I will soon be training a client who has lymphedema and cannot lift over five pounds with her left arm. My question is: other than some basic stretching exercises, what is the best way to get her started on a resistance program?
Thanks for your question! According to the National Lymphedema Network (www.lymphnet.org), Lymphedema can be defined as follows:
"Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arm(s) and/or leg(s), and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary). When the impairment becomes so great that the lymphatic fluid exceeds the lymphatic transport capacity, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid not only causes tissue channels to increase in size and number, but also reduces oxygen availability in the transport system, interferes with wound healing, and provides a culture medium for bacteria that can result in lymphangitis (infection)."
Outside of understanding what lymphedema is and how it can affect the movement system, we would address your client by assessing her CURRENT function (review her health history while consulting with her doctor if possible). Example questions for you to ask and answer are:
- What is the most intense form of movement(s) performed throughout her day?
- Is your training program helping this intense movement(s)?
- How well does she perform the movements?
- Can she perform the movements at various speeds relative to life’s demands?
- With respect to the arm that only lifts five pounds: can she LOAD before EXPLODE? In other words, if I want my client to lift the arm upward (unload), she first MUST be able to drive downward (load). Note: this is true for all functional movements – it’s based physical principles – its how we walk, etc.
- In what planes of motion is she successful? Example: Can she lift the weight in the frontal plane or transverse plane better than the sagittal plane? If yes, continue with her most successful plane and expand her threshold from that point.
Your goal with all clients, regardless of their situations (pathology, structural and/or functional anomaly), is to make the intended function (their life’s movements) easier and more enjoyable. To accomplish this, you must create a strategy based on sound principles and concepts. Examples of such principles are:
- Ground reaction forces
- Life is three dimensional (most exercises today are done in one plane????)
Your strategy such as finding her most successful plane of motion while lifting her arm now becomes a place to start and apply progressions to eventually assist her in lifting greater loads (if that is the intended function). Always remember, there are no black and white exercises to give for lifting greater loads – just exercises that are specific to a client’s function. So, your question is simply answered by saying: analyze her needed motions for life, find where she’s the most successful and build her movement vocabulary from that point. Note: An exercise is simply a MOVEMENT performed in a repeated fashion (don’t get caught up on the names!).
If you want a simpler route, be sure the ankles, hips and thoracic spine are moving in all three planes of motion. I guarantee there is a rotational deficiency in one or more of these rotational segments. Whatever you do, DO NOT eliminate rotation! If you eliminate rotation from her program, she is heading for an injury since life requires her to rotate (that’s how she gets out of her car to see you). The key is to rotate correctly. So, be sure she rotates through her ankles (subtalar joint), hips and thoracic spine – then her back will thank you!