Lymphatic Drainage Exercices

Guidelines for Lymphatic Drainage Exercises

The patient should follow these guidelines when performing a sequence of lymphatic drainage exercises. These guidelines apply to management of upper or lower extremity lymphedema and reflect the combined opinions of several authors and experts in the field.

Preparation for Lymphatic Drainage Exercises

Set aside approximately 20 to 30 minutes for each exercise session.

Perform exercises twice daily every day. Have needed equipment at hand, such as a foam roll, wedge, or exercise wand.

During Lymphatic Drainage Exercises

Wear compression bandages or a customized compression garment. Precede lymphatic drainage exercises with total body relaxation activities. Follow a specified order of exercises. Perform active, repetitive movements slowly, about 1 to 2 seconds per repetition. Elevate the involved limb above the heart during distal pumping exercises. Combine deep breathing exercises with active movements

of the head, neck, trunk, and limbs. Initially, perform a low number of repetitions. Increase repetitions gradually to avoid excessive fatigue. Do not exercise to the point where the edematous limb

aches. Incorporate self-massage into the exercise sequence to further enhance lymph drainage.

Maintain good posture during exercises. When strengthening exercises are added to the lymph drainage sequence, use light resistance and avoid excessive muscle fatigue.

After Lymphatic Drainage Exercises

If possible, rest with the involved extremity elevated for 30 minutes. Set aside time several times per week for low-intensity aerobic exercise activities, such as walking or bicycling for 30 minutes. Carefully check for signs of redness or increased swelling in the edematous limb, either of which could indicate that the level of exercise was excessive.

Selected Exercises for Lymphatic Drainage:

Upper and Lower Extremity Sequences

In the drainage of upper or lower extremity lymphedema. Many of the individual exercises suggested in lymphedema protocols, such as ROM of the cervical spine and some of the shoulder girdle or upper extremity exercises, are not exclusively used for lymph drainage. They also are used to improve mobility and strength. Several of the exercises highlighted in this section already have been described in previous chapters in this text. Only those exercises or variations of exercises that are somewhat unique or not previously addressed are described or illustrated in this section.

Sequence of Exercises

Total body relaxation exercises are implemented prior to lymphatic drainage exercises. Exercises for lymphatic drainage should follow a particular sequence to assist lymph flow. The central and proximal lymphatic vessels, such as the abdominal, inguinal, and cervical nodes , are cleared first with trunk, pelvic, hip, and cervical exercises. Then, for the most part, exercises proceed distally from shoulders to fingers or from hips to toes. If lymph nodes have been surgically removed (e.g., with a unilateral axillary node dissection for breast cancer or a bilateral inguinal node dissection for cancers of the abdominal or pelvic organs), lymph must be channeled to the remaining nodes in the body in the drainage of upper or lower extremity lymphedema. Many of the individual exercises suggested in lymphedema protocols, such as ROM of the cervical spine and some of the shoulder girdle or upper extremity exercises, are not exclusively used for lymph drainage. They also are used to improve mobility and strength of exercises that are somewhat unique or not previously addressed are described or illustrated in this section.

Sequence of Exercises

Total body relaxation exercises are implemented prior to lymphatic drainage exercises. Exercises for lymphatic drainage should follow a particular sequence to assist lymph flow. The central and proximal

lymphatic vessels, such as the abdominal, inguinal, and cervical nodes , are cleared first with trunk, pelvic, hip, and cervical exercises. Then, for the most part, exercises proceed distally from shoulders to fingers or from hips to toes. If lymph nodes have been surgically removed (e.g., with a unilateral axillary node dissection for breast cancer or a bilateral inguinal node dissection for cancers of the abdominal or pelvic organs), lymph must be channeled to the remaining nodes in the body section do not reflect the exercises included in any one specific protocol. Rather, the exercise sequences are based on the recommendations of several authors.

Exercises Common to Upper

and Lower Extremity Sequences

These initial exercises should be included in programs for unilateral or bilateral upper or lower extremity lymphedema. They are designed to help the patient relax and then to clear the central channels and nodes.

Total body relaxation

• Have the patient assume a comfortable supine position and begin deep breathing. Then, isometrically contract and relax the muscles of the lower trunk (abdominals and erector spinae) followed by the hips, lower legs, feet, and toes.

• Then contract and relax the muscles of the upper back, shoulders, upper arms, forearms, wrist, and fingers.

• Finally, contract and relax the muscles of the neck

and face.

• Relax the whole body for at least a minute.

• Perform diaphragmatic breathing throughout the entire

sequence. Avoid breath-holding and the Valsalva

maneuver

 

Posterior pelvic tilts and partial curl-ups

• Perform these exercises with hips and knees flexed, in the supine position.

Unilateral knee-to-chest movements

These exercises are designed to target the inguinal nodes. This is important

even for upper extremity lymphedema.

• In the supine position flex one hip and knee, and grasp

the lower leg. Pull the knee to the chest. Gently press

or bounce the thigh against the abdomen and chest

about 15 times.

