Let's Get Physical
Let's get our Lymph Flow On....
As a kid, I LOVED Olivia Newton-John! This song was the anthem to every 80’s kid’s dance as an exercise activity. We would deck ourselves out in leotards, leg warmers, and sweat headbands while kicking and stretching to the lyrics, “Oh, let’s get physical, physical, I wanna get physicaaaalllll.” I am sure this song had almost nothing to do with exercising, but as young kids, we believed that exercising and having fun was important while also looking cool.
As a physical therapist, our whole approach to practice is helping people work through their injuries, physical impairments, and disabilities to better their movement and mobility. We want to help our clients get physical and hopefully have fun too! How does this tie into lymphatic dysfunction disorders like lymphedema and lipedema? Let’s talk about movement and the lymphatic system!
Remember, there are 5 equally important pillars of Complete Decongestive Therapy (CDT): Compression, Manual Lymphatic Drainage (MLD), Remedial Exercise, Meticulous Nail and Skin Care, and Self Care Management. In a busy clinic visit, we therapists can sometimes place too much of our focus on bandaging and MLD. But I know from experience that once a patient goes home in their bandaging, they forget to move! Perhaps it’s the weight and bulk of the bandaging. We don’t want you to go and run a marathon in your bandages, but we want you to MOVE.
Why is movement so important? How do MLD, bandaging, and remedial exercises all fit together? Let’s dive into the anatomy of the lymph system.
The lymphangions (or lymphatic vessels) run alongside your arteries and veins. The deepest vessels run along the muscle bellies of your large muscles like the calf or biceps muscle. As you “pump” your muscles, you are “pumping” the lymphatic fluid through the vessels toward the lymph nodes for processing. The more you pump, the more lymph moves. In exercise, your rate of lymphatic flow can increase by 3 to 6 times! When someone is bandaged, the compression and materials of the bandaging act like a trampoline, giving your muscles even more power to move lymphatic fluid! Compression helps to Pump Up (Out?) the Volume (of stagnant lymphatic fluid). It is important that if you are undergoing intensive Complete Decongestive Therapy or have mild to severe lymphedema, you have your compression in place (bandages or garments) while engaging in exercise.
What are some easy ways to increase your lymphatic flow?
Aquatic Exercise! Studies have shown its effectiveness for those with lymphatic dysfunction. Water-based exercise helps to decrease gravity on joints due to water buoyancy. Depending on how far you submerge, you can decrease the weight of the joints up to 90%. This can help to make the limbs feel less heavy.
The pressure provided by the water due to a force caused by hydrostatic pressure, will act like the World’s Best Compression Garment! The water acts like the perfect fit and gradient, from the bottom being the highest amount and near the surface, the lowest. No need to wear your cloth compression garments when doing aquatic exercise.
Water not your thing? Well, many land-based exercises help to stimulate lymphatic flow as well. Walking, yoga, tai-chi, cycling, dancing, hiking, and rebounding. The important thing is to engage in exercise or physical activity that brings you joy.
The American Academy of Sports Medicine, U.S. Centers for Disease Control, and The World Health Organization all recommend:
Adults should participate in moderate-intensity aerobic physical activity for a minimum of 30 minutes on five days per week, or vigorous-intensity aerobic activity for a minimum of 20 minutes on three days per week.
AND
A minimum of two days per week, participate in activities that maintain or increase muscular strength and endurance.
These recommendations do not change for those with lymphatic dysfunction. Several studies support exercise for those with lymphedema:
In 2009 Kathryn Schmitz and her team conducted the Physical Activity and Lymphedema (PAL) Trial, a large randomized control trial with women with lymphedema or at risk of developing lymphedema. One group participated in a guided resistance program (now known as Strength After Breast Cancer). The control group just “went on their own.” The researchers found that those who were in Strength ABC did not have increased lymphedema symptoms and improved QOL than the control group. She published the results in 2010, and Strength ABC was born as a program where trainers and therapists can become certified. Join me for one of my sessions!
The Lebed Method, developed by Marc Lebed and Sherry Lebed Davis, is a therapeutic exercise program designed to improve lymphatic function, particularly in individuals with cancer or other chronic illnesses. Now called Healthy Steps, this low-impact program focuses on specific movements and exercises to enhance lymphatic drainage and overall well-being. Studies have shown that the Lebed Method can improve the quality of life, physical function, and emotional well-being in cancer survivors. If you are interested in joining me in a Healthy Steps class every other Monday, find me at The Little Red Door Cancer Agency this Spring in 2025 at their Indianapolis location.
So, let’s get physical and have fun while exercising to make the lymph flow! As always, make sure your physician has cleared you to participate in community-based exercise programs.