Self- Lymphatic Massage for Arm, Breast or Trunk Lymphedema

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1 Self- Lymphatic Massage for Arm, Breast or Trunk Lymphedema Patient Education Improving health through education The lymphatic system is part of our circulatory system. It helps balance the fluids of our body and plays an important role in our immune function. Every day our lymphatic system absorbs fluid, protein molecules and waste. Waste products are filtered and destroyed in the lymph nodes and eliminated by the body. The remaining lymph fluid and protein molecules are filtered and cleansed in the lymph nodes and are returned to the heart to join the blood. We have lymph nodes all over our body, but we have large clusters or chains of lymph nodes in our neck, under our arms and in our groin. Lymph fluid normally flows in certain pathways. For example, lymph fluid from your arm, trunk and breast would normally be filtered and drained by the lymph nodes under your arm. If you have had some lymph nodes removed or radiated under your arm, you may be at risk of developing swelling or lymphedema in your arm, trunk, breast, or back. Manual Lymph Drainage, or MLD, is a specialized type of gentle massage that is designed to aid lymphatic circulation. It helps move excess lymph fluid from an area that is swollen (or is at risk of becoming swollen), such as your arm, trunk or breast, into an area where the lymph nodes are working at their full capacity, for example, to the neck, unaffected underarm or groin nodes.

2 The pressure of your hands on your skin should be just enough to stretch the skin. It should be very light. Hands should be flat allowing more contact with the skin. This is how you stimulate the lymph vessels. If you can feel your muscles underneath your fingers, then you are too deep. When doing self massage remember: Support your affected arm on a table or with pillows, allowing your shoulders to relax. Never strain your shoulders, neck, arm or hand when doing self- massage Keep your hands soft and relaxed, use the flats of hands and fingers instead of finger tips Use a light pressure Gently stretch the skin as far as it goes naturally and then release. Massage towards the unaffected or alternate lymph nodes Self-massage should always be pain free. Self-massage may be done while seated or lying down. Do not do self-massage if you have an infection. Do not stroke across your chest if you currently have a portacath or if you have had treatment for breast cancer on both breasts. The following massage is based on Manual Lymphatic Drainage(MLD) 1. Deep Breathing A very important part of your self-care is deep breathing. There are lymph vessels deep in the abdomen that get stimulated by the contraction of the diaphragm when we breathe deeply. You can also practice deep breathing anytime! Place the palms/flats of your hands on your stomach Slowly, breathe deeply through your nose, allowing the stomach to expand Breathe out slowly through pursed lips, allowing the stomach to flatten Repeat 5 times with a short rest between each breath to avoid dizziness

3 2. Start at your neck Place the flats your fingers on either side of your neck just above your collarbone. Some people find it more comfortable to cross their hands when they do this stroke. Place your 2nd and 3rd fingers just above your collarbone on either side of your neck and stretch the skin just as far as it naturally goes. Stroke down towards your collarbone and inward. This stroke would look like two J strokes facing one another. This motion helps lymph fluid drain back to the heart. Repeat 15 times. 3. Side of neck Place your flat hands on either side of your neck just under your ears and gently stretch the skin down towards your collarbone and release Try to stroke your neck in a slow, gentle and rhythmical manner. Repeat this stroke 10 to 15 times. Remember to keep your pressure light

4 4. Back of neck Place your flat hands on the back of your neck just below your hairline on either side of your spine. Stretch the skin towards the spine and then down toward base of neck and release. Repeat times Place your affected arm in a comfortable position slightly elevated and supported so that you can do the chest and arm massage comfortably. Try placing it on an arm rest or table for comfort 5. Chest Preparation In preparation to redirect fluid in the chest area you gently pump your unaffected underarm by placing your palm against your underarm that has not had surgery gently rolling your palm up towards your head and into your body. Pump or knead your unaffected underarm about 10 to 15 times.

5 7. Chest Gently massage your chest - in a sweeping motion remembering to gently stretch the skin as far as it naturally goes and release. Place your hand by your affected underarm, above any scar and lightly sweep your hand across your chest over to your unaffected underarm.. Repeat this motion 10 to 15 times. Try to find the most comfortable position for your hand without straining your wrist too much. You may need to use both your hands. Also, try to do the massage when you are comfortably warm. Our muscles are more flexible when our body is warm. 5

6 8A. Upper Arm to groin We also want to direct the fluid from your upper arm and the side of your chest down the side of your body toward your groin. Pump, as you did with your underarm in #5, at your groin (on the same side as your affected arm) Place the flats of your hands over the crease at the top of your leg and pump gently. Repeat 15 times 8B. Continue with the arm comfortably supported and slightly elevated. If you have difficulty raising your arm, try bringing your arm forward. From the inner part of the upper arm, stroke around the outside of your underarm (remember you want to re-direct fluid around the underarm where lymph nodes have been removed and/or radiated) and continue the stroke from the side of the chest downward toward the groin. Remember to stretch the skin gently as far as it will go. Repeat 15 times.

7 8C. Chest to groin Massage from your affected under arm, below anyscar, down the side of your body to your groin area. Remember to stretch the skin and release. Repeat 10 to 15 times. 9. Upper Arm Starting with your shoulder, gently massage towards your neck and if it is not too much of a strain on your wrist, stroke across the back of your shoulder to your neck. Try to gently stretch the skin, towards your neck and release. Repeat 15 times. Lymphatic fluid in the upper arm normally flows into the underarm. We want to redirect this fluid to the back of your upper arm so we can move it into your neck and opposite underarm. Massage your whole upper arm from the inside of your arm to the top of your upper arm. Repeat 15 times Now massage from the back of your arm to the top of your upper arm. Stretch the skin and release. Repeat 15 times

8 10. Arm Gently massage your entire arm towards your head. Start with your shoulder, and then move to your upper arm elbow and forearm. Try to gently stretch the skin, push the fluid upwards and release. 11. Hand and Fingers If your hand is swollen massage the back and palm of your hand. Gently stretch the skin, towards the forearm and release. If your fingers are swollen place your index finger and thumb of your unaffected hand on the base of your finger and gently stretch the skin towards your hand. Massage the entire finger

9 Self massage does not have to be a chore! Make self-massage a part of your daily routine. Set aside some quiet time without interruptions so you can focus on practicing! Additional Notes

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