Meditation and Olympic Weightlifting Competitions

The warm-up during an Olympic weightlifting competition is perhaps the most intense and stressful part of the sport. Months of training but only six lifts count on the day of the competition, three for the snatch and three for the clean & jerk.

How does Meditation help?

I like to close my eyes, shut out the noise and craziness of the warm-up room, and practice a breathing meditation (Joshin Kokyo Ho) between the warm-up attempts.

It calms the mind, aligns the body, and brings energy and focus to the core. The craziness of thoughts subsides. Confidence and trust can surface: confidence in my ability, and trust in the laws of physics that the bar will accelerate and keep on moving upward, even if I don’t pull with the arms. The bar is too heavy for the arms anyway. 

It creates a state of openness that allows me to concentrate on the execution of the lift, no matter what weight is loaded onto the bar. It can bring forth my strong and capable Self on the platform. Having faith that I am better than I thought possible. The openness allows me to let go of whatever happened the weeks before in training, and also let go of the expectation of making the goal weight. The latter is important as it can create tension that is misplaced at the moment of the lift.

Breathing in and feeling energy in every cell of the body is strengthening and helps with recovery. It may also help to visualize a column of white light from the bottom of the feet to the top of the head. The bar will travel along this path (weightlifting is a linear vertical movement with minimal horizontal displacement): lift-off with control and then exploding upwards without fear.  However mental images may change from one day to the next. Enjoy when they come. They may be appropriate at that time, but holding on or mentally constructing such images can be obstructive.

In order for meditation to be helpful, it is important to practice regularly. This enables the mind to access that meditative state quickly and easily in the midst of stressful situations. There are no short-cuts in training for weightlifting, and there are no short-cuts in meditation practice. If everything flows smoothly and flawlessly together, weightlifting is like a miracle and brings great joy – and relaxation!

Bodybuilding benefits

Bodybuilding exercises are a great confidence booster. The Turning Point program is offered by some YMCA branches for breast cancer patients. One of these classes introduced me to bodybuilding. It is lovely to build up muscles in the chest, arms, and back after mastectomy. However, when trying something new, it is important to build up slowly to avoid complications such as lymphedema [see references below].

Weightlifters can use bodybuilding exercises to complement their training. It is not necessary to add more leg work as this is covered in the lifts, pulls, and squats during the regular training. But upper body exercises for  shoulders, chest, back, and arms can be helpful to gain stability or confidence in the overhead position of the Olympic lifts.

About 8-12 repetitions and 3 sets are sufficient. The bodybuilding exercises can be organized such that different muscles are used in any two exercises. In that case very little, if any, rest periods are needed between sets. It is helpful to use concentric and eccentric motions for each muscle group. For example,  push-ups vs rowing for the arms or pulls vs pushes (e.g. squats) for the legs. Using free weights rather than machines train combinations of muscles and activate the core (and won't strain the back through sitting). There are many exercises so that a bodybuilding program can be changed every couple of weeks to add variety. Having someone correct your form is needed to avoid injury and to get the most out of these exercises.
Soon we can start posing in front of a mirror and flex muscles.

References

1. Stegink-Jansen et al.  Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery. Journal of Orthopaedic & Sports Physical Therapy 2011: 41(6); 417-426. Link to article.   Findings: Combined stretches, such as extension and external rotation puts most strain on the pec muscle. Early postoperative abduction should be increased gradually. 
2. Schmitz.  Weightlifting and lymphedema: Clearing up misconceptions (about interpretations of the Physical Activity and Lymphedema (PAL) trial with  7 guidelines)

Sample exercises by muscle group:

Legs

• squats
• leg presses

Back

• Lat pull downs
• cable rows

Shoulders

• lateral raises
• DB presses

Chest

• pec flys
• chest presses

Triceps

• tricep extensions
• reverse cable pull down

Biceps

• DB curls
• hammer grip row

Core

• planks and side planks

International Womens Weightlifting Grand Prix

This competition took place in Nagold, Germany, June 8-10. There were around 100 women weightlifters from 16 countries, ages 10 to 58.  There was a DJ playing encouraging music when a lifter walked onto the stage, the audience clapped in rhythm, and, as we stepped up to the bar to get ready to lift - silence. It was fun, and a great opportunity to make new friends.

 Global sisterhood!

One year follow-up

Exactly 12 months ago was my bilateral mastectomy.

As a celebration I competed in a local weightlifting competition. This event was also my first competition a year ago. Despite the weight loss and although I hand't managed such weights in training I really wanted to repeat the weights lifted for the clean & jerk a year ago, 55kg - 58kg - 61kg.  It went fine until the clean of 61kg, which I caught badly. I was feeling disappointed that I had to drop it. But  then I thought "No way am I going to loose this bar!!!" And with sheer willpower and a little stumbling on the platform  I managed to save it. It is surprising how little time it takes to think all these thoughts and feel all these feelings and still act timely.

