Lymphedema: Exercise Guidelines

Exercise is a vital part of a Lymphedema Treatment program.  The lymphatic system and circulatory systems are greatly affected by active muscle contraction, which helps assist transport of lymph and blood supplies to tissues and organs.

  • Exercise only with the limb in a compression garment or wrap.
  • Include Deep Abdominal Breathing before and after every exercise program.
  • Do not wear tight restricting clothing (eg.  Bra straps, tight underwear, etc.
  • Perform exercise in a slow, controlled manner.  If any exercise causes pain, decrease number of repetitions or do not perform that particular exercise.
  • Alternate each contraction of the muscle with equal time of full relaxation.
  • Progress exercises slowly as to avoid soreness.
  • After exercising, rest and elevate the limb for 15 to 20 minutes.
  • You should rest 20-30 minutes between Manual Lymph Drainage Massage and exercising.

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

St. Luke’s*Idaho Elks Rehabilitation Services (SLIERS)

Boise, Idaho 

 

 

 

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LYMPHEDEMA RISK-REDUCTION PRACTICES

I. Skin Care – Avoid trauma/injury and reduce infection risk

  1. Keep extremity clean and dry.
  2. Apply moisturizer daily to prevent chapping/chaffing of skin.
  3. Attention to nail care; do not cut cuticles.
  4. Protect exposed skin with sunscreen and insect repellent.
  5. Use care with razors to avoid nicks and skin irritation.
  6. If possible, avoid punctures such as injections and blood draws.
  7. Wear gloves while doing activities that may cause skin injury (i.e., gardening, working with tools, using chemicals such as detergent).
  8. If scratches/punctures to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infection (i.e. redness).
  9. If a rash, itching, redness, pain, increased skin temperature, fever or flu-like symptoms occur, contact your physician immediately.

II. Activity / Lifestyle

  1. Gradually build up the duration and intensity of any activity or exercise avoiding soreness.
  2. Take frequent rest periods during activity to allow for limb recovery.
  3. Monitor the extremity during and after activity for any change in size, shape, tissue, texture, soreness, heaviness or firmness.
  4. Maintain optimal weight.

III. Avoid limb constriction

  1. If possible, avoid having blood pressure taken on the at risk arm.
  2. Wear loose fitting jewelry and clothing.

IV. Compression Garments

  1. Should be well-fitting.
  2. Consider supporting the at risk limb with a compression garment for strenuous activity (i.e. weight lifting, prolonged standing, running).
  3. Consider wearing a well-fitting compression garment for air travel.

V. Extremes of Temperature

  1. Avoid exposure to extreme cold, which can be associated with rebound swelling, or chapping of skin.
  2. Avoid prolonged (> 15 minutes) exposure to heat, particularly hot tubs and saunas.
  3. Avoid immersing limb in water temperatures above 102° F.

VI. Additional practices specific to lower extremity lymphedema

  1. Avoid prolonged standing or sitting.
  2. When possible, avoid crossing legs.
  3. Wear proper, well-fitting footwear.

 

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

St. Luke’s*Idaho Elks Rehabilitation Services (SLIERS)

