About ACOLS The Academy of Lymphatic Studies is the leading school in the United States to provide comprehensive lymphedema certification training for health care professionals in this specialized treatment technique. |
March 29th, 2012
A new study conducted by the American College of Surgeons Oncology Group, which was published in the Journal of the American Medical Association, may significantly change current procedures on removal of axillary lymph nodes. The study suggests that for about 20 percent of women affected by breast cancer, who meet certain criteria, complete axillary lymph node dissection (ALND) may be unnecessary, and that the surgery shows no clear benefit regarding the course of treatment, the risk of the tumors returning or spreading, or the chance of survival.
That is great news, especially in light of the post-surgical complications associated with ALND, to include wound infections, weakness in the arm, paresthesia, shoulder pain, axillary web syndrome (AWS) and lymphedema.
The objective of the trial, which included a total of 891 patients in 155 medical centers, was to determine the effects of ALND on survival (overall survival and disease-free survival) of patients with sentinel lymph node (SLN) metastasis of breast cancer.
The trial was conducted between May 1999 and December 2004.
 Sentinel Lymph Node Women eligible to participate in this study had histologically confirmed invasive breast cancer in clinical stage T1-T2 (tumor size 5cm or less) with no enlarged axillary lymph nodes, and up to two sentinel lymph nodes (first lymph node or group of nodes reached by metastasizing cancer cells from the primary breast tumor) containing metastatic breast cancer.
 Tangential Whole-Breast Radiation All patients underwent lumpectomy and tangential whole-breast radiation(radiation technique designed to include the entire breast, but the smallest possible volume of lung and heart). Those women who had metastases in the sentinel lymph nodes, which was determined by sentinel lymph node dissection (SNLD) were randomly selected to either undergo complete axillary lymph node dissection, or to undergo no further axillary specific intervention. A total of 446 women were randomized to SNLD alone, and 445 women were randomly selected to undergo complete ALND, which was defined as an anatomical level I and II dissection, including at least 10 lymph nodes. Additional systemic therapy (chemotherapy and endocrine therapy) was delivered to 403 patients in the ALND group, and 423 women in the SLND-alone group.
At a median follow-up of 6.3 years, the use of SNLD alone compared with ALND did not appear to result in statistically inferior survival. This includes overall survival, defined as the time from randomization until death from any cause, and disease-free survival, defined as the time between randomization and first documented recurrence of breast cancer. These results are in accordance with other randomized comparisons of SLND and or without ALND.
The findings are part of a trend to move away from radical surgery for breast cancer, and despite limitations of this study (no complete follow-up information on 166 women, possible randomization imbalance favoring the SLND-alone group) the results could have significant effects on clinical practice. The main indication is that women with a positive SNL and clinical tumors of less than five centimeters across, undergoing lumpectomy combined with radiation and followed by systemic therapy, do not benefit from additional complete ANLD in terms of local disease control and survival.
Implementation of this practice change could significantly improve clinical outcomes in thousands of breast cancer survivors each year by reducing possible complications, such as lymphedema, and improving quality of life with no diminution in survival.
Additional Resources:
Journal of the American Medical Association
NPR Article
New York Times Article
February 23rd, 2012
Sheila H. Ridner, PhD, RN, FAAN, Associate Professor at the Vanderbilt University School of Nursing asked me to share with you a call to individuals affected by lower extremity lymphedema to participate in a fully on-line study regarding symptoms experienced by these patients. Anyone with lower limb swelling can participate; names are not being collected with the data.
Lower Limb Lymphedema Symptom Survey
Vanderbilt University School of Nursing inNashville,Tennesseeis conducting a study to learn about symptoms related to lower limb lymphedema.
If you suffer from lymphedema or swelling in your legs and are over 18 years of age, you may be eligible to take part in this study. You will be completing a one-time survey for development of an assessment tool for lower limb lymphedema symptoms. This survey will take about 25 minutes to complete.
If you are interested, please contact Nancy Kidd at Nancy.Kidd@vanderbilt.edu or the Principal Investigator, Dr. Sheila H. Ridner, PhD, RN, FAAN, Associate Professor at Vanderbilt University School of Nursing, 525 Godchaux Hall, Nashville, TN 37240, 615-322-0831 at Sheila.Ridner@vanderbilt.edu
Anyone, anywhere who has access to the internet and is eligible can be in this study.
January 31st, 2012
 One of the most important aspects in the management of lymphedema is to ensure the preservation and improvement of the decongestive effect achieved during the intensive phase of Complete Decongestive Therapy (CDT).
