Water Exercises for Lymphedema

Family fun on the beach. @ LymphNotes.

Aquatic therapy consists of activities that are performed while immersed in water. These activities include swimming, exercises, and movements in the water guided by a therapist. 

These activities are particularly beneficial for those with lymphedema because:

• The support of the water makes it possible to perform motions that could not be achieved in other settings.
• The ease of movement through the water relaxes the muscles, decreases pain, and increases the sense of well-being.
• The buoyancy and support of the water allows exercise without heavy jarring or impact on the joints.
• The movement of the water against the body assists the flow of the lymph and blood as gentle movements in the water stimulate muscle and skin movement without stressing other body parts.
• The hydrostatic pressure of the water provides resistance that strengthens muscles and improves cardiac and respiratory conditioning.

WEARING COMPRESSION GARMENTS DURING WATER ACTIVITIES

• The hydrostatic pressure of water replaces the need for wearing a compression garment as long as the affected limb is under the water most of the time.
• Some therapists recommend wearing a compression sleeve if the affected arm is out of the water during most of the exercise session.
• If a sleeve is necessary, wear an old one because the chlorine in pool water is destructive to the the garment.

WATER TEMPERATURES FOR POOL ACTIVITIES

Strenuous exercises, such as swimming laps, should be performed in much cooler water, usually between 68°F (20°C) and 86°F (30°C) degrees. The cooler the water the longer you can stay in.

Hot water, which is greater than 94°F (34.4°C) degrees, should be avoided because this heat makes lymphedema worse.
Also very warm water raises the core temperature of the body and this can cause other complications such as added strain on the heart during strenuous activity.

Gentle water excerces are beneficial and relaxing. ©Lymph Notes.

Gentle exercises are usually done in water that is 94°F (34°C) degrees or slightly less. Water at, or just below this temperature, feels comfortably warm, it helps to soften fibrotic (hardened) tissues, and it relaxes the muscles. A gentle therapeutic session is usually 50-55 minutes in length.

IMPORTANT NOTES

• Stay hydrated. Your body looses water while you are exercising in the pool. To ensure that you do not become dehydrated, keep a plastic water bottle handy at pool side and take a refreshing sip as needed.
• Protect your affected limb against having the skin dry out due to being in the water too long. Applying a protective lotion is a good idea. If you will out in the sun, a combination of moisturizing lotion and sunscreen work well.
• Pool Hygiene. To avoid fungal infections, such as athlete’s foot, always wear protective footwear when walking to and from the pool and in the shower area. After your water session, when your skin is dry, use an antifungal powder between your toes and in deep creases.

POOL ACTIVITIES: WALKING IN THE WATER

Walking in the water is a good warmup activity to start your pool session. The more relaxed you are, and the more slowly you walk, the better it is for your lymphatic system.

• The recommended time for this activity ranges from 3 to 10 minutes of gentle walking. As you walk in chest level water, concentrate on your abdominal breathing and walk using these basic steps:
• Place your heel on the pool floor and roll on the outer edge of the sole of your foot toward the ball of the foot.
• Then lift your heel and for a moment stand on the tips of your toes. Next lift your foot, bring it forward, and place it on the pool floor again.
• Place the heel of the other foot on the pool floor, roll the outer edge of the sole towards the ball of the foot, and lift the heel. Use your toes to push off, take a step forward, and land on the heel.
• This basic step can be alternated with walking backward or sideways. Walking backward improves the stability of the spine and strengthens the back muscles. Walking sideways improves the stability of the pelvis and hips.

POOL ACTIVITIES: ARM MOVEMENTS

These arm movements can be varied as you continue to enjoy walking in the water.

• As you walk, let your arms trail behind you and enjoy the sensation of the water moving over them.
• If your arm is affected, let your arms float in front of you and gently move them from side-to-side as you walk.
• After your initial warm-up period you may want to increase your pace and swing your arms as if you were power walking.
• For power walking, bend your elbows then swing your arms back and forth as you walk. As you swing your arms forward bring them up toward the surface of the water.

POOL ACTIVITIES: RELAXING SHOULDER ROLLS IN THE WATER

Stand with the water up to the shoulders and relax.

• Let your arms float on the water in front of you.
• Roll your shoulders upward, backward, downward, and forward.
• Your extended, but relaxed, arms will passively follow this movement.
• Repeat these movements in reverse rotation.

POOL ACTIVITIES: HEAD MOVEMENTS IN THE WATER

Stand with the water up to the shoulders and relax.

• Head Tilt. Slowly tilt your head from the center to one side. Then tilt it to the other side and return your head to the center.
• Head Turn. Turn your head to one side and then to the center, then to the other side and back to the center again.
• Shoulder Roll and Head Turn. These head movements may be done with the shoulder rolls mentioned above while relaxing.

POOL ACTIVITIES: HAND PRESSING IN THE WATER
Press the palms of your hands together on the surface of the water and release.

Repeat this movement several times to increase lymph drainage from the arms and shoulders.