On the one hand I am much healthier now than I was then and feel awesome. The one year follow-up tests (blood lab values) were super good and better than before.  And I think about the cancer less and less, although it is a chronic disease.
On the other hand I have to take Tamoxifen for 4 more years. It has side effects. I take only half the dose to the dismay of the oncologist. Clearly tamoxifen has a good track record (it's been around for 30 years) of preventing recurrences. The unanswered question is how to balance the risk of recurrence with the risk of long term side effects increasing comorbidities for somebody with little or no risk factors like myself.

National Masters Weightlifting Championships 2017

• Good preparation with much more shoulder stability than it was a couple of months ago
• Excellent coaching
• Meditation between the warm-up lifts to stay calm
• 3rd place!

Benefits of competitions

It is well known that we benefit from exercise. How about the challenge of competitions?

In the preparation and participation for competitions we can find enjoyment in the physical improvements and testing our limitations, getting positive effects on mood from the training, being motivated to pursue regular, intensive exercise in order to reach the goals for competitions. Meeting other women weightlifters at the competitions and staying in contact via social media enriches life. In interviews at the World Masters Games in Sydney 2009 competitors aged  56-90 identified five themes, namely enjoyment of challenges, satisfaction with what their bodies are capable of, winning, motivation, and companionship ("Older athletes perceived benefits of competitions")

Competitions and training for competitions provide physical and mental challenges.  One has to deal with doubts or unreasonable expectations and finding a balance. There is the risk of injury, typically measured in number of incidences per 1000 hours of activities in the chosen sport. It is relatively low in weightlifting compared to ball or contact sports or running (Pakkari et al. Active living and injury risk.  Int J Sports Med 2004; 25: 209-216).  Injuries or comorbidities (such as cancer) make it necessary to adjust the training and not being able to achieve what one hoped. However at the competitive level athletes make these adjustments and continue to train.  In the documentary Impossible Dreamers (2016)  a 68 year old swimmer talked about how "something inside her kept her going and going" after a surgery so that she was able to break the world record a year later. An 85 year old sprinter said that "we don't let things stop us from max effort." A 94 year old yoga teacher and dancer said that it is the dance of life inside her, and that she tells her students not to give in to anything but to know that they can recycle their own bodies. 

At competitions we learn how to deal with our nervous system so that we can focus and find a still point that allows us to be at our best. It can be helpful to dedicate our efforts at a competition to something. For example, I wanted to succeed (meaning to participate and do well) at the world masters weightlifting championships for my breast cancer sisters in the world, and as an example that breast cancer need not stop us. There are many women with breast cancer diagnosis who participate in competitions at the highest levels: Sisterhood of breast cancer athletes

American Masters Weightlifting Championships 2016

This is exciting: 2nd place at the American Masters Weightlifting Championships at 6.5 months post mastectomy. And I was able to lift more than at the Worlds one month ago. My shoulder stability is improving.

Being confronted with having to do my own warm-up timing was daunting, but I gained confidence in doing so. It would be great, if at all competitions an updated start list with declared starting attempts would be easily accessible to lifters and coaches.

#BreastCancerRealityCheck

The hashtag  #BreastCancerRealityCheck is currently used on Twitter to add some reality to the pink ribbon party the breast cancer awareness month October seems to have evolved into.

Awareness what breast cancer may mean for weightlifting:
1. Dealing with continued swelling due to an interrupted lymph system: learning lymph massage, learning kineseo taping, having to wear compression shirts, avoiding upper body strength exercises, or any exercises that lead to increased swelling.  Lymphedema sleeves are not allowed in competitions.
2. One may need to argue about long sleeve compression shirts in competitions. They are allowed according to IWF rules, although not everybody knows this.
3. Getting a Therapeutic Use Exemptions (TUE), since breast cancer drugs are on the forbidden list in and out of competition.
4. Suffering through side effects of said breast cancer drugs that will lead to inferior performance in weightlifting.
5. Figuring out clothes: women's don't fit after a mastectomy,  and men's can be too wide in the shoulders while being too narrow in the waist.
6. Being grateful for any services that are offered at no cost. Out-of-pocket health care related costs amounted to close to $5000 this year.
7. Of the 221 women registered at the World Masters Weightlifting Championship, 27 (=1 in 8 is the rate reported for US women) are expected to get invasive breast cancer during their lifetime. Little do they know. Bad things happen even with positive thinking, healthy life styles, or low cancer risk.

World Masters Weightlifting Championships 2016

Achieved my hope and focus during the recovery: to compete in the World Masters Weightlifting Championship.
Result: 4th place, lifting a total of 100 kg. This is 10kg less than before the surgery, but it is awesome to be able to do this 5.5 months post mastectomy.
I am so very grateful to be able to be at this event and participate, and be a good example.

