To help cancer patients physically, we must also learn how to help them mentally, emotionally and spiritually, because cancer affects all levels of the human condition.

In one way or another, cancer has left its mark upon us all.

It has touched my own life many times. As I have watched friends, family members, and clients fight their own intimate battles with the disease, I realized that I was being given the opportunity to grow and learn from each experience.

My personal journey in exploring the relationship between body and mind started twenty years ago, while I was studying with an English healer named Matthew Manning. At the time, Mr. Manning worked with cancer patients in his clinic in England and performed seminars throughout Europe, sharing his techniques on healing through creative visualization.

I was deeply interested in his work because his teachings helped me understand the relationship between the left and right hemispheres of the brain, and how the restoration of balance and harmony within the physical and mental energies can effect the restoration of health. Creative visualization and energy work are the tools that I have integrated into my massage practice. By doing so, I have learned that there is more to cancer than just the physical disorder.

The Four Pillars

When I treat cancer patients, I ask them to imagine that there are four pillars supporting their existence and well-being: physical, mental, emotional, and spiritual.

Mental: This pillar supports the way we process information.

Emotional: The pillar of our perceptions, and the way we react to our environment, supports our relationships and responsibilities.

Spiritual: This pillar sustains the laws or principles of faith.

Physical: This pillar helps sustain the well-being of the body. A crack or weakness in this pillar is the manifestation of an illness.

The physical aspect of a disorder is its ultimate manifestation, but this manifestation may actually be a result of the lack of integration between the other parts. If one of the pillars is missing or neglected, we can still function, but eventually the lack of integration will erode the others, leading to the physical manifestation of the disease.

The first step in holistic treatment is to help patients visualize their own healing process. When patients are involved, we, as massage therapists, strengthen their trust and belief in that process. A person who gets any treatment without understanding how the physical, mental, emotional and spiritual elements interact may feel better temporarily, but the underlying problems will remain. Visualization is a technique that enables patients to be part of the experience. It gives them a tool that allows them to clear a path to their subconscious, which is where the healing takes place.

The Mental Pillar

Before I attempt to physically treat cancer patients, I make it a point to sit down with them and talk with them about their disease.

It is important to hear what patients think about their specific illnesses. I am often amazed by how little some patients know about their conditions – indeed, about their own bodies. Reference materials, such as gross anatomy videos and medical illustrations, can help a client mentally focus on the area of the body that is affected.

Understanding a client's state of mind will help them visualize how to overcome their illness. Different methods can be used to reveal how they process information. Free association techniques often help people disclose their subconscious perceptions. I have found these tools helpful in opening up a dialog that enables us to clear a path to the subconscious. This is where the healing takes place.

The Emotional Pillar

Though it does not always happen in the initial visit, I find that patients usually reveal their emotional concerns about having cancer in subsequent conversations. Fear, anger, sadness and frustration are just some of the emotions they acknowledge during our sessions.

The relationships and responsibilities in a person's life can have profound influence over their emotional state of mind. If a man, recently diagnosed with lung cancer, loses his job and his girlfriend in the same week, he will need to manage multiple emotional crises, in addition to the cancer he must learn to accept in his life.

As massage therapists, we must try to obtain an emotional blueprint of each patient so that we may treat him or her uniquely and appropriately. Whether a follow-up phone call, a supportive note in the mail, or a ride to the hospital for chemotherapy, every personal touch is appreciated and, too often, desperately needed.

Sadly, people often react with subconscious repugnance toward cancer patients, almost as if it were a communicable disease. Others simply don't know what to say. In times of need, all but the most loyal friends disappear from one's life, often as soon as things get rough.

If you are willing to go that little extra distance for your clients, you will probably find, as I did, that it will enable you to earn their trust. This can increase the effectiveness and success of their energy and visualization therapy.