• Repeat the procedure with the opposite lower extremity.

uninvolved lower extremity.

Cervical ROM

 Perform each motion for a count of 5 for

five repetitions.

• Rotation

• Lateral flexion

Scapular exercises

Perform exercise for a count of 5 for five repetitions.

• Active elevation and depression (shoulder shrugs)

• Active shoulder rolls

• Active scapular retraction and protraction. With arms at sides and elbows flexed, bilaterally retract the scapulae, pointing elbows posteriorly and medially. Then protract the scapulae.

Exercises Specifically for Upper

Extremity Lymphedema Clearance

The following sequence of exercises is performed after the general, total body exercises just described. The exercises, which are performed in a proximal to distal sequence, are done specifically for upper extremity lymph clearance

 Active circumduction of the arm

 While lying supine, flex the involved arm to 90_ (reach toward the ceiling) and perform active circular movements of the arm about 6 to 12 inches in diameter. Do this clockwise and counterclockwise, five repetitions in each direction.

Exercises on a foam roll

 While lying supine on a firm foam roll (approximately 6 inches in diameter), perform horizontal abduction and adduction as well as flexion and extension of the shoulder. These movements target congested axillary nodes and are done unilaterally. For home exercises, if special equipment such as an

Ethyfoam  roller is not available, have the patient perform these exercises on a foam pool “noodle.” Although the diameter is smaller, a towel or folded sheet can be wrapped around the foam “noodle” to increase the diameter of the roll.

Bilateral hand press

 With arms elevated to shoulder level or higher and the elbows flexed, place the palms of the hands together in front of the chest or head. Press the palms together (for an isometric contraction of the pectoralis major muscles) while breathing in for a count of 5. Relax and then repeat up to five times.

Wand exercise, doorway or corner stretch, and towel

Stretch

 Incorporate several exercises to increase shoulder mobility and to decrease congestion and assist lymph

flow in the upper extremity. Hold the position of stretch for several seconds with each repetition.

Unilateral arm exercises with the arm elevated

 The following exercises are done with the patient seated and the arm supported at shoulder level on a tabletop or countertop or with the patient supine and the arm supported on a wedge or elevated overhead.

• Shoulder rotation with the elbow extended. Turn the

palm up, then down, by rotating the shoulder, not simply

pronating and supinating the forearm.

• Elbow flexion and extension.

• Circumduction of the wrist.

• Hand opening and closing

Bilateral, horizontal abduction and adduction

 While standing or sitting, place both hands behind the head. Horizontally adduct and abduct the shoulders by bringing the elbows together and then pointing them laterally.

Overhead wall press

 Face a wall; place one or both palms on the wall with the hands above shoulder level. Gently press the palms into the wall for several seconds without moving the body. Relax and repeat approximately five times.

Exercises Specifically for Lower

Extremity Lymphedema Clearance

Unilateral knee-to-chest movements

 In the supine position, repeat this exercise for another 15 repetitions. If lymphedema is present in only one lower extremity, perform repeated knee to chest movements with the uninvolved leg first and then the involved leg.

Bilateral knees to chest

 In the supine position, flex both hips and knees, grasp both thighs, and gently pull them to the abdomen and chest. Repeat 10 to 15 times.

Gluteal setting and posterior pelvic tilts

 Repeat five times, holding each contraction for several seconds and then slowly releasing.

External rotation of the hips

 Lie in the supine position with the legs elevated and resting against a wall or on a wedge. Externally rotate the hips, pressing the buttocks together, and holding the outwardly rotated position. Repeat several times.

Knee flexion to clear the popliteal area

 While lying in the supine position and keeping the uninvolved lower extremity extended, flex the involved hip and knee enough to clear the foot from the mat table. Actively flex the knee as far as possible by quickly moving the heel to the buttocks. Repeat approximately 15 times.

Active ankle movements

 With both legs elevated and propped against a wall, or just the involved leg propped against a door frame and the uninvolved leg resting on the floor, actively plantarflex the ankle and curl the toes; then dorsiflex the ankle and extend the toes as far as possible for multiple repetitions. Finally, actively circumduct the foot clockwise and counterclockwise for several repetitions.

Wall slides in external rotation

 With the feet propped up against the wall, legs externally rotated, and heels touching, slide both feet down the wall as far as possible and then back up the wall for several repetitions.

Leg movements in the air

 With both hips flexed and the back flat on the floor and both feet pointed to the ceiling, alternately move the legs, simulating cycling, walking, and scissoring motions.

Hip adduction across the midline

Lie in the supine position with the uninvolved leg extended. Flex the hip and knee of the involved leg. Grasp the lateral aspect of the knee with the contralateral hand; pull the involved knee repeatedly across the midline in a rocking motion.

Rest

 With feet elevated and legs propped up against the wall, rest in this position for several minutes after completing exercises. Then rest the legs partially elevated on a wedge, and remain in this position for another 30 minutes.