How to Do Arm Lymphedema Exercises

1
Prepare for Arm Lymphedema Exercises

Arm Lymphedema
How to do arm exercises for lymphedema. Illustration © Pam Stephan

Breast cancer treatment, unfortunately, can have long-term complications. Arm lymphedema after lymph node removal (an axillary lymph node dissection, a sentinel node biopsy,) or even from breast cancer surgery without lymph node removal can be uncomfortable and very frustrating. Trauma to the lymphatic vessels during surgery or from ​radiation therapy causes extra fluid to build up in your hand or arm causing swelling.

The idea behind arm exercises is that muscle contractions in your arm may help move lymph fluid back to the veins in your armpit and neck; returning the fluid to your blood circulation. When the lymph fluid goes back into circulation, your swelling should go down.

These simple gentle exercises can help the proteins in lymph fluid to be reabsorbed, and your arm lymphedema symptoms to diminish or disappear. Be sure to discuss your exercise plans with your doctor—before you start. Your doctor may also refer you to a physical therapist who can help you learn these exercises, and teach you others as well.

If you have recently had surgery, wait until your surgical drains and sutures are out before trying these exercises. Do these exercises gently—you’re not body building here—and do not exercise to the point of pain. Always wear your compression sleeve on your affected arm while exercising. Stop exercising if your arm begins to swell or turn red.

Dress in loose, comfortable clothing—style is not important for these exercises. Warm your affected arm and hand before starting to exercise—take a shower, tub soak, or use a warm compress for about 20 minutes. Be regular about doing your arm lymphedema exercises. This will aid your recovery and give you the best results.

Here's what you need on hand to get started:

  • A set of 1 pound free weights
  • Your compression sleeve
  • A small flexible ball
  • A hard chair to sit on
  • An area big enough to lay down on
  • Optional: A pair of walking poles: Fitness, Nordic, or Exerstriding poles

Ready? Let's start with some seated exercises.

2
Ball Squeeze—Seated Exercise

Ball Squeeze Exercise
Ball Squeeze Exercise. Illustration © Pam Stephan

The ball squeeze exercise is done while you are seated and is a good way to gradually work into your other exercises. You can do the ball squeeze exercise with your surgery-side arm, as well as with your unaffected arm.

Use a flexible ball that is a bit larger than your palm. Your exercise ball should not be heavy and should offer some resistance to your grip. The proper ball will spring back into shape when you release it but will require some pressure to squeeze it. You will feel muscles in your fingers, lower and upper arm working as you do the ball squeeze. This muscle movement should help move excess lymph fluid back into circulation and help you avoid swelling.

Here's how to do the ball squeeze exercise:

Remember: Always wear your compression sleeve on your affected arm during exercise.

  1. Sit or stand with good posture—keep your back and neck straight and your shoulders relaxed. Grasp your exercise ball lightly between your palm and fingers. Extend your arm in front of you, holding your arm higher than your heart.
  2. While keeping your arm elevated, squeeze the ball with your fingers as tightly as you can. Hold the squeeze for about 3 seconds, then release.

Repeat the ball squeeze exercise 5 to 7 times. If your arm tires quickly, take breaks. You will gradually build up enough strength and stamina to do the ball squeeze several times without resting.

3
Elbow Flexion—Seated Exercise

Elbow Flexion Exercise
Elbow Flexion Exercise. Illustration © Pam Stephan

The elbow flexion exercise uses your upper arm muscles, which are close to your axillary lymph nodes. As these muscles work, lymph fluid can be pumped back into your system and absorbed, reducing arm lymphedema.

You can do the elbow flexion exercise with both arms. Use a one-pound free weight in each hand during this exercise. You will feel muscles in your lower and upper arm working as you do the elbow flexion.

Here's how to do the elbow flexion exercise:

Remember: Always wear your compression sleeve on your affected arm during exercise.

  1. Sit or stand with good posture—keep your back and neck straight and your shoulders relaxed. Hold a one-pound free weight in each hand with your palm up. Rest your hands on your lap.
  2. Slowly bend your elbows and lift both hands towards your chest. When your hands are halfway up, stop lifting and hold the position for about six seconds.
  3. Now slowly lower your hands back down to your lap. Rest a bit.
  4. Repeat this exercise 10 times, always moving gently.

If your arm gets tired or begins to swell, take breaks. You will gradually build up enough strength and stamina to do this exercise without resting. Try using heavier weights as you feel comfortable.