Compression garments perform this role, and in order to select the correct garment (ready-made or custom made), compression level, and if necessary fastening systems, the patients age, physical abilities, lifestyle, type of lymphedema and any other conditions must be taken into consideration.
It is important that a compression garment is chosen that meets the patient’s individual needs.
Most manufacturers provide various styles of compression garments in a variety of sizes. Custom garments should be ordered if the extremity is either too large or too small for standard size garments, or if a single compression garment with a compression level of more than 50 mm/Hg is necessary. It is advisable to order the stockings with a silicone border, which helps to prevent sliding of the garment.
While it would be best that a trained individual with a thorough understanding of lymphedema and its implications takes the measurements and teach patients how to wear them properly, it is sometimes necessary that patients measure on their own if they buy ready-made stockings from on online retailer for example.
- At what point should the measurements be taken?
At the end of the intensive phase of CDT (phase I), when the extremity is at its most reduced state. Ideally, the measurements should be taken early in the morning when the leg is smallest, at the end of a treatment or after the compression bandages have been removed.
While the sizes on some light support stockings are determined by shoe size or height and weight, the sizes on most compression stockings are determined using a few simple measurements.
Sizing for medical compression stockings is based on the circumferences at specific points and length of the leg.
Measurements are taken with a tape measure, which should be applied straight; a twisted or crooked tape measure will result in inaccurate measurements. If a tape measure is unavailable, a string and a ruler may be used; the circumferential and length measurements can be taken with the string and the individual lengths then measured with the ruler.
It is recommended to mark the leg with a non-permanent, non-toxic marker at each circumference measurement made. The length measurement is then taken even with the floor, along the inside of the leg, up to the respective circumference point.
The individual measurements should be written down on a notepad and compared with the sizing chart of the manufacturer to determine garment size and length. If the affected leg is unusually shaped, the positions of the circumferential and length measuring points should be taken on the unaffected leg first. This technique helps to identify the position of these points on the affected leg.
Measuring for a Ready-Made Knee-High Compression Stocking
Ankle Circumference
Place the measuring tape at the narrowest part of the ankle, just above the ankle bone and measure the circumference. Write this measurement down and label it as ankle measurement.
Calf Circumference
Measure the largest part of the calf. You may need to search for the largest part of the calf by measuring above and below the middle of the calf; the objective here is to get the largest measurement.
Write this measurement down and label it as calf measurement.
Length Measurement
Measure from the floor to the bend just behind the knee; do not wear shoes as you will get an inaccurate measurement. Make sure that you are measuring just below the bend of the knee. Measuring too high or too close to the bend of the knee may result in a stocking too long for your lower leg, especially if your length measurement is right on the edge of the short and long lengths.
This measurement determines the length of your leg – write it down.
You can now compare your measurements with the sizing chart of the manufacturer of your choice to determine the size and length of your stocking.
Measuring for a Ready-Made Thigh-High Compression Stocking
Ankle Circumference
Place the measuring tape at the narrowest part of the ankle, just above the ankle bone and measure the circumference.
Write this measurement down and label it as ankle measurement.
Calf Circumference
Measure the largest part of the calf. You may need to search for the largest part of the calf by measuring above and below the middle of the calf; the objective here is to get the largest measurement.
Write this measurement down and label it as calf measurement.
Thigh Circumference
Find the widest part of your thigh – right under your buttocks. Measure the circumference of this part of your thigh.
Write this measurement down and label it as thigh measurement.
Measure the length of the leg
For thigh high or pantyhose garments measure the length of leg from the top of the thigh to floor behind the heel. This is the length of your leg – write it down.
You can now compare your measurements with the sizing chart for the brand of stockings you’ve chosen to determine the size and length of your stocking.
When you receive your garments, it is important to put your stockings on first thing in the morning, right after the shower. By putting on your stockings before you swell, you can control your swelling easier.
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December 29th, 2011
Preservation and improvement of the therapeutic success achieved during treatment of upper extremity lymphedema with Complete Decongestive Therapy (CDT) is acieved with properly fitted sleeves ang gauntlets. To select the correct garment (ready-made or custom made), compression level, and, if necessary, fastening systems, the patients age, physical abilities (and limitations), lifestyle, type of lymphedema and any other conditions must be taken into consideration. It is necessary that a compression garment is chosen that meets the patient’s individual needs.