The Spiritual Pillar

With all cancer patients, and particularly those who are terminally ill, death becomes a significant topic after trust is established between a cancer patient and a practitioner. Most humans, even those with strong religious backgrounds and beliefs, fear the unknown. I try to help my clients with cancer explore their faith, as they define it, and encourage them to search for peace as they define it, through meditation and prayer.

The Physical Pillar

Corporeal illness can be the ultimate expression of imbalance and weakness in the other pillars. In many cases, patients go through radical surgery to remove their cancer. Conventional treatments like radiation and chemotherapy are utilized. Alternative treatments are still rare. Though massage has historically been considered contraindicated in the early stages of the disease, treatments that integrate light massage or energy work can be very effective as a part of an assertive treatment program for cancer patients. A combination of massage and physical therapy can help reestablish circulation and range of motion after surgery.

Paula's Story

For the past forty years, the most common treatment of breast cancer has been the radical mastectomy. This surgical procedure involves the removal of the breast (lobes and ducts), the underlying pectoral fascia (thin covering of the pectoralis muscles), and most of the lymph nodes under the arm.

Today, many surgeons perform radical mastectomies when the spread of cancer cells is rapid and invasive. But many surgeons are now performing conservative procedures like the modified or simple mastectomy (in which the breast is removed, but underlying muscles are left intact) and the lumpectomy (in which the cancerous tumor and a rim of normal breast tissue surrounding the cancer are removed).

The following case is one of a 49-year-old woman diagnosed with ductal carcinoma in 1998. Shortly after her diagnosis, doctors performed a simple mastectomy of her left breast. With her permission, I'll share her story with you.

In September 1998, five months after her mastectomy, Paula came to see me complaining of shoulder, chest and lower back pain. She was still very shaken by her surgical experience, and sensitive about her changed physical appearance. Our initial consultation gave me insight into her emotional, mental and spiritual disposition, and helped me to develop an individualized treatment plan for her.

Paula wasn't sent for physical therapy after surgery. Instead, she chose to see an osteopath once every two weeks, which she felt provided her with some relief. However, she believed that the physical therapy would have been more painful than helpful at that time. With her doctor's approval, she decided to postpone physical therapy until she could move her arm without pain.

After evaluating her posture and range of motion, it was obvious that she could barely elevate her left arm without experiencing additional pain. She protected and favored the arm, and in doing so, had adopted an unnatural posture that drastically limited her range of motion. After our first session, I began to think that the problems in Paula's left arm and shoulder might need more than simple therapy. All of the symptoms she displayed led me to believe that she might have a case of adhesive capsulitis, or "frozen shoulder". I advised her to see an orthopedic specialist.

After meeting with Paula and running some tests, the specialist confirmed my suspicions. He decided to perform a close manipulation, under local anesthetic, that would help restore movement in her shoulder joint.

A few days later, Paula called me to tell me that she had set a date for the procedure. Of course, she was a bit nervous about it, but I tried to reassure her that this was the best for her. The surgery was scheduled for a Sunday, and I offered to pick her up after the procedure and drive her home.

Five days later, we met again. Paula's shoulder was still sore, but clearly showed improvements. Now the challenge was to guide her to believe, mentally and emotionally, that she could regain strength in her arm. I had learned in a previous session that tennis was one of Paula's favorite sports when she was growing up, and now we developed and incorporated a creative visualization exercise that would be easy for her.

I asked Paula to visualize herself playing the final match of a major tournament. This was fun for her, and she really liked it. I asked her to immerse herself in the visualization, and we discussed the things she might experience: the little droplets of sweat running down her face, the crushing power of her backhand, the agility with which she could move around the court, cheers from an enthusiastic crowd, and the sweet taste of victory.

In the beginning she had a bit of difficulty remaining focused on the visualization. But after a little practice, Paula was able to view herself as the main character in the scene.

During each session, I would talk to Paula about her perceptions of her physical sensations during the visualization. "How's your shoulder holding up to those backhands?" I'd ask. When we first started our course of treatments, Paula tended to include pain and discomfort in her descriptions of her visualizations. At the midpoint of her treatments, she would respond neutrally that her shoulder "felt okay." Finally, during the last three sessions, I asked her how she was feeling and she replied, "My arm feels so strong that I'm gonna win this game in no time!"