4
Elbow Extension—Floor Exercise

Elbow Extension
Elbow Extension. Illustration © Pam Stephan

You can do the elbow extension exercise with both arms. You will feel muscles in your lower and upper arm working as you do the elbow extension. Gentle muscle movement should help excess lymph fluid move back into circulation and help you avoid arm swelling.

Here's how to do the elbow extension exercise with small free weights.

Remember: Always wear your compression sleeve on your affected arm during exercise.

Lie down on your back, keeping your back and neck in a straight line. To help keep your lower back flat, elevate your knees. Your feet should be flat on the floor, shoulder width apart. Don't keep your knees together—like your feet, they should be spaced apart. Use a one-pound free weight in each hand during this exercise. Your hands should be shoulder's width apart during this exercise.

  1. Keep your back and neck straight and your shoulders relaxed. Hold a one-pound free weight in each hand with your palms facing in towards each other. Raise both arms straight up above your body.
  2. Slowly bend your elbows and lower both hands towards your chest. When your elbows are bent at a 90-degree angle (see image), stop moving and hold the position for about six seconds.
  3. Now slowly raise your hands back up to position 1. Rest a bit.
  4. Repeat this exercise 10 times, always moving gently.

If your arms feel tired or they start to swell, take breaks. You will gradually build up enough strength and stamina to do this exercise without stopping. Try using heavier weights as you feel comfortable.

5
Shoulder Horizontal Adduction

Shoulder Horizontal Adduction
Shoulder Horizontal Adduction. Illustration © Pam Stephan

Shoulder adduction means to bring your shoulder and arm closer to the midline or center of your body, in a horizontal plane.

You can do the shoulder horizontal adduction with both arms. You will feel muscles in your shoulder and arm working as you do the shoulder adduction. Gentle muscle movement should help excess lymph fluid move back into circulation and help you avoid arm swelling.

Here's how to do the shoulder horizontal adduction with small free weights.

Remember: Always wear your compression sleeve on your affected arm during exercise.

Lie down on your back, with your knees elevated. Keep your back and neck in a straight line. Your feet should be flat on the floor, with your feet and knees shoulder width apart. Use a one-pound free weight in each hand during this exercise.

  1. To begin, keep your back and neck straight and your shoulders relaxed. Extend your arms away from your body, resting them on the floor. Hold a one-pound free weight in each hand with your palms facing the ceiling.
  2. Without bending your elbows, slowly raise both arms straight up above your body until you can bring your palms together. Hold this position for about six seconds.
  3. Now slowly lower your arms back up to position 2. Rest a bit.
  4. Repeat this exercise 6 times, always moving gently.

When your arms feel tired or start to swell, just rest. You will gradually build up enough strength and stamina to do this exercise without stopping. Try using heavier weights as you feel comfortable.

6
Shoulder Flexion—Standing Exercise

Shoulder Flexion
Shoulder Flexion. Illustration © Pam Stephan

Shoulder flexion uses your deltoid (shoulder) muscles and the front of your shoulder. Holding a light free weight while doing the shoulder flexion helps put some light pressure on your axillary lymph node area, and may help it drain.

You can do the shoulder flexion exercise with both arms. You will feel muscles in your shoulder and arm working as you do the shoulder flexion. 

Here's how to do the shoulder flexion exercise:

Remember: Always wear your compression sleeve on your affected arm during exercise.

  1. Stand with good posture, arms at your sides. Hold a one-pound free weight in each hand, palms toward your body.
  2. Slowly raise both arms, using a gentle controlled motion. When your arms are almost directly overhead, pause and hold this position for six counts.
  3. Now slowly lower your arms—don’t swing, but use control—until your hands are back beside your body. Rest.
  4. Repeat the shoulder flexion 10 times.

When your arms feel tired or if they start to swell, stop and rest. You will gradually build up enough strength and stamina to do this exercise without stopping. Try using heavier weights as you feel comfortable.

7
Shoulder Abduction—Standing Exercise

Shoulder Abduction
Shoulder Abduction. Illustration © Pam Stephan

Shoulder abduction means to move your shoulder and arms away from the midline or center of your body. This is the opposite of shoulder adduction, moving your arms in towards your center. Holding a light free weight while doing the shoulder abduction helps put some gentle pressure on your axillary lymph node area, and may help your excess lymph fluid to drain.