Compression sleeves are manufactured in a variety of styles and sizes. Custom sleeves should be ordered if the extremity is either too large or too small for standard size garments.
While it would be best that a trained individual with a thorough understanding of lymphedema and its implications takes the measurements (lymphedema therapist or certified fitter) and teach patients how to wear them properly, it is sometimes necessary that patients measure on their own if ready-made sleeves are acquired from an online retailer for example. If this is the case, the measurements should be taken by a friend, or spouse and the measurements should be written down on a notepad.
- At what point should the measurements be taken?
At the end of the intensive phase of CDT (phase I), when the extremity is at its most reduced state. Ideally, the measurements should be taken early in the morning when the arm is smallest, at the end of a treatment or after the compression bandages have been removed.
 Sizing for medical compression sleeves is based on the circumferences at specific points and the length of the arm. Measurements are taken with a tape measure, which should be applied in a straight fashion; a twisted or crooked tape measure will result in inaccurate measurements. If a tape measure is unavailable, a string and a ruler may be used. The circumferential and length measurements can be taken with the string and the individual lengths of the string then measured with the ruler. It is recommended to mark the arm with a non-permanent, non-toxic marker at each circumference measurement made. The length measurement is taken along the front the arm between the respective circumference points. The individual measurements are then compared with the sizing chart of the manufacturer of choice to determine size and length of the compression sleeve.
Measuring for a ready-made arm sleeve
Wrist Circumference
This is the point of greatest compression and therefore a very important point. Place the measuring tape at the narrowest part of the wrist, at the transition from the hand to the forearm and measure the circumference. Write this measurement down and label it as wrist measurement.
Elbow Circumference
Measure the largest part around the elbow with the arm slightly bent; the objective here is to get the largest measurement. Write this measurement down and label it as elbow measurement.
Upper Arm CircumferenceThis measurement is taken around the upper arm in the axillary fold. To determine the correct location of this point, it is often helpful to place a book into the arm pit area. The measuring point will be even with the top end of the book. Write this measurement down and label it as upper arm measurement.
Length MeasurementMeasure the distance between the wrist circumference measuring point to the upper arm circumference point along the front of the arm. This measurement determines the length of your arm – write it down. You can now compare your measurements with the sizing chart of the manufacturer of your choice to determine the size and length of your sleeve.
If an additional compression gauntlet is required, here is how to measure:
Measuring for a ready-made compression gauntlet with thumb stub (no finger swelling)
Wrist Circumference (same point already measured for sleeve)
This is the point of greatest compression and therefore a very important point. Place the measuring tape at the narrowest part of the wrist, at the transition from the hand to the forearm and measure the circumference. Write this measurement down and label it as wrist measurement.
Palm Circumference
Measure the width of the palm along the finger joints. Place the measuring tape around the palm with the palm up and the fingers slightly spread and measure the circumference. Write this measurement down and label it as palm measurement. Length measurements are not required for standard sized compression gauntlets. You can now compare your measurements with the sizing chart of the manufacturer of your choice to determine the size of your gauntlet.
Picture credit in this post: Absolute Medical, Inc. www.absolutemedical.net
Additional Resources: http://www.lymphedemablog.com/2011/05/12/compression-garments-for-lymphedema-custom-or-ready-made/
http://www.lymphedemablog.com/2010/09/19/the-role-of-compression-garments-in-the-treatment-of-lymphedema/
November 30th, 2011
LRF-LYMPHATIC RESEARCH LEADERSHIP AWARD
 The LRF-Lymphatic Research Leadership Award is intended to recognize individuals, including elected and appointed officials; organizations, including non-profit and for profit corporations; foundations; and institutions, who have made a significant contribution toward promoting and supporting lymphatic research at the international, national, state or local level, to advance the field of lymphatic research and/or to find improved treatments and cures for lymphatic diseases, lymphedema, and related disorders.
Nominations should be in the form of a letter, accompanied by the following information, along with any supporting materials that the nominator might deem useful to the Selection Committee. (The Selection Committee shall consist of the Lymphatic Research Foundation Board of Directors (BOD) and select individuals as determined by the BOD.) Self nominations welcomed.
- Candidate’s name, address and phone, and organizational affiliation (if any)
- What has been the candidate’s primary contribution toward promoting and supporting lymphatic research, at the national, state or local level, to advance the field of lymphatic research and/or to find improved treatments and cures for lymphatic disease, lymphedema, and related disorders?
