Remedial exercises for Upper Extremities

Nitocris

Hello Ladies,

I ordered Steve Norton's DVD "Remedial exercises for Upper Extremities" and have been practicing daily with it.  The program is divided in three parts:  Part I (exercises using only arms and hands) , part II (using a soft ball) and part III (using a yard stick).  I wrote down instructions in Finnish for our little Support Group here and also added illustrations to make it easier to remember the moves.  Our members are now using these exercises regularly and they can pick up the series they want to perform at any time of the day.   Each series is about 15-20mn.  I have text and  illustrations only for Part I and III.  For Part II, I have only written instructions.  The ball used is a 7'' soft ball.

I also prepared an English version based on the DVD.  I am putting the link for Part I below to test if this works:

http://dl.dropbox.com/u/47710826/NORTON%20EXERCISES%20FOR%20ARM%20LYMPHEDEMA-Part%20I.pdf

Lymph drainage exercises are an important part of self-management and should be easily available to many lymphers.  These are clinically accepted therapeutic exercises, but do not replace treatment by a certified professional.  If you are not sure you can perform some of the moves, always ask the opinion of your therapist.  There is also a DVD for lower extremities and genital LE.  Steve Norton demonstrates all the exercises with one arm wrapped up in bandages and his instructions are slow-paced and very clear.   Here is the link where you can find those DVDs in case you are interested.

http://www.lymphedemaproducts.com/products/videos.html

Steve Norton's material is used with his permission. 

Remedial exercises are better performed with compression. Here is an abstract of the National Lymphedema Network regarding Exercises:

For Individuals with Lymphedema

Exercise as lymphedema treatment ("Remedial exercise"):

Remedial exercise is an integral part of CDT, the current standard of care for lymphedema reduction and long-term management.13, 14 Exercise enhances lymphatic function through increased lymph and flow. Exercise in Phase I CDT is performed with short-stretch compression bandages on the involved body part to reduce lymph production and maximize the influence of muscle contractions. During Phase II CDT, remedial exercises should be performed on a regular basis with garments or bandages in place.

An important component of these exercises is Deep Breathing (abdominal or diaphragmatic).  Here is a  link  where you can learn more about breathing.

http://www.stepup-speakout.org/other_treatments_for_lymphedema.htm

This is the breathing exercise I to do as often as I can throughout the day:

• 1. Exhale deeply, contracting the belly.
• 2. Inhale slowly as you expand the abdomen.
• 3. Continue inhaling as you expand the chest.
• 4. Continue inhaling as you raise the shoulders up towards your ears.
• 5. Hold for a few seconds
• 6. Exhale in reverse pattern, slowly. Release shoulders, relax chest, contract the belly.
• 7. Repeat

Inhalation and exhalation should be slow, smooth and balanced.  Start with only a few breaths until you feel comfortable with the exercise.

Let me know if the link to Part I of the Norton exercises works fine, I will add Part II and III .

Take care

BeckySharp

Nitocris--Thanks for posting.  I bought this DVD early in my LE journey and used it daily when I was wrapped.  I highly recommend it.  Sometimes when I do not use a DVD I think I go too fast.  Norton really reminds one of the proper pace.  Becky

Nitocris

Thanks Beckysharp,

I use the DVD very regularly and I find that it is easier when the instructor sets the pace and explain the proper way the perform each exercise.  But, for those who want to do decongestive exercises but don't have the DVD, the following exercises could help:

Part I:  http://dl.dropbox.com/u/47710826/NORTON%20EXERCISES%20FOR%20ARM%20LYMPHEDEMA-Part%20I.pdf

Part II: http://dl.dropbox.com/u/47710826/NORTON%20EXERCISES%20FOR%20ARM%20LYMPHEDEMA-%20Part%20II.pdf

Part III: http://dl.dropbox.com/u/47710826/NORTON%20EXERCISES%20FOR%20ARM%20LYMPHEDEMA-%20Part%20III.pdf

To finish, a little bonus:

For those days when we hate LE, when we hate compression sleeves and gloves,  when finding motivation is hard, when we feel like crying because this is so unfair.... here is a song which words  should  inspire and empower us all:

"You haven't seen the last of me" by Cher.