Boise Idaho

Lymphedema: Links of Interest

Here are some links you may find of interest in relation to Lymphedema…
The National Lymphedema Network http://www.lymphnet.org/ is an organization that provides education and guidance to lymphedema patients, health care professionals, and the general public.
The American Cancer Society’s http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Lymphedema_5.asp   page about breast cancer and lymphedema.
LymphNotes.com http://www.lymphnotes.com/index.php is an independent source of objective information about lymphedema.
The Susan G. Komen Breast Cancer Foundation http://ww5.komen.org/ is a global leader in the fight against breast cancer, through its support of research and education.
LymphesDIVA http://www.lymphedivas.com/   LympheDIVAs™ LLC is dedicated to creating medically correct fashion: compression apparel for the savvy and stylish breast cancer survivor with lymphedema, which will inspire her to feel beautiful, strong, and confident.
The Young Survival Coalition http://www.youngsurvival.org/ (YSC) is a nonprofit dedicated to the concerns and issues that are unique to young women and breast cancer.
Living Beyond Breast Cancer http://www.lbbc.org/ is a nonprofit organization dedicated to empowering all women affected by breast cancer to live as long as possible with the best quality of life.
Breastcancer.org http://www.breastcancer.org/ is a nonprofit organization dedicated to providing the most reliable, complete, and up-to-date information about breast cancer.
Lymphedema People http://www.lymphedemapeople.com/  is a website created for, and by, people with lymphedema.
Shop Well with You  http://www.shopwellwithyou.org/  (SWY) is a nonprofit organization and body-image resource for women surviving cancer, their caregivers and healthcare providers.
eLymphNotes http://www.elymphnotes.com/ is an online magazine on lymphedema published by the Lymphedema Awareness Foundation, Inc. (LAF).
Slice of Fashion LLC http://www.sliceoffashion.com/ makes accessories for women with lymphedema.
KT Foundation http://www.ktfoundation.org/ is a group of volunteer advocates for those afflicted with Klippel-Trenaunay Syndrome (KTS.) The Foundation is a working center providing the latest medical news on KTS, an up-to-date list of specialists and accurate information to support individuals with KTS.
The Annie Appleseed Project http://www.annieappleseedproject.org/  is a great resource for information on complementary and alternative therapies for cancer patients.
Pink-Link    http://www.pink-link.org/   is an online breast cancer support group.
Bella Bandanas http://www.bellabandanas.com/ makes custom designed Swarovski crystal bandanas.
Spirited Sisters™ http://www.healingthreads.com/ and it’s Healing Threads™ Collection of Designer Hospital Gowns understand the physical and emotional demands of fighting any illness. These garments are sophisticated, attractive, comforting and dignified.
Haralee.com http://www.haralee.com/ creates fantastic sleepwear and pillowcases which are made of wick-away fabrics so hot flashes do not ruin your sleep! These fabrics draw perspiration away from the body to the fabric where it evaporates quickly- just like LympheDIVAs sleeves!
 
I hope these are helpful
 
Sonja M. Maul PT, CLT-LANA
National Board Certified Lymphedema Therapist
St. Luke’s*Idaho Elks Rehabilitation Services (SLIERS)

Lymphedema: Medicare Coverage and the Lack There Of

Medicare covers the treatment of Lymphedema under Physical Therapy Services, but the compression bandages, garments and devices required are not covered.  Here is a portion of an article written by Robert “Bob” Weiss, M.S. NLN LE Legislative Advocate, which can be found on the National Lymphedema Network website,   http://www.lymphnet.org/

Medicare Coverage of Compression Garments:    Current Medicare policy does not cover the cost of the compression bandages, garments and devices required in the daily Phase 2 treatment of lymphedema. In mid-2000 Robert Weiss and the NLN made formal requests for a National Coverage Determination (NCD) on the treatment of lymphedema. Responses from the HCFA (now CMS) Coverage and Analysis Group centered around the claim that “the supplies, namely the compression garments used for the treatment of lymphedema, do not fall within a separate benefit category set forth in the Social Security Act.” (Dr. Sean Tunis, Director, in a letter dated March 1, 2001 ).

This unsubstantiated statement from HCFA/CMS, the basis for continuing denials of compression bandages and garments, has been disputed by Medicare Administrative Law Judges (ALJs) around the country. Most recently, four different California ALJs ruled in four different cases that compression bandages, sleeves and stockings used in the treatment of lymphedema meet the statutory definition of “prosthetic devices” in §1861(s)(8) of the SSA as expanded by CMS Pub. 100-2, Medicare Benefit Policy Manual , Ch. 15, §120 Prosthetic Devices.