- Nominator’s name, address and phone, and organizational affiliation (if any)
Deadline for nominations: January 31, 2012
Letters of nomination should be sent to:
Lymphatic Research Foundation
Attention: LRF Lymphatic Research Leadership Award Committee
40 Garvies Point Road, Suite D
Glen Cove, NY 11542
or Fax: (516) 625-9410
November 18th, 2011
Dear Practicing Lymphedema Therapist,
 The American Lymphedema Framework Project (ALFP) invites you to participate in their second biennial online survey. The ALFP is a national initiative developed under the leadership of recognized clinical experts and investigators in the field of lymphedema. As a collaboration of health care providers, researchers, educators, patients, and industry representatives, the ALFP will develop and evaluate appropriate health care services for patients with all forms of lymphedema and advance the quality of lymphedema care both in the United States and worldwide.
This survey was developed under the leadership of the ALFP research committee chaired by Dr. Electra Paskett and co-chaired by Dr. Mei Fu with input by expert clinicians on the ALFP steering committee. The answers you provide on the survey will be used for research purposes only and are strictly anonymous. Your answers will be evaluated for statistical purposes only. Your input will assist the ALFP in understanding current practices of lymphedema care in the United States today, and will move forward the ALFP goals of evaluating appropriate health care services and improving quality of care for patients with lymphedema. As a practicing lymphedema therapist, your participation is valuable in this worthwhile endeavor. Please participate in 2011 whether you participated in 2009 or not. The survey will remain open until November 30, 2011.
To access the survey, please go to http://www.alfp.org and click on the “LE Therapist Survey” tab on the left. This website will provide directions for completing the survey online, via email, or by mail. The survey will take approximately 20 minutes to complete. The ALFP sincerely thanks you for your participation!
November 7th, 2011
Today’s article is a follow up to the last blog entry on the pathology of radiation-induced brachial plexopathy (RIBP), and covers treatment options if RIBP is accompanied by lymphedema.
Surgical procedures to decompress the brachial plexus and re-vascularize the nerves and surrounding tissues have been described in the literature; however, the results are often unsatisfactory. Unfortunately, RIBP is essentially an incurable condition and with the absence of satisfactory treatment, emphasis is placed on symptom control and therapeutic exercises, specifically addressing the maintenance of movement in the paralyzed extremity for as long as possible.
Physical and Occupational therapists work as part of a multi-professional team to address loss of function and flexibility, weakness, pain and lymphedema. Special adaptive equipment and techniques address basic functions of daily living and suggest ways to modify the home and workplace.
Special considerations to address RIBP in the presence of lymphedema:
Lymphedema management in individuals affected by RIBP is more challenging, but necessary to help control pain and to decrease the volume of the extremity. Volume reduction lessens the impact of excess weight on the shoulder joint, prevents the build-up of additional fibrotic (scar) tissue and significantly lowers the risk of infections commonly associated with lymphedema. It is often necessary to adapt compression and exercise protocols to accommodate the special circumstances associated with RIBP.
Compression Bandaging:
 Many individuals affected by RIBP experience impaired sensation on the skin and are often unable to provide accurate feedback related to their individual tolerance to pressure. Therapists applying compression bandages to the affected extremity during the initial sessions of complete decongestive therapy should be very conservative with application pressure, and use generous padding to avoid pressure sores; application pressure may be gradually increased in the absence of side effects.
 Effective compression therapy for lymphedema partially depends on the extent of the interaction between the bandage layers and the musculature working against the resistance of the bandages; this is also known as the working pressure. With partial or complete loss of muscle activity, the working pressure of the bandage is reduced, making the bandage less effective. However, even if compression bandages are applied with less pressure and the day-to-day results of these bandages are not as noticeable, they are still effective in promoting lymphatic return by increasing the pressure in the tissues.
It is also important to consider that some individuals affected by RIBP wear arm slings to reduce the degree of subluxation and discomfort of the shoulder joint. In these cases, the elbow should be kept in 90 degrees of flexion during the application of compression bandages.
The possible presence of joint contractures caused by muscular atrophy and immobilization should be addressed with special bandage application techniques.
Compression Garments:
Wearing of compression garments is essential to prevent lymphatic fluid from accumulating in the tissues and conserves the results achieved with manual lymphatic drainage.
Compression sleeves and gauntlets are available in a number of compression classes. The level of compression within the different classes is determined by the value of pressure the garments produce on the skin; these pressure values are measured in units of millimeters of mercury (mmHg). For a compression garment to work effectively, the pressure needs to gradually decrease from the wrist to the shoulder. This gradient is necessary to avoid tourniquet effects and subsequent obstruction of lymph flow.
