Exercises for Lymphedema in the Legs

When your lymphatic system isn't able to properly circulate fluids in your body, you can develop lymphedema. While this condition doesn't have a cure, lymphedema leg exercises may help.

See your doctor for an accurate diagnosis before performing these exercises. Leg edema can also be caused by certain foods or more serious conditions unrelated to the lymphatic system, such as congestive heart failure, acute kidney failure or blood clots. Each of these issues requires a specific treatment plan.

Read more: How to Reduce Swollen Legs & Feet

Lymphedema can result from abnormal development of the lymphatic system or as a result of another medical condition or procedure, such as surgery, radiation or infection, according to the Mayo Clinic. It often occurs after surgical removal of the lymph nodes — structures throughout your body that contain white blood cells to help fight illness and infection. Lymph nodes are sometimes removed during surgery for cancer.

In addition to severe swelling, lymphedema also causes aching pain, decreased range of motion, "heaviness" in the affected limb, recurring infections and hardening of the skin. This chronic disorder is classified in stages, from 0 to 3, as described in a June 2017 article published by the Turkish Journal of Surgery.

Stage 0 lymphedema is diagnosed when the lymphatic system has been damaged, but swelling has not yet occurred. Stage 1 is characterized by edema that goes away when the limb is elevated. When you first wake up, your leg might be a normal size. Gravity begins to pull fluid into your leg once you're up and moving.

Stage 2 lymphedema is diagnosed when swelling significantly increases the size of your leg, and it becomes "spongy" to the touch. Your skin can begin to harden in this stage as well.

Stage 3 lymphedema is characterized by fibrotic, or hardened, skin. Swelling in this stage is irreversible and can only be treated with surgery.

Treating your lymphedema isn't as simple as just doing leg exercises. Lymphedema treatment is multi-faceted and best managed under the direct supervision of a specialized physical or occupational therapist. Over time, you can manage your condition on your own.

Treatment for lymphedema occurs in two phases, as described by the UNC Health Care Center for Rehabilitation Care. Phase one, the intensive phase, is completed while under the care of a therapist. During this phase, your therapist will perform a technique called Manual Lymphatic Drainage (MLD), wrap your leg with multilayered bandages or fit you with compression garments, and teach you exercises to assist with lymphatic drainage.

In phase two, you are managing the swelling on your own, with periodic check-ins with your health care provider. Compression bandages or garments are typically worn whenever the affected limb is in a gravity-dependent position — such as standing or sitting — when the condition affects your leg(s).

According to a June 2017 review published in the Journal of Lymphoedema, many doctors recommend wearing compression bandages or garments during the day and removing them at night. For severe cases, you might need to wear them all the time, except when bathing. Either way, it is particularly important to wear your garments when exercising.

Read more: What Can I Eat or Drink to Reduce Swelling in My Feet & Ankles?

A lymphedema exercise program should include aerobic (cardiovascular) activities as well as gentle exercises to improve flexibility and range of motion. Consult your doctor or therapist to be sure these exercises are safe for you.

Obesity has been linked to worsening of lymphedema symptoms, according to the UNC. A regular exercise routine can help you lose the extra pounds and maintain a healthy weight.

According to the Centers for Disease Control and Prevention, a minimum of 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity should be performed each week to maintain a healthy weight. Increase this number if you are trying to slim down.

Moderate intensity activities can include brisk walking, biking at a casual pace or even doing yard work. Vigorous intensity activities may include jogging or running, jumping rope, cross-country skiing and rollerskating. However, these activities could be quite difficult if you have significant lymphedema in your leg(s).

Low impact aerobic exercise, such as stationary cycling or using an elliptical trainer, can reduce pressure through your leg joints if they are affected by lymphedema. If positioning your legs directly underneath you or standing on your affected leg(s) is painful, try using a recumbent stepper or recumbent exercise bike, as demonstrated by ExRx.net.

Exercising in water can reduce the amount of weight on your leg(s) and pressure on your joints while still boosting heart health. Considering water aerobics, deep water jogging or swimming laps as part of your workout routine.

Range of motion exercises may help decrease stiffness in the joints affected by your lymphedema. Contracting your leg muscles also helps to pump excess fluid out of the area.

