Patient Handout Living Well with Lymphedema

Helpful Resources, Terms, and Exercises

Often t imes i t can be overwhelming to be in a therapy room without unders tanding the t erminology assoc iated with your condi t ion. Here are some

he lp fu l de f in i t ions for re f erence re lated to the lymphat i c sys tem and lymphedema.

Axillary nodes: Lymph nodes found in the armpit that drain the lymph channels from the breast. Cellulitis: A fast and serious, spreading infection of the deep tissues of the skin and muscle that causes the skin to become warm and tender and may also cause fever, chills, swollen lymph nodes, and blisters. Complete Decongestive Therapy: (CDT) The system of lymphedema treatment that includes manual lymph drainage (MLD), compression techniques, and self-care training. Compression: The act of applying pressure to an area of the body. In lymphedema either the massage pressure that moves lymph or the compression of the therapeutic pump device. Also, compression/support from garments and wraps preventing swelling. Congenital lymphedema: A condition present at birth in which excess fluid called lymph collects in tissues and causes swelling (edema) in them. Congenital lymphedema is due to a congenital malformation (that is, a birth defect) of the lymphatic system. Edema: The swelling of soft tissues as a result of excess fluid accumulation. Edema is often most prominent in the lower legs and feet toward the end of the day because fluid pools while people maintain an upright position. Fibrosis: The formation of fine scar-like structures that cause tissues to harden and reduces the flow of fluids through these tissues. Fibrotic: Pertains to fibrosis or the hardening of tissues. It can be caused by radiation, chemotherapy, burns, and the improper treatment of lymphedema. Lymph: A clear fluid that contains lymphocytes (white blood cells) that fight infection and the growth of tumors. Lymph also contains plasma, the watery part of the blood that carries the blood cells. Lymph circulation: Flow of lymph "fluid" through the lymphatics. Obstruction of this flow results in lymphedema. Lymphatic fluid: The clear fluid found outside the cells which bathes the tissues. It is collected, filtered, and transported by the lymphatic system from around the tissues to the blood circulatory system.

Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin. Lymph space: A space, in tissue or a vessel, filled with lymph. Lymph vessels: A network of thin tubes that helps lymph flow through the body and returns it to the bloodstream. Lymphatic: Pertaining to a small, thin channel that is similar to a blood vessel and that collects and carries tissue fluid (lymph) from the body. This fluid ultimately drains back into the bloodstream.

Lymphatic system: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. The channels that carry lymph are also part of this system. Lymphedema: A condition in which excess fluid collects in tissue and causes swelling. Lymphedema may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed. It usually causes painless swelling. Pitting edema: When a swollen area is pressed, the pressure leaves an indentation (pit) that takes time to fill back in. Subcutaneous: Under the skin. http://www.lymphedemasupport.org/glossary.html http://medical-dictionary.thefreedictionary.com/lymphedema

Although lymphedema is a chronic condi t ion, there are many ways to he lp manage and improve your condi t ion. One o f the most prac t i ca l ways to l ive we l l wi th lymphedema is by exerc i s ing . Part i c ipat ing in s imple exerc i ses i s a great way to ge t lymph f lu id moving l ike i t i s supposed to . See the at tached exerc i se shee ts for more guidance .

2. Diaphragmatic breathing – Inhale through your nose. As you breathe in, your stomach should push out and your upper chest should move as little as possible. Exhale through your mouth, letting your stomach sink back in as you slowly bend at the hips. Repeat up to 5 repetitions.

3. Hip flexiona. Lying – Bring your knee up toward your chest as far as possible, then back down.

b. Sitting – Bring your knee up toward your chest, then back down, as if marching in place.

c. Standing – While holding onto a stable surface, bring your knee up toward your chest as far as possible, then back down, as if marching in place.

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Lower Extremity Lymphedema Exercises

Perform all exercises _______repetitions, _______ times a day.

Perform them slowly and hold 3 to 5 seconds. Do not push into pain.

1. Start by clearing the lymph nodes. Neck, under arm, groin, behind knee – 10 times Armpit/Axilla – 10 times Groin – 10 times Knee – 10 times

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www.AuroraHealthCare.org

Lower Extremity Lymphedema Exercises, Page 2

4. Hip abductiona. Lying – Lying on your back, slide your leg out to the side, then back in. Keep your knee straight and toes pointing straight up.

b. Standing – While holding onto a stable surface, bring your leg out to the side, then back in. Keep your knee straight and toes pointed forward.

5. Knee flexion and extensiona. Lying – Slide your heel up toward your hips, bending at your knees, then back down.

b. Sitting – Raise your foot up, straightening your knee as far as possible, then bend your knee back as far as possible.

c. Standing – While holding onto a stable surface, raise your foot back, bending your knee as far as possible, then straighten your knee and rest your foot on the floor.

6. Ankle pumpsa. Lying – Pull your foot/toes up toward you as far as possible, then point them down.

b. Sitting – Pull your foot/toes up toward you as far as possible, then point them down.

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Lower Extremity Lymphedema Exercises, Page 3

7. Ankle circles Lying or sitting – Move your ankle in a circle clockwise, making as large of a circle as possible. Repeat in counterclockwise direction.

8. Toe scrunches Lying or sitting – Curl your toes down as far as possible, then pull them up as far as possible.

Repeat all exercises in reverse order, starting with with #8 and ending with node clearing.

