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.
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