Perform these exercises in a pain-free range, several times per day. Begin with 10 repetitions of each move, working up to three sets in a row.

Move 1: Ankle ABC's

1. Sit on an elevated surface with your foot off the ground.
2. Draw the alphabet with your foot, leading with your big toe. Make the letters as large as you can, without allowing your knee to move.

Move 2: Ankle Circles

1. Rotate your ankle 10 times in a clockwise direction.
2. Repeat in a counterclockwise direction.

Move 3: Knee Flexion/Extension

1. In a seated position, bend your knee underneath the chair as far as possible without moving your upper body.
2. Straighten your knee fully while tightening the muscles on the top of your thigh.

Move 4: Straight Leg Raise

1. Lie on your back with your legs straight.
2. Keeping your knee straight, lift your right leg toward the ceiling.
3. Lower slowly back down and repeat on the opposite side.

If the straight leg raise exercise bothers your lower back, bend one knee while lifting the opposite leg.

Decongestive exercises, as explained by the Ohio State University Wexner Medical Center, are an important part of lymphedema management. Unlike the cardiovascular system, where the heart circulates blood throughout the body, the lymphatic system doesn't have a built-in pump. Instead, it relies on muscle contraction to help move excess fluids out of your lower leg(s).

Perform three to five repetitions of each of the following exercises and do them in order. Repeat these exercises two to three times per day.

Move 1: Abdominal or Diaphragmatic Breathing

1. Lie on your back on a firm surface.
2. Bend your knees and place your feet on the floor.
3. Place one hand on your chest and the other on your lower abdomen, just below your belly button.
4. Breathe in slowly through your nose and fill your belly with air. Only the hand on your abdomen should rise.
5. Slowly blow the air out through pursed lips, as if you are trying to whistle.

Move 2: Pelvic Tilt

1. Lie on your back with your knees bent and your feet on the floor.
2. Place your hands on your hip bones, resting your fingertips on the sides of your abdomen.
3. Tighten your lower abdominal muscles as if you are pulling your belly button down toward your spine. You should feel the muscles under your fingertips tighten.
4. Hold for a slow count of ten, then relax.

Move 3: Partial Sit-Up

1. Begin in the abdominal breathing exercise position.
2. Inhale into your belly.
3. Exhale slowly, lifting your head and shoulders off the ground, reaching your hands forward.
4. Lower back down and repeat.

Move 4: Cervical Rotation

1. Sit up straight and squeeze your shoulder blades together.
2. Inhale and rotate your head to the right for a slow count of five, looking over your shoulder.
3. Exhale and return to the middle.
4. Repeat to the left side.

Move 5: Head Tilt

1. In a seated position, look straight ahead.
2. Tilt your right ear toward your right shoulder.
3. Return to upright, then repeat to the left.

Move 6: Shrug Your Shoulders

1. Shrug both shoulders up toward your ears, as high as possible.
2. Hold for 5 seconds, then relax.

Move 7: Shoulder Rolls

1. Sit up straight with your arms resting by your sides.
2. Roll both shoulders backward and forward, ten times each.

Move 8: Heel Slides

1. Lie on your back with your legs out straight.
2. Bend your right knee, sliding your heel toward your buttocks.
3. Slowly slide back down.
4. Repeat on the opposite side.

Move 9: Knee Fall-Outs

1. Lie on your back with your knees bent and your feet on the floor.
2. Keeping your right knee stationary, slowly lower your left knee out to the side. Keep your left foot planted on the ground throughout the movement.
3. Repeat on the right.

Move 10: Leg Slides

1. Lie on your back with your legs out straight.
2. Keeping your toes pointed toward the ceiling and knee straight, slide your right leg out to the side.
3. Slowly return to the starting position and repeat on the opposite side.

Move 11: Ankle Pumps

1. Point your toes toward the ground as if you are pressing a gas pedal.
2. Pull your toes back up as far as possible. You should feel a gentle stretch in your calf during this movement.

Move 12: Ankle Eversion/Inversion

1. Turn your ankles inward, bringing the soles of your feet toward each other.
2. Turn your ankles outward, moving the soles of your feet away from each other.

Move 13: Spread Your Toes

1. Spread your toes apart, as far as possible.
2. Bring them together and curl them under.