Dance version :  http://www.youtube.com/watch?v=byqDXAU2_Yc&feature=related

Slow  version:  http://www.youtube.com/watch?v=5FM5Akcjraw&feature=related

olearca

This is amazingly helpful. Thank you so much. How are the Finnish ladies doing with the exercises? Are they finding some relief? YOU are incredible!! How lucky to have you on their side (and ours too).



Catherine

Binney4

I agree, Nitocris -- you're an inspiration. And I love the added inspiration of that music to exercise by. THANK YOU!

Hugs,
Binney

ptdreamers

Thanks these should be very helpful.

Anonymous

Wow! You are amazing, and it's wonderful that your support group now has access to these exercises.



I have the Lebed exercise DVD, and it looks like these routines are kind of similar. I am wondering if you or any of the other gals here have compared the two programs. One point I am curious about is the difference in movement of the neck. The Lebed DVD instructs to not move the head to the back. I have wondered why that is so, as I would think it would further help stretch the skin in that node area.



I appreciate this info about the Norton program and think it would be helpful for me to have an additional resource for self care. While I use the Lebed DVD and find it helpful, its syrupy nature is kind of annoying, and it would be helpful to have straightforward instructions for exercises.

carol57

Tina,

Good question about putting the head back.  Every time I fall asleep on an airplane, where I find myself pretty often for work travel, I wake up slumped...with my head back.  After using the Lebed videos, I have been wondering if this is contributing to my post-flight swelling.  I am not wild about schlepping one of those crescent shaped pillows onto every flight, but I have a terrible track record of staying awake on airplanes.  I'll be very interested if anyone weighs in on the don't-put-your-head-back question.

Carol

BeckySharp

I don't remember why but several years back my water aerobics instructor said new research says it is dangerous to roll your head to the back.  Then two years ago the professor who teaches exercise science where I work worked out a weight lifting program for three of us who were over 60.  He stressed not to roll your head to the back.  I will see if I can find out from  him why not.  I am sure he told us but I just remembered NOT to do it.  They were both emphatic.  Becky

Anonymous

I would be interested to know if in general I should refrain from doing that, as I sometimes feel the need to stretch my chest and neck because of the scarring I developed from the reconstruction. When I had my implants, it pulled my shoulders and everything forward and down due to their weight, capsular contracture and scar tissue. When I had the implants removed and the muscles put back in their normal position and tacked to the chest wall, my chest felt so much more "open" and I could breathe more easily. I have been to my myofascial release therapist and he has worked on my chest twice since the surgery. First time was about 10 wks after, and then again this past week. I had definitely tightened up somewhat, but nothing like when I had the implants. Anyway, toward the end of the session, he worked on the area just above the breast area, and I could feel the tightness all the way into my neck. Obviously, this is all connected. So, I want to go back again and have him work some more on this area. Then I probably wouldn't feel the need to lean my head back to stretch my neck and upper chest. I am now wondering if there are stretches that safely address the neck and upper chest. For me, this is just another example of how implant recon really messes with the structure of your body and is not the simple surgery that plastic surgeons suggest it is.

Nitocris

Hello,

Thanks for all your inputs.  The ladies in my group were really interested and enthusiastic because none of them knew about lymph drainage exercises and once they understood the proper sequence - i.e. deep breathing, opening of the lymphatics and then exercises, they started practicing regularly.  They said, they felt good about the fact that they were actually taking a more active part in the management of their lymphedema  and also felt motivated because they noticed that something was happening in their arm.

About the neck roll backward:  the purpose of  all the neck exercises is to increase the lymph flow through the neck and shoulders with gentle motions.    These are not  full stretches that you hold for a certain amount of time.  Exercise No. 3  is more like a slow and gentle "Yes" motion.   (the last picture illustrating  exercise 3 was indeed tilting too much backward; I will remove it. But first I have to find out how to edit a PDF file in Dropbox!).   I need your input to improve this move.  Some modifications are possible:

-  Only "Yes" moves (gently pumping)

-  Forward head rolls: Tilt head to the right without forcing the stretch. Slowly roll the head forward and to the left, finishing with the head tilted to the left. Return to start position.

- Chin tucks ( increase lymph flow at the back of the neck and improve head posture). Keep shoulders relaxed. Move head back, keeping the chin tucked in. Hold 1-2 seconds. Return to start position.