Adjustments to weightlifting training

Background
The pectoralis major ("pec") muscle is said to decrease in function and size after surgery. This may lead to reduced shoulder mobility. The fascia of this muscle is removed during a mastectomy. The reason for the removal is to reduce chest wall recurrence. To close the wound after breast tissue removal the skin is "quilted" to the muscle to reduce the risk of seroma formation.  Do these surgical procedures/techniques impact exercise?

Training observations
At 14 weeks post surgery I am attempting maximum lifts. I feel strong after having practiced more squats, more flexibility exercises, and more core exercises, since surgery. Volume training at reduced weights has been going well. Thus lifting the heavy barbell off the floor works, so do cleans. But the overhead portion of the movements do not "feel right," or do not feel the way it was before. And with heavier weights it becomes more noticeable. Here are a few observations:

1. The removal of the breast tissue creates a different balance, equivalent to 1-2kg weight. Thus muscles need to adjust, the brain needs to learn different signals. The proprioceptive sense can be off.
2. In overhead lifts such as jerk or snatch, the latissimus dorsi ("lats"), the muscle below the shoulder blade, spasms. It may be the case that I lean slightly back (observation 1).
3. In snatch or jerk  the elbow turnover is slower than before and elbows are often bent. Bent elbows instead of the "lockout" can be caused by not engaging the lats properly (observation 2).
4. During a split jerk at max weight, the right shoulder may collapse (possibly also of proprioceptive origin).

Lymph nodes were removed from the right side. There is still swelling under the right arm that can increase a day after exercises that are weight bearing on arms, such as push ups.

Plan

• built up deltoid and pec muscles hoping that this will improve the balance, e.g. with push-ups, planks on foam roller, behind the neck presses.
• strengthen back muscles and increase shoulder blade stability, e.g. GHD hip extensions with  or without weights, Sots presses, Good mornings.
• push presses and power snatches at a weight that challenges the feeling of it not being "right"

Ideas and thoughts from the experts (physical therapists, nurses, exercise science students, and others)

• Daily scar massage helps to keep the scar tissue supple and flexible. 
• Fascia is a protective layer around the muscle. Due to the removal the muscle can become more easily irritated. Nerves may have been damaged during the removal process, and thus the brain does not receive expected signals and needs to "retrain."
• Kineseo taping the pectoralis and serratus muscles can help reduce swelling as it gives a signal to the lymph flow.
• A well fitting compression shirt may support lymph flow and reduce swelling.
• A common problem after mastectomy is rotator cuff tendonitis due to overhead movements when the back is not straight. Namely, if tight pec muscles lead to internal shoulder rotation.

References
Most literature focuses on shoulder mobility after breast cancer surgery. The following two references do indicate the relationship of overhead stretch with back and chest muscles.

Stegink-Jansen et al.  Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery. Journal of Orthopaedic & Sports Physical Therapy 2011: 41(6); 417-426. Link to article

Findings: The overhead stretch produced one of the highest strain for clavicular, sternal, and abdominal portions of the muscle. (=meaning that this stretch uses the muscle more)

Muraki et al. Lengthening of the Pectoralis Minor Muscle During Passive Shoulder Motions and Stretching Techniques: A Cadaveric Biomechanical Study. Physical Therapy 2009: 89(4); 333-341. Link to article

Findings: The greatest length of the muscle is achieved with 30 degrees scapular retraction.

Changes

Some exercises feel different, such as lifting weight overhead and stabilizing. Perhaps this is due to a different weight distribution with the breast tissue removed. It may take some time for the muscles to relearn optimal movements. Very cool! Will this make the push-ups easier?

I like the breast-free feel. It is comfortable, especially in hot weather. People don't notice, unless they know about the mastectomy. Or they notice something, but don't know what, such as when I get a compliment how much weight I lost. Of course, I did! JJJ

However  I got a mastectomy bra and breast forms to use for special occasions or when I think I need props (e.g. some work events, but not all the time). I don't like bras unless they are super comfortable and I can breathe and expand my rib cage. I was thinking of going down one size, but smaller breast form sizes apparently do not go well with larger sized  bras (=the breathing requirement has priority). I tried it on at home. I had so gotten used to being breast-free in just 9 weeks post surgery that it feels like trying on high heels as a little kid. My loved ones don't care what I do as long as it works for me. They are keepers!

Weightlifting training 8 weeks postop

First time back with 2 hours weightlifting training 3 times per week. This is week 1 of a 7 week training plan to prepare for competitions.
I am very happy that it works, and much sooner than I had dared to hope.

According to plan this week is a high volume week with many repetitions and sets at a 60-80% level of the maximum weight lifted (prior to surgery).  While some of this is more than I had lifted post surgery so far, I was able to stay close to the prescribed percentages.
This includes snatches (up to 80% max), clean & jerk (up to 85% max).

