Pilates and Lymphedema

This question was sent and responded to through email, but we thought others might be interested!

Hello,
I am a Peak Pilates Certified Trainer in Bradenton, Florida. I have a client that has severe lymphedema and I would like to train her. Her arm is always swolen and she generally has 2-3 infections per year. I am not able to attend you Breast Cancer class but would be interested in purchasing the materials, perhaps. I look forward to hearing from you.

Patty McIntosh

Answer from Melanie Byford-Young:

Hi Patty!
Pilates can be an excellent approach to help her general health and lymphedema. There are several main things that you need to know and keep in mind.
1) Make sure you get clearance from your client’s physician before beginning any exercise program.

2.) wearing her compression garment is a great idea, especially at the beginning, or until you know how she is going to react to the activity.
3.) Diaphragmatic breathing can help stimulates the pumping of the lymphatic system, which will hopefully help with her swelling. Adding lymph massage throughout the session can be very useful if she or you know how to do that.
4.) You do NOT want to overwork the arm! It is suggested that you begin with breathing and some abdominal work to help stimulate the lymph system, then do some leg work; then start some arm work moving the proximal muscles/ joints first, then progressing to the more distal muscles and joints, and then to return to the proximal/ shoulder muscles to help get blood and lymph moving and clearing from the arm. Follow this up with more abdominal and breath work. You can repeat these steps throughout the workout. Minimally, start with the trunk, and then alternate between leg and arm work so as to not overtax the affected arm.
5.) In the past, women with lymphedema were told to never lift anything heavier than 10 pounds. This advice has changed recently, and experts suggest beginning with very light resistance and progressing very slowly. There is a great website www.lymphnotes.com where you can do some more reading on the topic.
6.) You always must consider whether your client has osteoporosis because of her treatments. If there is any concern that she may have decreased bone density, avoid all inverted positions, avoid thoracic flexion and avoid combined flexion and rotation. If she has osteoporosis in her hips, avoid full compression of the hip in a flexed position. If her wrists are involved, then avoid weight bearing through the wrists. Make sure that you include balance work to help prevent falls and fall related fractures. Again, make sure her physician has given her approval and that there are no special exercise modifications to take into consideration.
I cannot take the credit for putting together the STOTT PILATES® Breast Cancer workshops and DVDs, another team created them. The mat and equipment DVDs are excellent and provide a very good introductory preamble,as well as a well balanced exercise program. You can order them on line at www.stottpilates.com or call 1-800-910-0001.
I hope this helps you out. Good luck to you !

Tagged as: advice, bone density, Breast Cancer, breathing, compression garment, exercise, Lymphedema, Melanie Byford-Young, modifications, osteoporosis, Pacific NW Pilates, pilates, Pilates Angels, STOTT PILATES®, STOTT PILATES® Cadillac, STOTT PILATES® Injuries and Special Populations, STOTT PILATES® Reformer, STOTT PILATES® Rehab Program