BY JOACHIM ZUTHER
In this last part of the three-part series about exercises, I would like to address decongestive- and breathing exercises, which 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. 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.
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.
Following are sample decongestive exercise protocols, combined with breathing exercises for the upper and lower extremity, which are published in the book Lymphedema Management. 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.
Continuation of Article and additional exercise articles:
Editor's Note: I am including this article not only because of the quality of the information, but as an introduction to one of the best lymphedema information sites available. The blog was founded and is maintained by Joachm Zuther of the Academy of Lymphatic Studies. You really need to include this blog in your list of reading sites. Pat O'Connor