POOL ACTIVITIES: ARM LOOPS IN THE WATER

Stand with the water up to your shoulders. Then relax and let your arms float.

• Turn the elbow of the affected arm down and bring it up and towards the front midline of the chest.
• Continue the loop outwards and take the elbow around the side toward the midline of the back of the chest.
• The second loop is continued until the elbow and arm are back to the starting position.

POOL ACTIVITIES: KNEE BOUNCING IN THE WATER

These movements are good exercise for flexibility and muscle movement. They also stimulate the inguinal lymph nodes.

• Stand straight and use the side of the pool to support your back.
• Bounce one knee towards your chest.
• Return that foot to the floor and then bounce the other knee.

NOODLE AND BALL ACTIVITIES

A noodle, also known as a pool floater, or a ball are excellent exercise aids in the water.

• Pushing a noodle down. Hold the noodle, or ball, in front of you and push it down until your arms are fully extended. Then, while still holding the noodle, slowly let your arms come up to the surface.
• Sitting on a noodle. Sit on a noodle as if you are sitting on a swing. Bring both knees upward toward the chest and then push them outward again. This improves abdominal breathing, supports drainage of the groin nodes, and helps to improve your balance.
• Standing on a noodle. Begin in a sitting position on the noodle and then bring your feet up and move into a squatting position on the noodle.
• Push the noodle down to the pool floor and stand on it. Just in case you loose your balance, it is best not to do this too close to the edge of the pool. This activity improves your balance and flexibility. It also improves abdominal breathing, supports drainage of the lymph nodes in the groin, and helps to improve flexibility.
• Walking on the noodle. Once standing on the noodle, take small steps from one side to the other side of the floater. To maintain your balance, you need to turn your feet as you move. This activity improves balance, muscle strength, and flexibility.

Swimming is a great form of water exercise.

SWIMMING STROKES

Specific swimming strokes improve your muscle tone and encourage deep breathing.

• The breaststroke is recommended because it involves gentle stretching motions.
• The butterfly stroke is NOT recommended when one or both arms are affected, because it requires strenuous repetitive movements of the arm.
• Beyond these recommendations, the strokes you use depend on your swimming skills.

SALT WATER ACTIVITIES

Sea water is an excellent medium for aquatic therapy because the salt in the water increases the buoyancy of the body. The salt water also kills many bacteria on the skin.

A salt water pool is a beneficial setting for aquatic exercises and therapy sessions. Enjoying sea water in its natural setting, such as on the beach, is also a wonderful way to relax, have fun, and to get some exercise.

• Caution: If lymphedema affects your lower extremities, always wear protective footwear when walking on the beach or exercising in the sea water.
• Caution: When exercising out of doors, always wear a good sunscreen and reapply it as necessary!
• Caution: Before going into the ocean or a non-chlorinated swimming facility, review the warning about the risk of developing a Mycobacterium marinum infection. This risk is discussed in the article Pets and Lymphedema.

SNORKLELING AND SCUBA DIVING

Scuba diving in cold water.

Snorkeling is a fun way to explore the beauty of under water sights without being too deep in the water.

• If you are able to swim, there is no reason why lymphedema should prevent you from enjoying snorkeling.
• Wearing a t-shirt over your swim shirt is a help in protecting against sunburn but you do not need to wear a compression garment.
• You still need to wear sun screen to protect exposed body parts from sunburn. This includes repeatedly applying it.
• If your feet a are affected by lymphedema, wear underwater footwear to protect your feet from broken shells or other similar hazards.

Scuba diving can be a fun sport that takes you deeper under the water; however, before undertaking this activity, determine that the muscles of your feet and legs have the necessary strength required for this sport.

• If you have not been scuba diving before, taking instructions with a qualified instructor is essential.
• More equipment is needed and this may include a wet suit. Getting it on-and-off may be difficult if your feet and legs are affected.
• Go slow at first as you build up the strength in your feet and legs that you will need to accommodate kicking and the use of flippers.
• If you are exploring rough surfaces, and your arms or hands are affected, long sleeves and gloves are essential to protect yourself against rough surfaces.

REFERENCES

• Aqua Lymphatic Therapy for Postsurgical Breast Cancer Lymphedema by D. Shimony and A. Drouinin the Journal of Rehabilitation Oncology, 2004.
• "Breast Cancer Water Fitness Video" featuring Mary Essert, an experienced international instructor  and breast cancer survivor. For details go to Mary Essert Educational Products
•  Exercise, Lymphedema, and the Limb at Risk by Bonnie B. Lasinski, MA, PT, CLT-LANA.
•  "Living Well with Lymphedema" by A. Ehrlich,MA, A. Harrewijn PT, CLT-LANA, and E. McMahon. Lymph Notes, 2005, pages 185-194.

© LymphNotes.com 2015.This information does not replace the advice of a qualified health care professional.

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Category: Self-Care for Lymphedema Updated: 2015-10-08