 Thanks and take care

carol57

Today I asked an exercise expert about putting the head back, and her opinion is that neck extension--the tilting back of the head we talked about-- puts a lot of pressure and compression on the cervical spine, so not a good idea.  Whether this move in any way limits lymph flow, she is looking into and I'll update if she finds an answer to that part of the question.

carol57

I keep forgetting to ask: is anyone aware of an LE exercise 'dvd' that can be downloaded to a smart phone and viewed on the phone?  I often travel with a laptop that has an optical drive, but I can do so much on my phone, that the (heavy) laptop is not always needed on my trips.  I really like to follow Lebed method exercises using a dvd (and will check the Norton ones out, too--thank's for the hint, Nitocris), because I find I do it more honestly, paying more attention to pace than if I use printed materials to guide me.  So I would love to be able to run an exercise program on my phone.  Maybe a short one, if there are file size problems?  --Carol

Anonymous

I looked on YouTube for the Lebed exercises since I know they are there. For the initial lymphatic opening exercises, there are at least 10 or 11 videos. They need to be done in sequence, starting with Part l. If you search for: Healthy-Steps - Lebed Method Lymphatic Opening Part l, ll, lll, etc you can find them. Not the same as downloading a DVD, but it's better than nothing.



In Part ll of the sequence, Sherry comments about not tilting your head to the back. She says the reason is that it stops lymphatic flow. Carol, it looks like you'll be traveling with that neck pillow after all! And I will no longer be stretching by leaning back that way - I will leave that to the myofascial therapist. Thank you, Becky, for passing along this info from your instructors!

Nitocris

Hi,

 Here are the links for the Lebed videos on YouTube:  Lebed Method Lymphatic Opening - Part I to XII.

http://www.youtube.com/watch?v=h2luK4JRAbo&feature=related  (part I)

http://www.youtube.com/watch?v=k6f7N8dtJLM&feature=related (part II)

http://www.youtube.com/watch?v=6zPTmjSG9aA&feature=related (part III)

http://www.youtube.com/watch?v=tv0-velI7cw&NR=1 (part IV)

http://www.youtube.com/watch?v=jJ-GJeQ7OMs&feature=related (part V)

http://www.youtube.com/watch?v=vAtSPEbKg70&feature=related (part VI)

http://www.youtube.com/watch?v=90h6NMngWHM&feature=related (part VII)

http://www.youtube.com/watch?v=mjrNp7-MayA&feature=related  (part VIII)

http://www.youtube.com/watch?v=zhfAIOLuapI&feature=related (part IX)

http://www.youtube.com/watch?v=CAyS651vcPw&feature=related (part X)

http://www.youtube.com/watch?v=5dp-hfTgsxY&feature=related (part XI)

http://www.youtube.com/watch?v=-IOwZe_dwOM&feature=related (part XII)

With Lebed and Norton, there is a good diversity of lymph drainage exercises now.

Take care.

Anonymous

Nitocris, thank you for posting the direct links to the Lebed exercises on YouTube. That makes them so easy to access.

Nitocris

Hello Ladies,

 I modified the neck exercise (No.3) for Part I and tried to improve a bit the layout of the illustrations for Part I and III.  The documents were in PDF format, so I could not make the changes and keep the same links.  So, here are the two news links:

http://db.tt/C7ZV4dZK   - Part I

 http://db.tt/bR5AHWUR   - Part III

Take care

Nitocris

Hello Ladies,

Adding on to the Norton therapeutical exercises.  On  this web site - Native American Cancer Research -, there are about 25-30 short videos demonstrating exercises with lympedema.  Neck rotations,  shoulder blades squeeze, fist clenches,  etc.. some exercises have special names like "spider woman", "climbing from one world to the other".  And also some upper body exercises using canned food and Indian artefacts (a thin arrow or a thicker flute for instance).  Just scroll down the page.  It is interesting and creative and shows that LE knows no cultural barriers.

http://natamcancer.org/lymphedema-exercise.html#xerc-5

Take care

kira66715

Very interesting and helpful. And they have videos! And I really appreciated the weights of common food objects.

Great resource--thank you!

carol57

Nitocris, you are an amazing Internet researcher.  Thank you for this.  I am always looking for exercise resources I can access on my laptop while traveling on business.

Carol