Symmetry

Athletes need symmetry to perform their best. Breast cancer treatment forces symmetry decision-making that may not be conveniently timed, but is needed to avoid future rehab.

The first time the notion of body symmetry penetrated my consciousness was when I was getting fit for my first pair of reading glasses, in my 40s. The tech said, “Wow, your eyes are exactly equidistant both vertically and horizontally. That’s not common”. What ensued was a lively discussion about the human body, but what stayed with me was the idea that, in an ideal state, the human body performs equally on the left as it does on the right.

This concept, of symmetry and the corollary of symmetry in motion, became a part of my swim coaching practice. My alert is tuned to “lazy” left (or right) arms that have a shorter stroke, earlier entry, and less follow through to the natural end point of the stroke. I look for cross-over (where one arm crosses the body’s mid-line on entry), and a wide-legged kick on the breathing side, which is compensating for late and long breathing, and can also lead to arm cross-over. There is also a classic outward curving of one wrist just before and on entry that shortens the power of the catch on that side of the body.

Stroke corrections associated with these non-symmetrical motions are often important because most swimmers I have encountered with these issues also have shoulder problems. A telltale sign is the swimmer rubbing the non-symmetrically performing shoulder between sets. And then, when you ask about injury history, somewhere in the past there was an injury that affected the shoulder that is getting the mid-workout massage from the opposite hand.

Swimmers are often unaware of the imbalance. Thanks to modern phone technology, a quick video of the stroke issue makes the issue readily “seeable” and then we work together to get the stroke back into balance. Below are two videos illustrating the concept. Drew is a highly competitive IronMan triathlete. He came back to workout this season with a wide right arm that had a shortened entry due to a bent elbow, and therefore, a shortened stroke.

Drew Jordan, 2nd swimmer with a white cap, swimming free before the right arm correction. (Lessly Field)

Drew, after correcting the wide and short entry right arm. (Lessly Field)

I’ve been dealing with my own cancer treatment-related symmetry issues. Three years after my left-side mastectomy with a breast reduction on the right, I was at physical therapy, trying to regain left shoulder mobility so that I could swim butterfly again. My physical therapist had me face down on an exercise ball with my spine in a horizontal position. She commented that my right hip was higher than my left hip. That same week, my massage therapist said the same thing. I asked my acupuncturist if she could see an imbalance and she said, “yep”. This was a new development and one I hadn’t anticipated. So, it was off to the internet for answers.

Holy cow! Imbalance after a mastectomy is a real thing. Even the NIH has studied it: Changes in Spine Alignment and Postural Balance After Breast Cancer Surgery: A Rehabilitative Point of View. This is one of those things that I wish I had known and understood as I began my cancer journey. My decision to delay any sort of reconstruction on the left was driven by the intensity of the surgical and recovery process. My situation was such that I would be only able to have a belly-fat reconstruction, which is a two year process that leaves a scar from hip-to-hip in your abdomen and can be painful. It certainly involves months of not being able to swim. There can be later in life complications from scar tissue and vein relocation if you need gall bladder, appendix or other abdominal surgeries.

Photo of left side mastectomy with right side reduction. Even a little imbalance leads to spine alignment and postural balance issues. (LField)

My non-decision in 2020, at the time of my mastectomy was to put off any major surgical decisions. I was wiped out - we started treatment with chemo “max” that also came with sepsis and all kinds of other infections, my mom was dying, my 14 year-old needed TLC, and the whole “you might die” thing was overwhelming. My surgeon agreed with my instinct to delay making such a big decision and said that I had plenty of time to make my next decision about breast symmetry. So we did a significant reduction on the right at the same time as the mastectomy.

In retrospect, I’m not sure that I had plenty of time. If I had made the decision - do the belly fat surgery or get a right side mastectomy, I wouldn’t be facing more rehab, now for spine imbalance. Complicating the spinal imbalance, in my situation, is that my T-9 had the shit radiated out of it and is very likely to break. T-9 is the last vertebrae before you begin the lumbar vertebrae. Exacerbating the situation, as the NIH discusses in their article, may be my left-side lymphedema.

In the next couple of weeks I am meeting with the surgeon to schedule a right side mastectomy. So, here’s my message to you if you are facing a single-side mastectomy: If you are an athlete, you need the symmetry. Even if you are tired, make the decision - schedule the rebuild right away or go for it and get that second side mastectomy. My wish is that fixing post-mastectomy imbalance was as simple as a video analysis, some competent coaching and hours swimming over a black line. Alas, it’s more complicated than that. The good news is that you may be able to avoid the imbalance by making definitive symmetry decisions early in the treatment process.