Water Exercises for Lymphedema

Introduction

Water exercise, also known as hydrotherapy or aquatic therapy, consists of activities and exercises that are performed while immersed in water. These activities, including swimming and movements in the water, are particularly beneficial for those with lymphedema because:

• The support of the water makes possible motions that could not be achieved in other settings.
• The ease of movement through the water relaxes the muscles, decreases pain sensations, 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 movement 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 during movements that strengthens muscles and improves cardiac and respiratory conditioning.

Photo courtesy of the West Virginia Lymphedema Network

Wearing Compression Garments During Water Activities

• The hydrostatic pressure of the water replaces the need for a compression garment as long as the affected limb is under the water most of the time.
• Some therapists do 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 is recommended because chlorine in the water is destructive to the compression value of 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.
• 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, helps to soften fibrotic tissues and relaxes the muscles. A therapeutic session is usually 50-55 minutes spent in the water.
• Hot water that exceeds 94° F (34.4° C) degrees should be avoided because heat makes lymphedema worse. Also very warm water, which raises the core temperature of the body, can cause other complications such as added strain on the heart during strenuous activity.

Important Precautions

• 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 so you can take a refreshing sip as needed.
• Protect your affected limb. You do not want the skin on the affected limb to get dried out from being in the water too long. Applying a protective lotion over that area before going into the water is a good idea. If you are out in the sun, a combination of moisturizing lotion and sunscreen should 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 the skin is dry, use an antifungal powder particularly between the 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.

• 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 the shoulders, relax, and let your arms float.

• Turn the elbow of the affected arm down and then 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 Strokes

Swimming improves your muscle tone and encourages 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.

References

Aqua Lymphatic Therapy for Postsurgical Breast Cancer Lymphedema by D. Shimony and A. Drouin. 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, A. Vinjé-Harrewijn PT, CLT, and E. McMahon. Lymph Notes, 2005, pages 185-194.

Water Exercise by Martha White. Human Kinetics, 1995.

© LymphNotes.com 2007.This information does not replace the advice of a qualified health care professional.

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Category: Self-Care for Lymphedema Updated: 2007-01-29