On January 2, 2007 a request was made to CMS to add over 100 new and revised codes to the HCPCS Code Book for lymphedema treatment supplies. The CMS HCPCS Workgroup rejected this proposal on November 2, 2007 without referring to legal and medical arguments presented, only stating that “no insurer (i.e. Medicare, Medicaid, Private Insurance Sector) identified a national program operating need to establish unique codes to distinguish all the products listed in this application. Existing codes adequately describe the array of products available.    

In a recent discussion with SADMERC, the Medicare contractor responsible for developing and maintaining HCPCS codes, I was asked whether I was working with the manufacturers, since I have no standing to submit specific requests for product coding. In August 2006, while preparing the formal request for HCPCS code changes, I contacted major manufacturers of compression bandages and garments (i.e. Bellisse, BSN Jobst, CircAid, Derma Sciences, Hartmann-CONCO, Innovative Medical, Juzo, KT Medical, Lohmann Raucher, Medi, Lohmann, Peninsula Medical, Sigvaris-Ganzoni, Solaris, Telesto) asking them to submit requests to list their products as prosthetic devices with an L-code to demonstrate that there is a need for change. To my knowledge, no formal requests were submitted.

Robert “Bob” Weiss, M.S.
NLN LE Legislative Advocate

Check out more Legislative Updates at    http://www.lymphnet.org/lymphedemaFAQs/legislation/legUpdates/legUpdates.htm

 

 

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

St. Luke’s*Idaho Elks Rehabilitation Services (SLIERS)

 

Exercising for Lymphedema Guidelines

The lymphatic system and circulatory systems are greatly affected by active muscle contraction, which helps assist transport of lymph and blood supplies to tissues and organs.

·        Exercise only with the limb in a compression garment or wrap.

·        Include your Deep Abdominal Breathing before and after every exercise program.

·        Do not wear tight restricting clothing (eg.  Bra straps, tight underwear, etc.)

·        Perform each exercise in a slow, controlled manner.  If any exercise causes pain, decrease number of repetitions or do not perform that particular exercise.

·        Alternate each contraction of the muscle with equal time of full relaxation.

·        Progress exercises slowly as to avoid soreness.

·        After exercising, rest and elevate the limb for 15 to 20 minutes.

If you have just had/performed Manual Lymph Drainage massage you should rest 20-30 minutes before beginning exercises.

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

Lymphedema: Risks of Not Treating

Some may become overwhelmed by the concept of having to deal with the chronic condition of Lymphedema, especially if they have already gone through so much with cancer treatments.  It is a personal choice to manage, or not to manage, any medical condition.  The risks of not managing Lymphedema include:

·        Continued increasing size of the arm/leg.

·        Risk of recurrent infections (Cellulitis) that may require hospitalization on IV antibiotics.

·        Skin changes:  dry flaking, yellow scaling, wart like growths, lymph blisters…

 

The earlier you start managing Lymphedema, the easier and quicker it is to get it under control, though at any point in the process CDT can make significant improvements and improve quality of life.

 

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

 

Lymphedema: Effects of Pregnancy

Pregnancy is a unique situation for a woman’s body.  The hormones released during pregnancy and the expanding uterus can affect the expectant mother’s veins.  Consequently, one in three women experience common vein ailments such as heavy, tired, aching legs or swollen feet and ankles.  Existing varicose veins tend to worsen during pregnancy.

These conditions occur for several reasons, including:

  • Increase of blood volume.
  • Loss of venous wall tonicity from Relaxin in the system.
  • Increased pressure in the leg veins, caused by the position of the baby.
  • Change of blood consistency.

 

The likelihood of pregnancy-related venous disorders is further increased if the following factors are present:

  • Family history of venous disease.
  • Pre-existing venous conditions.
  • Multiple pregnancies.
  • Prolonged sitting or standing.

 

These factors on their own cause swelling in the legs (and arms) of many, so in the presence of already existing Lymphedema it can, and most likely will, aggravate swelling as it further stresses the lymph system.

 

This is a time to be extra diligent at your Lymphedema Home Maintenance Program.  You may find increasing the number of times per day you do your Self Manual Lymph Drainage Massage may help.

 

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist