Exercises for the Treatment of Lymphoedema

Judith R. Casley-Smith

Exercises most important aspect of Complex Physical (Lymphedema) Therapy (C.P.T. / C.L.T.), as an adjunct of C.P.T., not as a treatment by themselves.

The ones available from the L.A.A. were specifically designed for this purpose. However they also benefit sufferers from lymphoedema who, for one reason or another, are unable to attend a clinic. This is not to say that other exercises may not be equally efficacious, but these are the only ones which have been demonstrated to be effective.

Exercises are performed wearing the appropriate compressive bandaging, sleeves or stockings. They should be performed once or twice a day in the clinic and always after discharge.

They have been carefully designed to be followed in sequence, and have three functions:

1. The first exercises empty central lymph reservoirs (nodes and the proximal lymph trunks). This gives space into which the lymph from the periphery may flow. (Otherwise, very high hydraulic resistance in nodes reduces flow of lymph.)

2. Other exercises make any surviving lymphatics work better. In spite of contractions by the walls of collecting lymphatics, lymph flow is much aided by varying total tissue pressure - such as is achieved by the compression of these vessels by contracting muscles against the surrounding fibrous tissues. The initial lymphatics only pump by virtue of such varying total tissue pressure. Such variations also greatly assist in the passage of fluid through the interstitial tissue.

3. They also help mobilize joints and swollen areas, and strengthen the limb.

The exercises are given in detail in booklets available from the L.A.A. However after a while patients forget how to perform them properly. For this reason, a video tape is available. A patient's performance should be checked at a clinic.

Some are unable to attend a clinic. A video-tape encourages them to continue their exercises in the correct manner, order and timing. It serves as an aid in the training of therapists, and as a psychological help, especially if no support group is readily available. The first part is common to arm and leg lymphoedema, the middle is only relevant to the arm, the final to the leg. Each exercise is demonstrated once with the correct timing. The number of repetitions of each is in the booklet.

Also, exercises get rather boring when performed in a vacuum. So a music cassette has been produced. On one side there is a voice-over which helps patients to remember the details of how to do them and how often.

This itself will get boring, so on the other side is just the music with minimal words.

It is very important to remember that the exercises have to be adapted for the individual patient by the therapist. Hence the booklet, video and cassette must only be taken as a guide, to be modified as required.