Decongestive and Breathing Exercises for 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. Ideally, decongestive exercise protocols are performed two to three times daily for about 10-15 minutes, and the patient should rest with the affected limb elevated for at least 10 minutes following the exercises.

These active, non-resistive and repetitive exercise protocols should be customized by the lymphedema therapist and/or 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.

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; however, abdominal breathing exercises are also beneficial for patients affected by lymphedema of the arm. 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.

Following are sample decongestive exercise protocols, combined with breathing exercises for the upper and lower extremity, which are published in the book “It’s Not Just a Swelling! Lymphedema”. This book also contains self-MLD and self-bandaging protocols for patients affected by lymphedema. The exercise protocols below serve as guidelines and the movements outlined must not cause discomfort, pain, or soreness.

Before you engage in any exercise program, especially if you have additional medical conditions, please make sure to get your physicians approval.

Decongestive Exercises for the Upper Extremity

•  Exercises should be performed wearing compression bandages or compression sleeves (except when exercises are performed in the water)
• Tight or restrictive clothing (tight underwear or bra, heavy breast prosthesis) should not be worn while performing the exercises.
• Exercises should be performed twice daily for about 10-15 minutes. The duration of the program should be slowly increased over a comfortable period of time.
• Movements should be performed in a slow and controlled manner, and the musculature should be relaxed between each individual exercise. The relaxation phase should last at least as long as the time spent during the exercise.

Exercises are performed sitting on stool or a chair without leaning back. Many of the exercises however may be performed lying on the floor. Proper breathing techniques should be used throughout the session.

Abdominal Breathing (3 repetitions)

Place both hands on your belly
Inhale deeply through your nose into your belly (feel how you breathe against your hands)
Exhale through your mouth

Perform breathing exercises as often as possible during the day

Neck Exercises                      (2-3 repetitions each)

Turn your head slowly and look to the right as far as possible; return to normal position; repeat on the left side

Bend your head to the right and try to touch the shoulder with your ear (do not shrug your shoulder). Return to the starting position and repeat for left side

Shoulder Exercises

“Shoulder Rolls”                         (3-5 repetitions each)
Rotate shoulders alternately on the right and left side.
Perform shoulder rolls using both shoulders forwards and backwards

“Shoulder Shrug”                       (3-5 repetitions each)
Shrug both shoulders and inhale. Exhale while the shoulders relax

Arm Exercises                        (3-5 repetitions each)

Fingers

Place palms and fingers together
Move little fingers away from each other and back together
Move ring fingers away from each other and back together

Continue with each finger

Alternate position:

Hold palms out in front of the body with the palms facing up
Move thumb and index finger together, so the finger pads touch each other, return to open hand
Move thumb and ring finger together, so the finger pads touch each other, return to open hand

Continue with each finger

Hand

Alternate between hands, the relaxed hand rests on the leg
Make a fist and hold for about three seconds
Open the fist and relax the hand for about three seconds
Make a fist and rotate the wrist clock wise and counter-clockwise
Make a fist and touch it to the opposite shoulder

Arm and Hands

“Picking Oranges”
Stretch out arm and lean forward
Make a fist and return hand to leg

“Climb up the Ladder”
Alternate between arms and continue for about 30-40 seconds
Hold arms above head
Grasp rungs of imaginary ladder and “climb” as high as possible (remain seated)

“Swimming”
Use breaststrokes as far as possible to the front, move arms to the side, then to the knees and to the front again

“Push Hand to Opposite Knee” (Alternate between arms)
Place the palm of one hand on opposite knee and push down with hand, and upward with knee
Hold for five seconds

Exercises with a Broomstick (3-5 repetitions each)

“Climb up and down the stick”
Hold the stick vertically between your knees with your hands
Take the stick at bottom with one hand and walk up and down the stick with alternating hands

“Weight Lifting”
Hold the stick with both hands horizontally with the palms up
Lift the stick up and towards your head and return to original position

“Wringing the Stick”
Hold the stick with both hands horizontally with the palms down and about one foot apart
Attempt to wring the stick moving one hand forward and the other back
Hold for about 3-5 seconds and wring in the other direction                                                      

“Canoeing”
Hold the stick with both hands horizontally with the palms down and about one foot apart
Start to paddle to either side with nice and big strokes