Rehabilitation guide
Lymphoedema is a long-term swelling, usually in an arm or a leg, that develops when lymph fluid cannot drain properly; it is most often seen after cancer treatment. It does not go away completely, but it can be kept under control with compression garments, skin care, movement and specialised massage. Research shows that exercise done properly neither triggers lymphoedema nor makes it worse.
The lymphatic system is the network of vessels and glands that collects excess fluid in the body and fights infection. When this system does not work well, fluid builds up in the tissues and swelling develops.
There are two types. Lymphoedema present from birth (primary) is rare. Lymphoedema that develops later (secondary) is much more common: it appears when cancer treatments such as surgical removal of lymph nodes, an infection, an injury, inflammation or a long period of immobility damage the lymphatic system.
For many years, people treated for breast cancer were told not to tire their arms. Research has not borne out this fear. According to the Cochrane review, progressive resistance exercise does not increase the risk of lymphoedema as long as symptoms are closely monitored (two trials, 358 people); starting shoulder movements early after surgery does not appear to increase the risk either, and it improves shoulder movement in the first months. Because the overall quality of the evidence is low, the authors ask for the results to be interpreted with caution.
The American College of Sports Medicine considers supervised, progressive resistance exercise safe for people who have lymphoedema or are at risk of it. Contracting muscles push lymph fluid along the vessels; that is why movement is one of the four main components of treatment.
Three rules: start gently and build up little by little. If you have a compression garment, wear it while exercising. Check the swollen area during and after exercise; if anything changes, stop and let your lymphoedema team know.
The recommended treatment is “decongestive lymphatic therapy”, which has four components. First comes an intensive phase of several weeks aimed at reducing the swelling; then the maintenance phase begins, in which you take over your own care and go for a check-up every few months.
In an area with lymphoedema the skin is more open to infection, and every infection can damage the lymphatic system a little more. That is why small precautions matter:
Exercises at home
Sit upright with your arm comfortably supported. The movements should be painless; a slight stretching feeling is normal. Talk to your doctor or lymphoedema therapist before you start. The movements are different for lymphoedema of the leg or of the head and neck.
Relax your shoulders and upper chest. Rest one hand just below your ribs. Breathe in slowly and deeply through your nose, feeling your hand rise as your tummy rises; breathe out slowly through your mouth. Always begin the other movements with this.
5 breathsSit upright. Raise your shoulders towards your ears, then let them drop. Then roll your shoulders forwards, and then backwards.
5–10 repsSit upright with your hands on your knees. Bring your hands to your shoulders, then lift your arms as high as is comfortable and lower them back to your knees. There should be no pain; a slight stretching feeling is normal.
5–10 repsMake a fist, then spread your fingers as wide as you can. Then touch your thumb to the tip of each finger in turn.
5–10 repsSlowly squeeze a soft ball in your palm or between your two hands, and release. Muscle contractions help lymph fluid move along the vessels.
5–10 repsIf you have been inactive for a long time, walking is the best way to start. Begin with a short distance and build up slowly. If you have a compression garment, wear it while exercising; check the swollen area during and after exercise.
Every day, building up little by littleWhen sitting, rest your arm on a pillow at a comfortable height. If your leg is affected, do not sit for long with your feet hanging down; put your leg up with a pillow under your knee.
Video
From the YouTube channel of Cancer Research UK, the UK cancer research charity.
A video showing the deep breathing done before starting the movements.
A video showing movements for arm lymphoedema.
There is no cure for lymphoedema; however, symptoms can usually be kept under control with compression garments, skin care, regular movement and specialised massage. Care that starts early helps stop the swelling from progressing.
Research does not show this. In the two trials in the Cochrane review (358 people), progressive resistance exercise did not increase the risk of lymphoedema as long as symptoms were monitored. Muscle contractions help lymph fluid move along. Start gently, wear your compression garment during exercise if you have one, and check the swollen area.
The UK’s National Health Service (NHS) advises avoiding injections and blood pressure readings in the affected area where possible. Tell the health professional that you have lymphoedema and ask them to use your other arm.
Redness, warmth, pain, increased swelling, fever or shivering can be signs of a skin infection (cellulitis). Infection develops more easily in an area with lymphoedema and can damage the lymphatic system further; see a doctor the same day, without waiting. Treatment is usually antibiotics by mouth.
See a doctor without delay if you have any of the following:
Sources
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