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The information presented is intended for general information and educational purposes. It is not intended to replacethe advice of your health care provider. Contact your health care provider if you believe you have a health problem.Aurora Health Care is a not-for-profit health care provider and a national leader in efforts to improve the quality of health care.

PATIENT EDUCATIONpatienteducation.osumc.edu

Lymph Drainage Exercises for Lower Extremity

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.© August 7, 2014. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

Decongestive exercises can play an important role with managing your lymphedema, especially in the initial phase of treatment. The exercises should be done in the following sequence: trunk, neck, shoulder, legs. Do 3 to 5 repetitions of each exercise, 2 to 3 times each day. You may choose to do more, but it is important to follow the sequence. It does not have to be a strong muscle contraction to be eff ective; the idea is to simply contract the muscle. If you have any diffi culty doing these exercises, talk to your physical therapist about changes that can be made. Your bandages or stockings should be worn during the exercises. Exercises should be done with both the aff ected and non-aff ected limb.

Trunk ExercisesAbdominal Breathing

x� Lie on your bed or fl oor, knees slightly bent with your feet fl at and your hands resting on your stomach.

x� Take deep breaths to relax, as you breathe in you should feel your stomach rise and fall.

x� Breathe out slowly through your mouth, letting gravity pull your stomach back toward the bed or fl oor. Repeat.

x� Take a short rest before getting up to avoid dizziness.

Lymph Drainage Exercises for Lower Extremity

Pelvic Tilt

x� Lie on your back with knees slightly bent and feet fl at. Using your stomach muscles “tilt” your pelvis and fl atten your lower back into the fl oor or bed. Imagine pressing down on a penny with the small of your back and count to ten. Release and repeat.

Partial Sit Up with Breathing

x� Inhale by breathing into your belly. As you exhale, slightly lift your head and shoulders off the fl oor, reaching forward with your hands. Be careful not to strain your neck.

Neck ExercisesNeck Rotation

x� Turn your head slowly to the right as you inhale and count to fi ve. Return to the center as you exhale. Repeat to the left.

Head Tilt

x� Gently move your right ear toward your right shoulder, hold for 5 seconds, and then slowly bring head back to the center. Repeat on other side.

Lymph Drainage Exercises for Lower Extremity

Shoulder ExercisesShoulder Shrug:x� Lift both shoulders towards your ears as you inhale, exhale and return to relaxed position. Next, pull shoulders down as far as possible while inhaling, exhale and return to relaxed position.

Shoulder Rolls

x� Roll shoulders back making a continuous circle.

Leg ExercisesFlexion

x� Lie with both legs straight. Slide one leg up bending the knee and slide it back down. Repeat with other leg.

Leg Falls

x� Bend both knees and keep your feet fl at on the fl oor or bed. Keep one leg in place and slowly lower your other leg out to the side. Bring your leg back to center. Repeat with the other leg.

Lymph Drainage Exercises for Lower Extremity

Leg Slides

x� Lie with both legs straight. Slide your leg out to the side and return it to the center. Keep your knees straight and pointing up during the exercise. Repeat with the other leg.

Ankle Exercises Ankle Pumps

x� Move your foot up and down as if pushing down or letting up on a gas pedal in a car. Repeat 10 times. Repeat with other foot.

Ankle Inversion / Eversion

x� Move your foot side to side. Repeat 10 times.

You may want to end your exercise session with more abdominal breathing. It may also be a good idea to continue lying down and elevate your leg on a pillow while relaxing for a few minutes.

Other Resources – there are many he lp fu l resources onl ine as wel l as books that can be highly bene f i c ia l for you to v i ew or read. Listed be low are a f ew o f the

webs i t es and books that we would re commend you taking a look at . This i s only a short , s tar t ing l i s t , as there are many re l iable resources avai lable to you onl ine . Websites

• Supportgroups.com • Lymph Notes, an online information resource and support group for those with

lymphedema and for the family, friends, and therapists who care for them. Web site: www.lymphnotes.com/index.php

• Lymphedema People. Web site: www.lymphedemapeople.com/ • Lymphatic Research Foundation. http://www.lymphaticresearch.org • Lymphedema Awareness Foundation. http://www.elymphnotes.com/

Books

• Lymphedema Caregiver’s Guide: arranging and providing home care by Mary Kathleen Kearse, PT, CLT-LANA, Elizabeth McMahon, PhD, and Ann Ehrlich, MA

Caregiver's Guide is the first book to provide detailed instructions for caregivers on all aspects of lymphedema home care including physical care (skin care, simple lymph drainage, compression, exercise, etc.), communications skills and emotional support, and activities of daily living. Caregivers will also learn ways to protect themselves from injury and burnout. Caregiver's Guide outlines a systematic approach to determining the patient's care needs, arranging care, and coordinating multiple caregivers.

• Living Well With Lymphedema by Ann Ehrlich, Alma Vinje-Harrenwijn, Elizabeth

Elizabeth McMahon, PhD

This book will help you live well with lymphedema through treatment, self-management, and helpful tips for daily living. It will also help you understand how the lymphatic system works, how lymphedema is diagnosed, how to cope with the emotional challenges of lymphedema, how to find treatment, and deal with insurance issues. Living Well is for those with, or at risk for, lymphedema as well as healthcare professionals, caregivers, and friends and family.