You can do the shoulder abduction exercise with both arms. You will feel muscles in your shoulders and arms as well as your shoulderblade working as you do the shoulder flexion. Controlled, gentle muscle movement should help excess lymph fluid move back into circulation and help you avoid arm lymphedema.

Here's how to do the shoulder abduction exercise:

Remember: Always wear your compression sleeve on your affected arm during exercise.

  1. Stand with good posture, arms at your sides. Hold a one-pound free weight in each hand, palms facing forward.
  2. Slowly raise both arms out to your sides, using a gentle controlled motion. When your arms are not quite overhead, pause and hold this position for six counts.
  3. Now slowly lower your arms—don’t drop your arms, but use a controlled motion—until your hands are back beside your body. Rest.
  4. Repeat the shoulder abduction 10 times.

When your arms feel tired or if they start to swell, stop and rest. You will gradually build up enough strength and stamina to do this exercise without stopping. Try using heavier weights as you feel comfortable.

8
Pole Walking—Standing Exercise

Pole Walking
Pole Walking. Illustration © Pam Stephan

Pole walking, also called Nordic walking, uses your arms, shoulders, upper chest and back muscles. While you're getting a good cardio workout, all your major joints are exercised, and your muscles will get stretched and lengthened.

When done properly, pole walking is done while your arms are relaxed. Your shoulders will be working in a swinging motion, similar to shoulder flexion, but with a greater range of motion. This continuous motion should help excess lymph fluid move back into circulation and help you avoid arm lymphedema.

Here's how to do the pole walking exercise:

Remember: Always wear your compression sleeve on your affected arm during exercise.

Use a set of fitness walking poles that have a hand strap at the top. The poles should remain behind your stride and always point diagonally backward as you walk. These will help you exercise your shoulders, assist with balance, and provide support for knee joints and leg muscles. Keep your shoulders relaxed and hold the poles near your body.

  1. Step forward with your right foot, and swing your left arm forward, up to waist height. Your left pole hits the ground just behind your right foot.
  2. Keep your torso upright, don't lean forward as you walk.
  3. Let your right arm straighten out behind you, forming a line that ends at the tip of your right pole. Roll your left foot from heel to toe as you walk, pushing off with your toe.
  4. Alternate feet and poles, while maintaining good posture as you pole walk.

It may be a little nerve-wracking doing some of the more active of these exercises. We are learning, however, that even resistance exercise training at intensities enough to gain strength appears to be safe without a risk of provoking lymphedema related to breast cancer. Learn more about lifting weights with lymphedema.

Bottom Line on Exercises to Help Prevent or Treat Lymphedema

The exercises above are typical exercises recommended for women coping with lymphedema. That said, your physician or your physical therapist may have a different take on which exercises would be helpful for you and which ones you might want to avoid. There is currently a lot of research in progress looking for newer and better ways to manage the frustrating symptoms of lymphedema. It should be stressed again that you should not begin these exercises until you are well healed from your breast cancer surgery and your surgeon tells you it is okay to begin exercising.

Research has been demonstrating that arm exercises can reduce swelling, but how much of an effect it has on prevention has not been well studied. We know that lymphedema can occur anytime after breast cancer surgery, with reports of people first developing these symptoms as many as 50 years after a mastectomy. 

Since the science behind exercise and lymphedema is still young, it's important to stay abreast of findings and/or changes in recommendations. As with all aspects of your care, it's important to be your own advocate in your cancer care.

Practicing these exercises can take time out of your schedule, and you may be tempted to give up. Instead of viewing this exercise as a burden—yet another leftover side effect of treatment—it might help to view this as a positive. Studies have found that many women who survive breast cancer become healthier with regard to eating and exercise habits, and these exercises are a way of starting a healthy habit. Yet that's not all. In fact, we are learning that having cancer can change people in positive ways. Not just with regard to lifestyle, but when it comes to compassion and an appreciation of life.

Sources:

Di Blasio, A., Morano, T., Bucci, I. et al. Physical Exercises for Breast Cancer Survivors: Effects of 10 Weeks of Training on Upper Limb Circumferences. Journal of Physical Therapy Sciences. 2016. 28(10):2778-2784.

Morris, C., and K. Wonders. Concise Review on the Safety of Exercise on Symptoms of Lymphedema. World Journal of Clinical Oncology. 2015. 6(4):43-4.

Nelson, N. Breast Cancer-Related Lymphedema and Resistance Exercise: A Systematic Review. Journal of Strength and Conditioning Research. 2016. 30(9):2656-65.

Continue Reading