M. D. Anderson Cancer Center
Date: December 2009
[ Music ]
Welcome. Today, I have Jane with me, and she's going to help me demonstrate how to do self manual lymph drainage for someone who has lymphedema in their left leg. This technique is one of the vital aspects of helping to manage your lymphedema in your home treatment. For someone with lymphedema in their left leg, lymph nodes may have been removed in their groin or their abdomen. This technique will help stimulate the lymphatics, and make new pathways for the fluid. Normally, body fluid that is below the waist and above the foot drain into the lymph nodes in the groin, and then from there, to the deep abdominal lymph nodes, and then back to the heart. But if lymph nodes have either been damaged by radiation, or surgically removed in the groin or abdomen area, we need to make new pathways.
So instead of taking the fluid to the groin and abdomen, we're going to be moving the fluid to the left underarm. We always work what is called proximal to distal. This means that we clear the fluid closest to the heart and gradually work away. The last place the fluid drains back into the heart is right below the neck. So we will start at the neck. You will be clearing fluid right above the neck. Right in this area, right here, where you can see it makes a nice hollow in your neck. You're going to use your two fingers. You either cross your arms, or you can have them open and straight. So either like this, or like that. Or you can do one at a time. Take your two fingers, and place them here. Slowly stretch the skin down towards the neck, towards the collar bone, into the neck, and then release. Do this about two seconds, slowly. I'm not coming back up, I'm letting the skin take my fingers back up to that spot. Very, very light, just enough pressure to stretch the skin and release. Okay, so let me see you try that.
Either like that or you can cross your hands if it's easier. First, two fingers in, and then just let the skin bounce back in place. So you don't need to lift your fingers off the skin. Down and in towards your neck, and then let the skin bounce back in place. Excellent. We want to do that slowly, 15 times to clear the neck area. Okay, very good.
Next, we're going to re-direct the fluid to your left underarm. So you're going to take your right hand and open your arms slightly, and you're going to put the palm of your hand in your underarm. You're going to stretch the skin towards your midline, and up into your underarm, and then just let the skin bounce back in place. This clears the lymph nodes in the underarm area. Again, do this slowly 15 times. So it's stretching the skin, not sliding. We're not going to do all 15 repetitions now, but this is what our audience will want to do.
The next place we're going to be taking the fluid is from the waist up. This is the way the fluid normally drains. So we're going to clear that area first. You will place your hands, however is comfortable, underneath your underarm, and stretch up towards your underarm. Very good. Just stretch and release the skin. And if you could put this hand even closer to your underarm in this position that would be even better. Good. So that's the way the fluid normally flows and we're just clearing it. And the next place we're going to go is from the waist down. We're going to start moving the fluid from the waist down, up towards the underarms. So this is making a new pathway now. So right here, you're going to place your hands, and move the fluid up towards your underarm. That's right. So it's just stretching the skin and letting it bounce back in place. Now, normally we would be doing it right on the skin, but for demonstration purposes we're going to maintain Jane's modesty, and keep her shorts on. Okay.
After you've done that 15 times, we're going to clear the deep abdominal lymph nodes. So place your hands right below the ribs, and you're going to take a deep breath in through the nose. And as you take a deep breath, your abdomen comes up; you're going to hold that for a second, one or two seconds. And then as you exhale slowly, you're going to press into the abdomen, and slightly up into your ribs, so you're helping yourself exhale. And then as you inhale, you just release that pressure. So this is the same sort of diaphragmatic breathing that is part of the exercise program. So the more deep breathing you can do during self manual lymph drainage the better. Because you are also getting the benefit of helping to pump the fluid back to your heart by using your diaphragm muscle. Good. We're going to do this three to five times. And we want to do it nice and slowly, so you don't hyperventilate, and get dizzy. These exercises help clear the trunk area.
Now we're ready to start on the leg. We're going to start moving the fluid from the inside of the thigh to the outside, to help move it up towards the underarm. To begin, put your hands on your thigh, in any position that is comfortable for you. And move the fluid from the inside of the thigh, stretching it to the outside of the thigh, using the flat part of your hands and your fingers. Stretch the skin, and then just let it bounce back in place. So imagine that you have an invisible line down the center of your groin. Do the inside of your leg 15 times, and then you can bring it around to the outside of your leg and repeat 15 times.
Right, exactly. And just stretch the skin without sliding though, if you can.
Oh, without sliding?
