Exercises in the pool

Hello fellow lymphedemas,

            As we all know, once breast cancer surgeries, chemotherapies, irradiations etc are over, then the corresponding arm, or both arms may start to swell.  Lymphedema!  If left untreated lymphedema can be life-threatening; as there is little immunity, a life-threatening infection may develop (cellulitis) and in rare cases a rare type of cancer.  For these reasons the swelling must be controlled, with exercises that help move the lymph, with specialized massage therapy and above all with compression bandaging. The latter can be very effective, but it can be dangerous too, because any scratch or scrape or the compression itself even, if it presses at the same point can trigger an infection.  The lymphatic vessels are very superficial unfortunately, and easy for bacteria to reach.

            Exercising helps, and in addition to reducing lymphedema, recent research has shown that it can act as a drug in inhibiting the proliferation of whatever residual cancer cells may still be present after treatment (Cancer Research 77:4894-4904, 2017). 

However, depending on the case, the heat generated with the exercise may exacerbate the swelling.  This can get worse because of the hot flashes caused by menopause or the anti-estrogen drugs (tamoxifen or aromatase inhibitors) used to treat the cancer, and the hot flashes can get worse with the exercise in some women.

Here comes the importance of exercises in the water. The heat dissipates and disappears, which also feels great in the summer. Besides, as the arms float, you can move more freely and gently and the hydrostatic pressure of the water is the best possible kind of pressure, that cannot be imitated or duplicated by any bandage.  You don’t even feel the pressure as it is so perfectly uniform, although even at 1 meter the pressure is greater than the sleeves or bandages!

I used to swim and skin-dive deep years ago.  The bottom of the sea, even at 2 meters is an incredible world.  This is why I went into Biology, then Cell Biology, Virology and Cancer research.  When lymphedema set in, I started swimming with strong flippers on and the arms extended forward. The flow of the water has to be from the fingertips to the trunk, not as in “crawl” swimming.  Diving deep also helps (it is the opposite of flying…) with the increased pressure, although the excessive pressure may cause a rebound effect.

Dorit Tidhar is a physiotherapist originally from Israel.  She has worked with and trained by Dr Anna Towers of McGill University in Montreal, the lymphedema expert. She has developed a series of exercises to do in the pool that are demonstrated in a video. In principle, you massage the nodes first to stimulate them to start pumping, and to make space for the lymph to go to. On the temples, neck, under the clavicles, the groin. Then massage from the fingers towards the trunk and to the Lymph nodes.

When swimming in the sea I keep sleeves/gloves on for protection from sunburn, jelly fish or scrapes.  I take them out for the swimming pool. Make sure the pool is clean because you are prone to infections.

BCAK has purchased this video and you can view it or borrow it.  Or, you can purchase it yourself ($60US).  The information with a short description is at the link below. 

Happy swimming!

Leda Raptis,

December, 2019


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