 Donning Device In general, compression levels provided by class 2 garments (30-40 mm/Hg) are sufficient to prevent swelling in most individuals affected by lymphedema of the upper extremity. However, if lymphedema is combined with RIBP and partial or complete immobility with subsequent loss of normal muscle tone, a lower compression may be required in order to avoid tourniquet effects. Patients need to be thoroughly educated in the use of donning devices for compression sleeves and alternatives for night bandaging.
Exercises:
 Immobility is detrimental to the lymphatic return. In addition to support the return of lymph fluid, the main goal of the exercise protocol is to focus on mobility. Modifications to the usual decongestive exercise program may be necessary to address impaired motor function. Exercise protocols for RIBP with partial or complete loss of mobility are geared towards the development of strategies that compensate for lost muscle function by using those muscles that still have function. Specific exercises also help to maintain and develop any strength and control that remain in the affected musculature. This also helps to prevent further shortening of muscle fibers (contracture) and to maintain and regain range of motion in the arm. Elevating the arm as often as possible to promote lymphatic return is even more important in patients affected by RIBP.
Therapists and doctors may also suggest adaptive equipment that helps the patient to maintain a normal life. For a very comprehensive list if adaptive devices and coping tips, I would like to refer you to the RIBP page of the “Step Up – Speak Out” website.
Additional Resources:
BreastCancer.org Discussion Forum
Step Up – Speak Out
Lymphedema People
October 24th, 2011
Dear Readers:
 I received a message from Heather Ferguson, the young mother from North Carolina who was instrumental in securing the coverage for treatment of lymphedema in North Carolina. Heather was also instrumental in convincing Congressman Larry Kissell of North Carolina to sponsor the Lymphedema Diagnosis and Treatment Cost Savings Act, HR 2499 (formerly HR 4662). This bill, if passed, would improve coverage for the diagnosis and treatment of lymphedema.
Here is Heather’s message – please support this important cause:
On November 2-4, 2011 lymphedema advocates from around the country will be traveling to Washington DC to raise support for HR 2499, the Lymphedema Diagnosis and Treatment Cost Saving Act of 2011! As part of this trip, organized by the Lymphedema Advocacy Group, participants will conduct a Staff Briefing to educate Congress about lymphedema and the importance of this bill.
To ensure good turnout at the Staff Briefing we need your help with a very quick and easy but important task. Please go to www.LymphedemaTreatmentAct.org and visit the “Contact your Representative in the House” and “Contact each of your Senators” pages.
The template letter has been temporarily changed to an invitation for Congressional staff to attend the HR 2499 Staff Briefing taking place on Thursday, Nov 3rd.
Please complete your name and address to send this invitation to your Representative and Senators’ offices.
This will only take a couple moments of your time so please do your part to support passage of this bill! For questions or additional information please contact Heather Ferguson at info@LymphedemaTreatmentAct.org.
October 1st, 2011
The beneficial effects of radiation therapy in breast cancer and other malignant diseases are well known and documented. However, this life-saving treatment has potential adverse effects on a number of body systems, which are exposed to the rays during treatment – such as skin, nervous tissues and inner organs.
 Brachial Plexus Radiation-Induced Brachial Plexopathy (RIBP) is caused by radiation damage to the brachial plexus, a network bundle of nerves located near the neck and shoulder. The nerves forming the brachial plexus originate at the spinal cord in the neck and are responsible for the sensory and muscular innervation of the entire upper extremity.
In breast cancer, radiation treatment is administered to the axillary area, chest, or neck. Radiation damage to this network of nerves can result in sensory and/or motor damage, with or without accompanying pain in the brachial plexus distribution in the arm. Symptoms may include tingling, pricking, numbness (paresthesia), dysesthesia (abnormal sense of touch, such as burning, itching, feeling of an electric current, “pins and needles”, pain), decreased sensitivity, partial loss of movement (muscle weakness and difficulty performing simple tasks such as opening jars, or containers, holding objects), complete paralysis of the arm, muscular atrophy, impaired mobility and partial dislocation of the shoulder joint.