Yes, without sliding. You're going to go from the inside of the thigh, moving it to the outside of the thigh…15 times in the inside, and 15 times to the outside. And you can also slightly be angling the movement up towards your hip too. Okay, now we're ready to do the knee. So you're going place your hands under your knee, and you're going to stretch the skin towards your groin area, or towards your hip. Do this slowly, 15 times. Okay, good.
Now we're ready to do the lower leg. Start with your hands in whichever position is comfortable for you. Do the whole calf area by moving your hands around and stretching the skin, letting it bounce back in place. Right, that position is fine. Remember to use your hands and fingers without digging into the tissue. The movement is very, very, light.
Sometimes, our patients may have some areas where they have a particular accumulation of fluid, or the tissue is hard. If this is your case, your therapist may have instructed you to use a little bit more pressure to help break up that hard area that's known as the fibrotic area. And then we would use deep pressure. But generally, it's very light pressure, just enough pressure to stretch the skin, and no more. So it should never cause any redness, never leave any white marks on your skin. For the calf area, we start at the top part of the calf. And then we can go right above the ankle, same technique, just stretching the skin, and letting it bounce back in place, however is comfortable for you to put your hand. Okay.
The last place we're going to work on is the foot. It is helpful to lean over a little bit more, and then you can place your hand on your foot. Begin by stretching the skin on top of your foot. Stretch the skin towards your heel, or towards your ankle. In this technique, we always work closest to the heart, and gradually work down to the foot. But we're always stretching, always trying to bring the fluid back up towards the heart. Okay. If someone has swelling in their toes, they could very lightly stroke the toes from the nail to the base of the toe, each toe 15 times. However, a lot of our patients don't have swelling in their foot. So do this only if you notice swelling in your toe area. Okay. After we finish the toes, you would work back up the leg, in the same direction. But now we start at the bottom and move the fluid up. Begin by doing the foot 15 times, then do the ankle, the lower portion of the leg 15 times, and then the upper portion of the calf 15 times.
Okay. And then the same thing with your thigh.
On the thigh, stretch the skin from the inside of the thigh to the outside. Good. And then we clear the side, taking the fluid back up towards your underarms. Repeat this 15 times here, and 15 times here. Okay. It is also helpful to work on your back to help clear the back part of your leg. I will demonstrate.
Watch me, and then I'll have you turn a little bit, so we can work on that area. For this area, use your hands to help move the fluid up towards the underarm. Let’s start at the top part of the upper back, moving the fluid towards the underarm. And then do the lower portion. From the waist down, this is making a new pathway for the fluid. So this is opposite of how the fluid usually goes. So if we can reach, we can do it this way, or this way. Or if we need to, we can use a long-handled soft body brush, a sponge on a stick, like this one, or a paint roller, a back scratcher, something that would help. And we can use this to help move the fluid.
Move the fluid from the back area up towards the underarm. And then we do the lower leg. So let me have you turn and try that, either with your hands, or with the sponge on a stick. So you start from the waist. You stretch up towards your underarm. Do this 15 times. And then you can go a little bit lower, towards the lower back area, down here. Repeat this 15 times. After you clear the trunk area, work on the backside of your leg. Put your leg up here. Reach across like this, and stretch the skin on the back portion of the leg. You're angling it towards your hip and underarm. Remember, try to visualize that there is an invisible line down the center of your inner thigh. So you're moving the fluid from the top portion of the leg. You're taking the fluid to the outside, so from the inside to the outside. We are directing all the fluid towards the underarm. So do this 15 times. Right. And this portion of your leg. Remember to always work proximal to distal. You first work on the area closest to the hip, and then the area closest to the knee. And then the lower leg would be the same as you did before. Work on the back of the knee again. Just stretch and release, stretch and release. Exactly. And then you can do the lower leg. Stretch here 15 times, and here 15 times. Okay. It is best to do this manual lymph drainage at least 10 to 15 minutes every day at the bare minimum. If you have more time that would be even better. Spend a little extra time in any areas that you need to. You could come back up the leg like we did on the front part of your leg. Throughout the day, whenever you're waiting for an elevator or sitting at a red light, you could inconspicuously work on your neck, or clear your underarm. Whenever you're wearing shorts and watching TV, you can try to move fluid up your leg. Whenever you are bathing or putting lotion on, always try to rub your skin from the inside of the thigh to the outside, always rubbing up your leg. In the torso area, always try to rub up towards your underarm.
So all these things can help. Try to use any opportunity to do self manual lymph drainage, for example, when you are bathing, putting lotion on or drying off with a towel. You can use these opportunities to do the self manual lymph drainage.
© 2009 The University of Texas M. D. Anderson Cancer Center
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