Lymphedema exercises: treatment using myolymphokinetic exercises and activities Lymphedema is a clinical condition that leads to edema in parts of the body resulting from the accumulation of macromolecules in the interstitial space with subsequent fluid retention.
Lymphedema is a clinical condition that leads to edema in parts of the body resulting from the accumulation of macromolecules in the interstitial space with subsequent fluid retention. Myolymphokinetic exercises and activities, when carried out correctly, are essential to treat lymphedema, however they are harmful when performed the wrong way. Therefore, guidance from a specialist is indispensable. Unfortunately, this is the reality and we suggest that if the patient does not have individualized specialist guidance it is preferable not to do this type of therapy alone thereby preventing the possibility of irreversible harm and worsening of the lymphedema.
1 - How do myolymphokinetic exercises and activities work?
Myolymphokinetic activities are defined as any physical activity that we normally perform on a daily basis. Myolymphokinetic exercises are physical exercises that are performed in a carefully planned manner. They act by exerting external compression on vessels and the interstitial space thus generating intermittent variations of pressure favoring lymphovenous drainage. These movements exert a pressure, denominated vis-a-latere, on the vessels thus creating differences in pressure and potentializing the drainage of the lymph. In the interstitial space, this pressure differential potentiates the formation of lymph. Both myolymphokinetic exercises and activities are very important to treat lymphedema. This concept, defined in the Godoy Method, is fundamental to understand their use in treatment.
2 - Can myolymphokinetic activities injure vessels and exacerbate edema?
Yes, depending on how they are performed they can further damage the vessels and worsen the edema. However, myolymphokinetic activities are very important in lymphedema treatment, as without them therapy is more difficult. It is important to remember that they should preferably be associated with restraint mechanisms. This is one of the most important bits of information patients should have. Activities are generally stimulated, but they should be performed with less intensity using little effort and for a shorter time with intervals between one series of movements and the next. Activities with repetitive movements should be performed for a short time and always combined with other activities with different movements that use other muscle chains, thus reducing the risk of overloading and worsening the edema. Clinical stories of patients who were well for years following breast cancer treatment but who after more intense physical activity evolved with edema are common in the daily practice. As you can see, it is fundamental to follow the guidelines for performing myolymphokinetic activities in order to prevent lymphedema.
3 - How can active physical exercises worsen or trigger edema?
We have several cases to illustrate this, both the onset of edema and worsening of the edema. Exercises that go beyond the lymph drainage capacity can cause increases in the limb size. In this way, exercises should be evaluated and personalized by a trained professional. This detail is vital because we find all kinds of information in social networks that are often erroneous and that can harm the patient. It is essential to remember that every extra injury in these cases is irreversible; therefore, they not only worsen the condition, but also make treatment more difficult.
We have patients with bilateral leg lymphedema who have normalized the edema and now run 10 km two or three times per week. However, we have 15-year-old patients who cannot run short distances without aggravating their lymphedema. Therefore, each case is different and the situation of each patient must be analyzed individually.
Publications in the scientific literature show that active exercises are important, as they really are, but we cannot generalize and indicate active exercises for all patients without guidance and a follow-up. When performed incorrectly they can exacerbate the situation, often irreversibly. The advice to these patients when they wish to exercise is to consult a lymphedema specialist so that he/she can guide them correctly about safe exercises as a useful activity.
4 - What are the main myolymphokinetic activities for leg lymphedema?
There is no doubt that walking slowly is the best option, but it should be while wearing an elastic or grosgrain stocking. We carried out an experiment evaluating walking without a stocking and found that increases in the leg volume were observed. When the walking was done without adjusting the stocking correctly, there was no difference in the volume before and after walking, however when the stocking was well adjusted, there was reduction of leg size. This observation was also made in patients with varicose veins using elastic stockings while walking. We concluded that walking is the best option for leg lymphedema patients, but the exercise must be associated with a restraint mechanism (elastic or grosgrain stocking).
Studies specifically evaluating exercises in patients with leg lymphedema are rare and we have not found it used as monotherapy. Therefore, the only activity we have evaluated that is safe and recommended is walking. A series of leg exercises is suggested in the literature and in social networks, but without any quantitative scientific evaluation of the results. Even so, many of them can be performed under professional supervision. Exercise bicycles are not recommended for patients with leg lymphedema because this exercise does not utilize the calf muscles very much; the calf musculature produces the ‘aspiration pump’ effect which helps lymph drainage.
5 - What are the main myolymphokinetic activities for arm lymphedema?
Fatima Godoy\'s doctorate thesis identified eight types of daily living activities including sweeping the house, ironing and brushing the teeth. Patients were instructed on how to perform the activities, all of which were associated with a grosgrain restraint sleeve. This approach transforms everyday activities into myolymphokinetic activities and occupational myolymphokinetic exercises. It was only with this adaptation that it was possible to treat breast cancer-related lymphedema. Thus, the best option is to identify what each patient enjoys doing during their daily lives and stimulate this activity.
6 - Active arm exercises
Exercises are recommended for the arms, however their routine indication should not be made without monitoring by a specialist. It is suggested that the patient has supervised guidance of each type of exercise that he/she proposes to perform.
Our experience over many years found that supervision is paramount even in respect to informing patients on how they should do the exercises as often they do them in what they think is the best way which is not necessarily true. We have an exercise lab for arms where we carry out educational research with patients. In one experiment, we first counseled patients on how to do exercises correctly and then we measured by volumetry how much of the lymphedema was reduced during one hour of activity. Subsequently, we said that they could perform the exercises, as they wished. We demonstrated that when they did not do the exercises correctly, there was an increase in limb volume, not a reduction.
7 - What are the main indications for myolymphokinetic exercises and activities?
There are three important indications:
- a) To reduce the edema
- b) To improve muscular trophism
- c) To improve joint mobility
8 - What type of exercise is suggested to reduce edema?
Passive exercises are the best because they require less blood flow during movements. When opting for active myolymphokinetic exercises or activities, we suggest that they are performed with restraint mechanisms. Myolymphokinetic activities performed correctly with grosgrain restraint sleeves allow the reduction of edema and thus these are the cheapest way to treat arm lymphedema.
9 - What kind of exercise is recommended to maintain muscle trophism?
In this case, active exercises are recommended, however the goal is only to maintain muscle trophism and this is not suggested for muscle hypertrophy. Hypertrophy may lead to increased compartment pressure, which is not good for a patient with lymphedema. Thus, we first recommend reducing the edema to avoid muscle tendon injuries. A very heavy limb may increase the chance of this type of injury.
10 - What is suggested to improve joint mobility?
In this case, we initially suggest reducing edema because often, just with this reduction, it is possible to improve mobility. If this does not achieve the goal, an active exercise plan adapted to the needs of each patient should be designed.