Adam received a referral for a woman with a early stage thyroid cancer. He’s been a Cancer Exercise Specialist for six months but has not had any experience working with thyroid cancer. He asked if he could hire me to help her with custom exercise programming and teach him how to put together Sharon’s exercise program. He completed her initial assessment and health history and shared the following information with me:
- Sharon is 34 years old and a Zumba instructor (she’s been dancing since she was a child)
- Sharon is 5’7″ and 171 lbs. She has 22% bodyfat.
- She had been teaching 10 classes per week prior to her diagnosis
- She had a total thyroidectomy with node biopsy in December 2016
- She was diagnosed with thyroid cancer in December 2016
- She underwent radioactive iodine treatment in December 2016 and December 2017
- She is struggling with fatigue, weight gain, and self-confidence
- Her BP is 110/70 and her RHR is 63.
Adam conducted a comprehensive assessment.
· Sharon has moderate to severe upper-crossed syndrome
· Her left shoulder is slightly elevated
· She has limited shoulder flexion in her left arm
· She has a moderate to severe anterior pelvic tilt
· Her right knee is laterally rotated and per her Thomas test, she has tight right ITB and quad. She complains about knee pain when she teaches her classes. Her hip flexors are extremely tight on both sides.
· She has excellent balance
Since the thyroidectomy, Sharon has been fearful of moving her neck because she is afraid of opening up the incision. Adam believes that this has contributed to the compensations that have led to her poor upper body posture and limited ROM in the shoulder.
I started by compiling my own notes and breaking everything down for Adam one step at a time.
- Because she underwent a total thyroidectomy she will be on thyroid hormone replacement for the rest of her life. She and her doctor are still struggling to find the right dosage. She has been fatigued and has gained 20 lbs. since having her thyroid removed.
- Because of her upper-crossed syndrome, Sharon needs to stretch both her pecs and lats while strengthening the scapular stabilizers. She should avoid pushing exercises like push-ups and chest press and focus on shoulder retraction/depression, rowing, and maybe reverse flys.
- Because her left shoulder is elevated, Adam recommends a variety of neck stretches to alleviate what appears as tension in the musculature.
- Because she had a few lymph nodes removed in her neck, Adam is including upper body lymph drainage exercises in her workouts and suggesting that she does them daily to prevent lymphedema. He also gives her a list of ways to prevent lymphedema and educated her on the subject (she had no idea what lymphedema was, let alone that she would be at risk for it).
- Adam is concerned about the lateral rotation of the knee and hip on the right side and how continuing with improper tracking can lead to future degeneration and injury.
- Sharon may have an elevated risk of hypocalcemia if her parathyroids were affected by the surgery. Adam is planning on incorporating strength training to increase her bone density as well as her metabolism with a greater percentage of lean muscle.
Once I wrapped my head around the aforementioned notes, I was able to come up with the following workout routine for Adam to facilitate with Sharon for her initial 6-8 weeks.
· Lymph drainage exercises for her upper body.
· Any form of cardio (walking, bicycling, dancing, etc.) to help her build her stamina up so that she can resume teaching classes. Adam recommends 10-15 minutes to begin with. The cardio should also give her much-needed energy and improve her mood.
· Stretch pecs and lats. This can be done more often if desired and tolerated. Start with corner stretch for chest and progress to door stretch. Hold for 20-30 sec. Child’s pose to stretch lats as well as improve shoulder flexion. Hold for 20-30 sec.
3 x PER WEEK
· Perform several repetitions of scapular stabilization exercises.
· Squats are critical for activities of daily living. Working with Sharon on form is important to her quality of life and ability to teach Zumba without the fear of injury from poor biomechanics. She will start with body weight and do as many repetitions as she can with good form and, in the absence of pain. Adam will start to add weights as Sharon tolerates it and in the absence of pain.
· Adam is recommending a beginning yoga class to Sharon to help with shoulder ROM, postural awareness, and mindset
· Adam includes a strength training component that begins with little to no weight for Sharon’s upper body. Because she is at risk for lymphedema, they do not know what her body can tolerate. He will have her add repetitions and weight as her body tolerates it and in the absence of swelling. She has no limitations on her lower body as far as lymphedema goes, but the exercises need to focus on muscle balance and proper biomechanics.
o Stretch ITB/strengthen adductors – avoid abduction exercises as they may exacerbate the lateral hip rotation and tight ITB
o Daily quad stretches
o Focus on strengthening her hamstrings to balance out quad dominance
· To correct her anterior tilt, Adam feels that she needs to stretch her hip flexors several times per day and include exercises that focus on hip extension and strengthening the glutes.
Adam refers Sharon to a colleague of his who is a registered dietician specializing in oncology. Sharon wants and needs to lose the 20 pounds she has gained. It is causing her knee pain to get worse, slowing her down, and killing her self-confidence. She also has a history of diabetes in her family and that is a huge concern for her.
Adam will re-assess Sharon in 8 weeks and either continue with this routine, or progress to longer duration of cardio, more repetitions, and additional weight and repetitions for strength training exercises.
If you are in need of assistance with a special-needs or physically-challenged client, you can get Andrea Leonard’s help in with custom exercise programming.