 The exact mechanism of RIBP is not yet completely understood; research indicates that damage to the brachial plexus results from a combination of direct nerve cell damage from ionizing radiation and more progressive damage by the development of scar tissue (radiation fibrosis) in and around the nerves, combined with damage to adjacent vessels that supply these nerves with oxygen and nutrients. Radiation of nerve tissue also causes the nerve cells to shrink, resulting in a decrease in elasticity of nerve fibers, which further aggravates the situation. The extent of damage is associated with the radiation dose and technique, and the concurrent use of chemotherapy.
The progressive damage to vessels and the development of scar tissue continues to evolve significantly in some, and gradually in other patients after the initial radiation therapy, which explains why some patients develop RIBP symptoms many years after radiation treatment. Most patients develop symptoms within the first three years; however, the average interval between the last dose of radiation and the onset of RIBP symptoms reported in the literature varies widely (range between six months and 20 years). The prevalence of RIBP is reported to be between 1.8% and 4.9%; RIBP is more common after radiation in combination with chemotherapy, and nerve tissue of younger patients seems to be more vulnerable.
The Relationship between RIBP and Lymphedema
Individuals who had surgery and radiation for breast cancer and do not present with post-mastectomy or lumpectomy lymphedema are considered to be in a latency stage, and are always at risk to develop lymphedema. Any additional stress to the lymphatic system, such as trauma, loss of mobility or pain may cause the onset of lymphedema in the upper extremity.
The presence of RIBP, especially in cases with partial or complete loss of mobility is one of these triggering factors. The return of lymphatic fluid from the upper extremity partially depends on the pumping action the muscles exert to the outside of the lymph vessels. Immobility of these muscles due to pain, partial or complete paralysis has a detrimental effect to the return of lymphatic fluid and causes lymph to stagnate in the extremity. Combined with the adverse effects of gravity, this may trigger the onset of lymphedema.
Those individuals who already have lymphedema and develop RIBP may experience an increase in swelling due to pain and partial or complete loss of motor function.
The next blog entry will cover the treatment options for RIBP with special considerations to the presence of lymphedema.
September 1st, 2011
When a portion of the lymphatic system develops abnormally, or is injured by trauma, surgery or radiation, the functionality of the lymphatic system is impaired, which can cause swelling most often affecting the upper or lower extremities. A well-balanced exercise program in combination with other treatment options used in the management for lymphedema is an important component to reduce the swelling, and a vital tool for patients to continue with normal activities of daily living.
Exercise protocols are customized by the therapist and physician to meet individual goals for patients affected by lymphedema. The stage and type of lymphedema, specific restrictions and limitations of joint and muscle activity, as well as additional medical conditions need to be considered.
Decongestive Exercises
 Active, non-resistive and repetitive exercises are an integral part in the treatment and management of lymphedema. Unlike the heart in the blood circulatory system, the lymphatic system does not have an active pump to propel lymphatic fluid back to the bloodstream. Effective lymph flow depends on sufficient muscle and joint activity, especially if the functionality of the lymphatic system is compromised. Decongestive exercises are most effective if performed while the patient wears compression garments or bandages, which are also essential components in lymphedema management.
Aerobic Exercises
 Aerobic conditioning is generally performed in a repetitive fashion using large muscle groups. Some long-term benefits include decrease in resting heart rate, improved muscular strength, weight control and increased return of venous and lymphatic fluids. It is important to understand that certain aerobic exercises and recreational activities could trigger an increase in swelling and should be avoided by patients suffering from lymphedema.  Examples of these high-risk activities include soccer, kick-boxing or step-aerobics for lower extremity lymphedema, and tennis or golf for lymphedema affecting the arms. Beneficial activities include swimming, walking, water-aerobics, easy biking or yoga.
Resistive Exercises
 Strength exercises improve muscular power, increase the strength in ligaments, tendons and bones, and contribute to weight control. Resistive exercises are typically performed in a repetitive fashion against an opposing load. Certain strength exercises are beneficial for lymphedema patients and should always be performed with the compression garment or bandage in place. Resistive exercises using weights present possible problems in regard to injury or overuse and should be discussed with the therapist and physician.
Breathing Exercises
 The downward and upward movement of the diaphragm in deep abdominal breathing is an essential component for the sufficient return of lymphatic fluid back to the bloodstream. Patients affected by lymphedema of the leg benefit greatly from an exercise program including diaphragmatic breathing exercises. The movement of the diaphragm, combined with the outward and inward movements of the abdomen, ribcage, and lower back, also promotes general well-being, peristalsis and return of venous blood back to the heart.
Additional Reading:
Lymphedema People
National Lymphedema Network
Breastcancer.org
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Joe Zuther
