Karen Ashforth, MS, OTR, CHT, CLT-LANA
Bandaging is part of the gold standard of treatment for lymphedema. However, a degree of strength and mobility is required to self-bandage, particularly when wrapping the legs. A number of clients in my practice have chronic lymphedema in one or both legs and are concerned about their future ability to apply bandages. Thankfully, there are techniques available that make the process easier.
Put the spine in a neutral position: Most people sit to wrap their legs and feet, but holding that position for the amount of time it takes to apply bandages can place a strain on the back. Instead, try lying on the floor or bed while wrapping the feet and lower legs. This allows the back to be supported.
Daily stretching to maintain good flexibility: Just as athletes warm up their muscles and joints prior to an event, gentle stretching prior to bandaging can increase the body's ability to hold the position of bent hips and knees. It is important to stretch without compression to maintain good range of motion; even elastic compression garments can be bulky enough to limit full joint motion. Stretching in water is ideal because the water compresses without the restriction of a bandage or garment. Daily stretching at home can also be very effective and may be especially helpful just before performing self-bandaging.
Perform gentle, prolonged stretches: Gentle stretches, held for several minutes at a time, can be very beneficial in the long run by elongating muscle fibers, which leads to increased flexibility. Stretching also helps to warm up joints before an activity. Use deep breathing to engage the diaphragm, to help pump and empty the abdominal lymphatics. Start by holding each stretch for one or two breaths and gradually build the length of time. Never overstretch to the point of feeling pain. Check with your doctor or therapist before starting a program if you have special needs or problems.
What to stretch:
- Hamstrings: These are muscles on the back of the thighs that cross the hip and knee joints. They are tight in most people because they shorten during sitting, the position of choice for most of us during the daytime. When tightened, the hamstrings may pull on the pelvis and throw the spine out of alignment, which can cause back pain. One way to stretch the hamstrings is to bend forward from the hips to touch your toes. This is done while standing with the knees slightly bent to take the pressure off the low back, with the feet shoulder width apart, pointing straight ahead. It might be helpful to start by placing hands on the knees, and then "walk" the hands towards the ankles.
While it is a great goal to touch the toes, if you feel a stretch in your back or the backs of your legs, stop there and gradually work downward in future stretching sessions. You'll find your flexibility can get a little better each time! A more advanced way to stretch the hamstrings that is particularly helpful for protecting the lower back is to lie on the floor or bed and position the legs up the wall. At first it might be necessary to bend the knees and leave some space between the buttocks and the wall. As the body becomes more and more flexible, eventually the buttocks will be flush against wall, the back of the legs will touch the wall from heel to thigh, and the toes can bend down towards the face to increase the stretch.
- Knees: Warm up knee joints by lying on the back and hug the knees to the chest. Start with one knee at a time. Another method is to stand and hold onto a table, and bend the knees slightly, then straighten them.
- Ankles: While doing the knee stretches, warm up the ankle joints by doing ankle circles and bending each foot forward and back.
Keep the upper body strong and flexible:When the arms and shoulders are securely anchored by the upper back muscles, there is less strain on the entire body.
- Roll the shoulders backwards and downward slowly while squeezing the shoulders together. Focus on engaging the muscles between and below the shoulder blades and keep the neck relaxed.
Be aware of the body's signals: Take time while stretching to do a "check in" with the body to identify any emerging problems. Possible signals of infection are changes in skin temperature and color, swelling and/or pain. Also look for areas that have had too much or uneven pressure and are vulnerable to skin breakdown.
Self care is a good investment: Giving yourself time to breathe, stretching, and monitoring your body will pay off in the long run by keeping you healthy and flexible, and in top condition for self-bandaging.
© 2010 Karen Ashforth
Karen Ashforth, MS, OTR, CHT, CLT-LANA
Dominican Santa Cruz Hospital
Lymphedema Management Program
Karen [dot] ashforth [at] chw [dot] edu (Karen.firstname.lastname@example.org)
Karen works full time in a hospital-based outpatient lymphedema clinic. An occupational therapist for 30 years, she combines technology, creativity and innovation in her practice of lymphedema.