I have just recently signed on a new client, and in the health check, he disclosed he has lymphedema stage 2 in his leg. As I have never come across this condition before, I don't know what exercises I can give him without aggravating the condition further.
PLEASE NOTE: This column is not intended to substitute for medical advice. Each client is different, and medical clearance should be obtained before participating in this or any exercise program.
Kudos to you for wanting to be safe as well as proactive for your client. Before your client embarks on an exercise program, please be sure to obtain medical clearance from his doctor. In addition, check to see if he is receiving any treatment for the lymphedema. Some exercises may be counter-productive and harmful to his leg. The lymphedema therapist may be able to recommend specific exercises you can implement and reinforce for the patient.
Stage 2 lymphedema is chronic swelling, which fills the limb with protein-rich fluid that cannot be easily eliminated from the thigh and/or foot. The leg may feel firmer to the touch as the tissue becomes fibrotic. Lymphedema can be uncomfortable. It can make moving difficult as the limb is heavy, it can create clothing restrictions, and it leaves one prone to infections. There are three stages, and at this stage, one must be cautious to prevent further swelling and progression to stage 3.
It is important to find out if your client has primary or secondary lymphedema. Primary lymphedema is a congenital malfunction of the lymphatic system, which can develop at birth or later on. Secondary lymphedema can develop from surgery, radiation, infection or trauma. Specific cancer surgeries for melanoma, prostate, testicular, bladder or colon cancer can place patients at risk for lymphedema. In addition, radiation also damages the lymphatic lymph nodes and vessels, further contributing to the risk. That is why a complete medical history is integral to learn the other risk factors for lymphedema your client may have. For example, someone with CHF must be monitored very carefully as strenuous exercise may cause too much fluid for the heart to pump.
Recommended forms of exercise include Pilates and yoga, which incorporates deep breathing and helps to facilitate return of lymphatic fluid back to the heart. Pilates exercises where the client is lying supine with the legs elevated are beneficial. For example, the hundred followed by leg circles would be an example of an exercise progression adding in lymphatic flow. If the leg is heavy, you might have to place his legs in tabletop at first or support them against the wall. Ankle pumps for ankle flexion/extension and rotation would be helpful.
Cardiovascular exercise such as walking, indoor cycling and swimming are recommended. However, one should proceed cautiously with exercise intensity and duration. Exercise that involves repetitive stress to the knee and foot such as stair climbing would not be advised. A well fitting compression garment should be worn, which fits the leg with at least 30 mm hg pressure. This garment is used when engaging in exercise throughout the day. However, swimming does not require a garment as the limbs are supported by the water. In addition, the water pressure acts as a natural compression for the limb. Exercise should be progressed slowly and gradually. The number of repetitions should not be increased at the same time as the resistance when working with the legs. It is best to start with few repetitions of each exercise and monitor your client’s response to the exercise. If the limb feels heavier or full or has decreased flexibility at the ankle, this would indicate that the exercise is too strenuous. You can proceed normally with strength training for the upper extremities provided there are no other medical issues.
I would recommend both you and your client learn more about lymphedema. Some good web sites to explore include www.lymphnotes.com and www.lymphnet.org.