At each session, I asked Paula the same questions about her imagined physical sensations during her visualization. I did this for several reasons: I wanted her to become aware of the changes in her body, conscious of her increasing strength, and self-empowered by her own affirmations.

After three sessions, I asked her if she thought she was ready to start physical therapy and build up some muscle strength. She agreed, and found that the therapy truly helped her build both muscle tone and self-confidence. Furthermore, I suggested to Paula that she find a nutritionist who could help her rebuild her immune system with a customized diet plan, which would also help her lose those extra pounds taken on during recovery.

During the course of our program, this lovely woman came alive again. When we finished, she looked, felt, and sounded like a new person. Life had given her another chance. She found a wonderful new home, an old flame reappeared in her life, her career thrived, and she initiated many other changes that might never have occurred if she hadn't had breast cancer. As odd as it sounds, Paula's terrifying experience with breast cancer was the catalyst she needed to make positive changes in her life.

We never know why things happen to us, or the mystery behind the karmic lessons we learn in our lives. The only spiritual conclusion I was able to share with Paula was that a miracle is the ability to see and accept uncommon things in a common way.

The Physical Treatment Program

The sequence of movements presented in the photographs accompanying this article can be used by all women recovering from breast surgery or mastectomy.

These photos document the final results of ten sessions of treatment for Paula. Many of these movements were not possible for her when she began treatment. When I started working with Paula, she was unable to lift her arm above her waist. We achieved results gradually, session after session.

The technique will help restore circulation and range of motion throughout the following regions:

Neck: Cervical and Supraclavicular

Upper Limb: Deltoids, Axillary, Brachial and Cubital

Thorax: Pectoral and Scapular

Back: Thoracic, Lumbar and Sacroiliac

Begin each session with movement that is comfortable for the patient. You may want to modify some of these movements to fit your patient's needs, and you can expand on them gradually as the range of motion is broadened.

Remember, however, that each patient is different. Some may require additional (or fewer) treatments before changes are observed. In all cases, work should be executed with caution, particularly with any patient recovering from surgery.

PROCEDURE

Length of session: One hour and fifteen minute consultation; one hour treatment; fifteen minutes rest after treatment; two hours and thirty minutes (2:30) total

Equipment: Two large sheets, one medium size towel (soft if possible), one head pillow, and one large pillow

Positioning: Position patient as you would do when working with a pregnant woman (on his or her side). The affected shoulder should be facing up, and the large pillow should be thick enough to keep the hip leveled with the shoulder. Ask your patient to come as close as possible to the edge of the table (about 6"). This will provide you with greater leverage and put less strain on you while you are working.

Beginning: I like to begin by placing one hand on the patient's forehead and the other on the shoulder. He or she can now begin the visualization process, according to the scenario you have discussed and developed together. You can assist by suggesting images relevant to the visualization.

Touch & Technique: The objective at this stage is deep muscle relaxation, so you'll be working mostly on relaxing the fascia of the muscles. Your touch should be light and your pressure, gentle. When you think that you have reached the comfortable limit of a stretch, decrease it to half its pull. Hold the positions for at least two minutes, and slowly increase and decreasing each stretch.

Ending: Allow the patient to rest for at least fifteen minutes after each session. This is very important!

The author would like to thank Jim McKnight for his assistance with the technical aspects of this article.

Sabino L. Manzulli, LMT lives and works in Kailua, an idyllic little town on the windward shores of Oahu, Hawaii. For the past twenty years, Manzulli has been involved with the studies and practice of alternative healing through creative and suggestive visualization. He is presently establishing the One Healing Foundation, which will study and offer free alternative methods for the cure of cancer, and developing a series of workshops to help massage therapists in the local community familiarize themselves with the "Four Pillars" theory.

Caroline Wright is a freelance writer based in South Carolina.