My client tells me she has breast cancer. I am in shock. The beautiful and contagious smiles my client so generously shares are gone.

The beginning of a long series of procedures starting with a double mastectomy including node removal on one side; removal of hormone-producing organs (ovaries); expanders inserted and gradually filled; and finally breast reconstruction surgery.

You will be emotionally affected on a profound level by what your client is going through – be prepared.

In preparation for breast cancer surgery, get your client’s arms and shoulder girdle as secure as possible, and include plenty of stretching.

Your client will need to be able to get in and out of bed without using her arms for support after surgery. Before surgery, strengthen the abdominals with lots of roll-ups from the supine. Remember to balance these with thoracic extension.

Your client can’t lift their arms above their head for six weeks post-surgery.

After surgery, supine work is best with the head and shoulders propped up on a pillow — arms by the side and propped with pillows or rolled-up towels.

Start with ribcage breathing – breathing can relieve anxiety – for you and your client.

One of the goals in breast cancer surgery recovery is to regain mobility and strength in the arms and shoulders as well as to avoid lymphedema (only if lymph nodes were removed) and frozen shoulder. Even so, programming has to progress with gentle mobility first slowly – try scapular mobility such as shrugs, protraction, and retraction keeping arms by the side initially.

Keeping the arms by the side in supine, externally rotate at the shoulder girdle – think of starting with forearm rotation and gradually move to shoulder rotation, keeping the arms by the side.

Keep hands and wrists mobile with hand circles and stretching out the fingers and making a fist. Doing this can work as a pump for any excess fluid.

When my client walked in one day grinning and wearing a T-shirt, “Yes, they’re fake – the real ones tried to kill me!” I knew we were well on the way to the return of her beautiful smiles again!

That has been a tiny taste of my experience with a client who has gone through breast cancer. I am very grateful to her for sharing her journey with me.