found this advice on LBBC

vlnrph

Living Beyond Breast Cancer usually has pretty good information but I was a little surprised at this author's take on what must be a very common question -

Question: I had radiation to the armpit and an axillary lymph node dissection as part of my treatment. I know because of that I am at high risk for developing lymphedema. What poses should I avoid? Downward Facing Dog? Others?

Ms. Chapman: Dear One: Your question reminds me why I am so passionate about teaching Yoga instructors to adapt Yoga practices for people in cancer treatment and recovery. I frequently default to physiological nursing in teaching Yoga teachers, because I want them to understand the underlying dynamics that are at play in the physical body.

I personally can’t say, “These poses are counter-indicated and these poses are therapeutic,” in your situation. I would need to know a whole lot more: How many nodes were removed? Was it left- or right-sided breast cancer? Can you show me your range of motion in that arm and shoulder and the places of any discomfort or pain? How long have you been out of treatment? We need to look at all the factors and variables at play in each circumstance, with each person individually, to suggest poses that will support healing and poses that will tax the body’s fluid dynamics.

Even while I say that, there are some generalities to offer you: Arms held overhead or at shoulder height while activating muscles (like wiggling fingers, squeezing and releasing fists) will help support lymphatic drainage and healing. Muscle actions with the arms below shoulder height can force fluids away from the drainage field and cause undue fluid pressures. If you love Downward Facing Dog, plant the affected arm without pressing weight into it, so that it is resting there for balance while most of the weight is pressing on the opposite arm.

It is the regular exerciser who is less likely to get lymphedema than the sedentary person. The lymphatic system hugs the muscles and muscle action moves the lymph, which has to fight gravity to drain into the blood supply below the collarbones. There is a lot of teaching that can be given about lymphedema, but, it cannot be said in a few sentences. I wish you all the best in your healing and recovery and I hope that all cancer patients and survivors receive adequate teaching about lymphedema.

To learn more about lymphedema, read our Guide to Understanding Lymphedema

Me again with these comments: I'm not sure where the evidence is that allows her to say regular exercisers are less likely to get LE. The risk will never go away so it doesn't really matter how many nodes were removed or when! She is certainly correct that survivors need adequate teaching, perhaps the guide they suggest has more cautions. I know carol57's document on stepup speakout is more helpful & specific regarding yoga positions...

kira66715

Binney, Carol and I worked long and hard with LBBC to be cautious when they put out their handout on yoga. And it seemed like they heard us.

Where did you find this? I'll get back to them, as there was a lot of misinformation, yet the actual author had to avoid upper extremity weight bearing with her yoga practice due to another medical issue and did ultimately understand our concerns.

They push yoga without "getting" that it needs to be modified.

kira66715

LBBC has removed the statement that "exercise prevents LE" and this was an "ask the expert" forum, and this slipped by them. Thanks for pointing it out! We have a very good relationship with the people at LBBC, and they're trying hard to keep their information evidence based.

I'd argue with the advice to do downward dog with little pressure on the bad arm, and I discussed that in my email.

Why yoga gets  free pass as more therapy than exercise, I don't understand. Yoga is exercise. I wouldn't tell a woman to go golf or swing a tennis racket without careful preparation, and I sure wouldn't advise that they do push ups or downward dog...

My mother suffered a serious complication from doing the yoga pose where you do some sort of head stand and put your feet over your head (how she did at her age was laudable, but still), and there are books about yoga injuries.

Binney4

Thanks, Kira. They have been good about listening--they sincerely don't want to do damage. As for the yoga, it does seem to have permeated the "survivorship" movement as a kind of therapy for dealing with the emotional effects of cancer treatment. It can be good for that, but it would be really helpful if the proponents all had a clearer idea of just what kind of life-long damage they can cause with their abbreviated information, or outright misinformation. It's touted as healing and safe, and it can be as long as it's adapted to our actual physical realities.

For more information, Carol's amazing guide to exercise safe practices is here:
http://www.stepup-speakout.org/Handout%20doc%20for...

Be well!
Binney

vlnrph

Big THANKS to our intrepid experts (above). I don't do well posting links - felt victorious that I got it to copy & paste correctly!

The tone just did not sound right. Perhaps it was a transcript of an informal talk. Even so, it could have been misleading and allowed someone to go "full force" into trying who knows what.

I did like her description of the raised arm fist pumps we always suggest. She could have taken the opportunity to discuss the importance of deep breathing and the beneficial effect on lymph transport. Never hurts to mention hydration either since many of us might be tempted to neglect that.