WEEKLY SUMMARY
TOTAL Weightlifting training about 6 hours
TOTAL Cardio about 1 hour
TOTAL Core: (almost) daily Pilates with foam roller up to 2 hours, yoga class 2 hours
TOTAL Mindfulness practice:  Tai Chi 2 hours, Reiki meditation 6 hours

There is still fluid under the right arm, sometimes more, sometimes less. Less after weightlifting and stretching, more after push-up type exercises.

Workout log after the 6th week postop

TOTAL core about 1.5 hours
TOTAL cardio about 1 hour
TOTAL weightlifting training about 6 hours

This is week 6-7 post surgery.

Not included in the daily summary, usually in the evenings: restorative yoga (legs up the wall, supported backbend, supported child pose, stretches), PVC pipe work (Burgener warm-up, pull positions)

May 29 (Sunday):  about 1.5 hours
Cardio: 30 minutes cycling with speed intervals, 10 min rowing
Strength: 10 box jumps, 20 min isolated arm muscles

May 30 (Monday):  about 1 hour
Cardio: 20 minutes cycling with speed intervals
Strength: 20 min isolated arm muscles,  20kg bar good mornings, pulls
                isolated leg muscles

May 31 (Tuesday): 2 hours + 20 min
Core: 20 min Pilates
Strength: skill session on snatch including warm-up

June 1 (Wednesday): 30min
Core: Pilates
Strength: isolated arm muscles

June 2 (Thursday): 2 hours + 1 hour
Tai Chi (1 hour)
Strength: weightlifting training including snatches (total 41), front squats (total 15)

June 3 (Friday): 2 hours
Strength: weightlifting training including clean & jerk (total 34) and front squats (total 25)

June 4 (Saturday): 1 hour
Core: Pilates


Since it added up to a lot, my weightlifting coach suggested to return to the training plan and possibly reduce weight and/or reps. This should make for a more balanced weightlifting training. Starting next week. This is about 3 weeks sooner than I thought I could. I am delighted!

Training opportunities post surgery

A great opportunity presents itself after mastectomy: literally learning the lifts from the ground up.
First I can pay attention on improving the squatting positions and hip flexibility without distraction by more complex movements. Next the pulls (1st and 2nd) are added, and doing these movements incorrectly can immediately be felt in the upper body (stitches...). Lastly the overhead movements are added, and then everything can be put together.
Since the ego won't get in the way of adding weights to the bar too soon, perfection of technique is the primary focus at this time. It is a thrill to make the movements smooth and then fast and faster. Effortless effort.

It is a blessing to have experienced weightlifters cast a critical eye on the execution of the exercises and generously give feedback and tips for improvement.

with Fred Lowe

6th week exercise summary and looking beyond

It is not easy to figure out what is the right amount of exercise. Even when you know your body well, and you pay attention, what feels right may still be too much.

After some intensive exercises that included GHD sit-ups, I developed superficial thrombophlebitis across my abdomen. This is benign and will go away eventually (see post on cording). I also have swelling under my right arm, the location of sentinel lymph node biopsy, from chest to armpit to shoulder blade. This is bothersome. It helps to lift the right arm and sleep with the arm up, but fluid accumulates again when the arm is lowered. Due to this (and menstruating for the first time since surgery - unexpected!) this was a light week with a couple of days off or only some exercise. However the following are new accomplishments this week:

• Push-ups with exercise ball
• outdoor bicycling 
• a more "regular" weightlifting training session, including snatches with PVC pipe, strict press, overhead squats, drop snatches with 15kg bar. Then a clean & jerk series with 35 kg. Pulls (snatch grip) with 35 kg, and back squats at 60kg for a 90 minute workout   J   J   J  

I look forward to add more upper body strength next week.
Tip: As much as I was looking forward to NOT wearing a bra anymore, when the barbell touches the mastectomy scar, it is unpleasant! A yoga top with a built-in bra, provides a double layer that may help.

This completes the 3 to 6 week post surgery period. It was unclear from the official recommendations how much exercise one could possibly do during this time and my motivation for this blog. A summary is here: my exercises 3 to 6 weeks post surgery

Official recommendations:

• The American Cancer Society posts only stretches: week after surgery
• The Canadian Physiotherapy Associations says to start strengthening exercises at 4-6 weeks post surgery starting with 1-2 lbs: Exercises after breast surgery  

Unofficial  recommendations: There are blogs and forum posts by women sharing their own stories of recovery and exercise. These are usually slices in time. One blog and Facebook page with a more complete history is by Jen Hanks, who competes nationally in mountain bike races: http://athletefightscancer.blogspot.com

Weightlifting training session with clean & jerk at 35kg @ 6 weeks postop