Excercise Program

Exercise is an integral part of lymphoedema treatment. It helps improve strength and range of motion, improving quality of life. Additionally, muscle contraction facilitates venous and lymphatic circulation.

On the other hand, compression bandaging prevents re-accumulation of fluid in the affected areas and enhances the joint-muscle pump while softening fibrotic tissues. Together, regular exercise and compression compliance facilitate a natural way to drain lymphatic fluid.

Participating in Self-Directed Manual Lymphatic Drainage (S-MLD) will stimulate the lymph nodes (see A.1 – Nodule Opening) before exercising to clear the fluid pathway to ensure a better flow out of the target limb. Opening your nodules should not be painful. You will feel a sensation of pressure, but if there is tenderness, reduce the amount of pressure you are applying.

A1. Lymph Node Opening / Self-MLD

Neck – in sitting

  1. Place your index and middle finger at the corner of your jaw, just below your earlobe, but not on the bone
  2. Keeping firm, gentle pressure, trace small circles in place, going backwards towards the spine (anticlockwise)
  3. Continue this for 15 circles on both sides

Collarbone – in sitting

  1. Let your fingers find the natural divot above your collarbone, about halfway across the length of the bone. It may be easier to have your hands crossed over your chest. 
  2. Then make a peace sign with each hand – having your pointer finger above the bone, in the divot, and middle finger directly below the bone.
  3. With a gentle, firm pressure, press down whilst breathing in. 
  4. Repeat this 15 times. This movement is to be done slowly, in time with your breathing.

Underarm – in sitting

  1. Place your fingers in your armpits, as if you were trying to warm them up. 
  2. Find the most concave part of your armpit and gently press your fingers in towards your ribs 
  3. Whilst maintaining the pressure, trace small circles towards your spine
  4. Trace the circles 15 times

Abdomen – in standing

  1. Place your hands one on top of the other in front of you horizontally. Slide the top hand across until your fingertips are in line with your middle knuckles on the bottom hand. 
  2. Place your hands (in that position) on your abdomen to cover your belly button. 
  3. Take a deep breath through your nose to feel your hands rising on your stomach. 
  4. As you slowly inhale, with firm pressure, press your fingers towards your spine. You will feel resistance against the breath you’re taking.
  5. Repeat this motion 4 times.

Groin – in standing

  1. To find the groin node, pretend you are putting your hands in your pockets, at an angle
  2. With the pads of the first three fingers (not your fingers), press inwards with firm pressure, aiming for your tailbone. 
  3. Trace small circles in the position, 15 times, maintaining the pressure.

Range of motion exercises

Shoulder abduction

Resting Position

Arms down by your sides with palms against your thighs. 

Action

Raise your arms sideways, making a T with your body. Once you reach this T, continue raising your arms up as though you are going to clap above your head. Repeat 20x.

Shoulder flexion

Resting position

Arms down by your sides. 

Action

Raise your arms forward as far as they can go above your head. Return to your resting position and then bring your arms behind you, squeezing your shoulder blades as you do so. Repeat 20x

Dynamic chest stretch

Resting position

Arms down by your sides with your elbows at a 90-degree angle.

Action

Swing your forearms out to the sides, keeping contact between your elbow and your torso. Repeat 20x.

Hip flexion-extension

Resting position

While standing, place both hands flat on a wall. 

Action

On an inhale, bring one knee to your chest as high as you can. Then, as you exhale, slowly return to resting and draw it as far back as you can.

Hip abduction-adduction

Resting position

While standing, place both hands flat on a wall you’re your hips parallel to the wall. 

Action

Swing your leg out to the side as high as you can and then swing it back the opposite way, towards the centre of your body, stopping when your knees are aligned. Come back to resting. Repeat on the other leg.

Static Stretches

Doorway stretch (for chest)

Resting position

Stand next to an open door with your shoulder out to the side and both shoulder and elbow at 90 degrees

Action

Place forearm against the wall and lean into the open doorway. You should feel the stretch in your chest and upper arm. Hold for 30 seconds and repeat 2x.

Wall stretch (for shoulder)

Resting position

Stand facing a wall with your hand on the wall. 

Action

Slowly slide your hand up the wall as high as you comfortably can. You can also lean towards the wall to emphasise the stretch. Hold for 30 seconds and repeat 2x.

Thigh stretch (hips)

Resting position

Lay on your side with the target limb on top and your knee bent. 

Action

Grab your ankle and pull your leg back. You should feel the stretch on the front part of your thigh. Hold for 30 seconds and repeat 2x.

Ankle stretch

Resting position

While sitting, loop a towel or a sheet under your forefoot and grab onto both ends with each hand.  

Action

Pull your foot up towards you. You can emphasise the stretch by keeping your knee straight. You should feel the stretch on your calf. Hold for 30 seconds and repeat 2x.

Strengthening Program

These exercises are done with just the weight of your body first before progressing to free weights, starting with 1kg dumbbells. Complete each exercise 10x, repeated through 3 sets.

Shoulder press

Resting Position

Make a fist with your hands and bring them up to your shoulders, palms facing forward

Action

Extend your arms upwards, keeping your elbows towards the front and then come back to resting

Bent over dumbbell rows

Resting Position

Bring your torso forward by hinging at the hip. Have the working arm straight down, palm facing towards the midline of the body. Can support yourself on a table ledge with your free hand. 

Action

Draw your elbow towards the sky until your hand is in line with your hip. You are aiming to feel the contraction in your working shoulder blade. Return to resting

Bicep curls

Resting Position

Arms down by sides, palms facing forward.

Action

Bend your elbow, bringing your hands towards your shoulders and then extend back down to resting

Triceps extensions

You will need an open door and your resistance bands for this exercise. 

Resistance Band Setup

Loop your resistance band over the top of the door so there is an even length on either side of the door

Resting Position

Grab the middle of the resistance band to create a 45° angle, keeping your elbows by your side. 

Action

Keeping your elbows by your side, pull the resistance band down. Come back to resting

Mini squats / squats

Resting position

Place both hands on a tabletop or a kitchen bench and keep your feet apart at shoulder-width.  

Action

Bring your hips down and as far back as you are comfortable. Try to keep your knees in line with your toes.

Sit-to-stand exercises

Resting position

Sit on the edge of a chair with your feet apart. 

Action

Bring yourself up to a standing position. You may use your hands if you feel like you are going to fall over; otherwise, try not to use your hands.

Step-up exercises

Resting position

Stand in front of a stable stool or a set of stairs. 

Action

Place one foot on the step and bring your body up. With your weight on the same foot, slowly bring yourself back down.  You may place one hand on a rail if you feel unbalanced but try not to pull yourself up with your hand.