made small outward circles. - d. Repeat this exercise with your left foot. Side-to-side Rolls (This exercise helps prevent bedsores) Caution: This exercise should be done with the bed rails raised if the patient is in a hospital bed, or with someone on the other side ofthe bed to make sure that the patient does not rollout of bed. Give the patient the following instructions: - a. Lying on your back, slightly bend your knees and elbows. - b. Lift your left shoulder and roll to the right, reaching with your left arm for the bedrail or other side of the mattress. - c. Roll back and repeat the exercise on your other side. This series can be done either alone or assisted by family members. 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