A Proposed Exercise Pathway for Recovery Enhancing the lymphatics during recovery

› Review of the Lymphatic System

Understand how exercise can enhance lymphatic function

Finding your limits

Evidence-based guidelines: an exercise pathway for recovery including a model for weights training

Post-op exercises (evidence-based)

Encore program (evidence-based)

Dragon boating (evidence-based)

Gym Cardio, Weights (evidence-based

guidelines)

Yoga/Pilates/ tai-chi

(some evidence)

Physio, exercise professional

(follow guidelines) ???’Other’

Lymphatic System › Waste disposal system (‘storm water drain’) › Essential for effective circulation › How does lymph fluid circulate? Intrinsic pump of lymphatic vessels Pump of large arteries close by Deep breathing Muscle pump

2-3L of fluid is returned to the blood in 24hrs 40% of lymph is produced in muscles

One-way system › Fluid forms in the interstitial space = lymph › Initial lymphatics → lymph vessels → lymph

nodes › Contains water, protein, electrolytes, fats,

fat/chyle, antigens Surgery vs. Lymphatics

› System becomes sluggish, ‘clogged/slow stormwater drain.’

› Initial lymphatics → lymph vessels → lymph nodes

What goes in must come out!!

Initial lymph formation

Lymph nodes /stormwater processing

Waste disposal + back to general circulation

Exercise

Heat e.g. sun/sunburn, hot spas, Infection

Exercise

Garments, other strategies

Courtesy of NBOCC

Risk factors for the development of BCRL include; › Extent of breast and axillary surgery › Axillary radiotherapy › Being overweight/obese › Infection and trauma to the affected side › Air travel › ?Exercise

Approximately 20% likelihood

Lymphatic Function and Arteries › 40% of the body’s lymph fluid is produced

within muscles › Lymph formation is directly proportional to

arterial flow i.e. more vigorous activity, more lymph formed Implications for lymphoedema???

› By-products of exercise like lactic acid further increase blood flow to the muscles Leads to increased lymph fluid production

Arteries pulse near lymph vessels

Lymphatic Function and Veins › Veins transport the blood from the muscles

back to the heart › Return of blood to the heart is increased by

a combination of movement and muscle activity (similar to lymphatic flow)

› Static positions and exercises decrease venous flow and increase pressure in the surface veins Increase load on the lymphatic system

Enhanced lymph flow overall

- Consider lymphatic principles to enhance

the overall effect!! - WHAT COMES IN MUST COME OUT!!

Faster lymph

formation

Deep breathing Slow and controlled exercises/movements Consider exercise in the water e.g. swimming Warm up and cool down periods

recommended Build up both aerobic and strength activities

over time (weeks/monghts) to allow circulation, including lymphatics to adapt to new activities

??Caution with high intensity + highly repetitious weights programs › e.g. Pump classes and sustained positions

during exercise More research required to determine the

whether high intensity aerobic and resisted exercise increases risk of BCRL

Components of Lymphatic Massage › Deep

breathing › Lymph

node massage

› Stroking › Exercises

DOES LYMPHOEDEMA CHANGE THIS??

Post-op exercises (evidence-based)

Encore program (evidence-based)

Dragon boating (evidence-based)

Gym Cardio, Weights (evidence-based

guidelines)

Yoga/Pilates/ tai-chi

(some evidence)

Physio or personal trainer

(follow guidelines) ???’Other’

What comes in must come out Exercise as ‘medicine’ Optimise your lymphoedema self-

management regime, ‘stabilise’ for exercise??

Address barriers to this regime Do something you enjoy!!

Questions?

Positive Motion Physiotherapy

› University of Canberra Faculty of Health Clinic (Bruce Campus) ph: 6201 5843

› liz@positivemotion.com.au

Early Intervention › Skin Care + treat/prevent infections › Lymphatic Massage Self-massage (TMEPR) Lymphoedema Therapist (MLD)

› Compression Garments › Exercises (specific lymphatic) › General Activity (‘Exercise as medicine’)

Aim to ‘reverse the backflow’ or ‘unclog the pipes’ of the stormwater drain!!

Low level laser therapy › Handheld › Scanning

Pneumatic Pumps Bodyflow/TENS

Kinesiotape for chronic swelling › Various shapes e.g. fans, strips › Application

Courtesy Kinesiotape for Lymphoedema and Chronic Swelling

Moderate to Severe Lymphoedema › Multilayer compression bandaging › Short stretch bandages + padding › Various treatment regimes

Courtesy lymphademaininfo.blogspot.com

Exercise!! Massage Compression garments Special stretches/lymphatic pumping

exercises General activity Bandaging and CPT Emerging Treatments