How I manage to weight train with lymphedema

Through the late 1990s, women who had breast cancer surgery (especially lymph node removal) were told to not lift anything over 15 pounds…. ever. Lymph nodes in the armpit area are removed and tested to see if the cancer has spread beyond the breast. It’s an essential biopsy to have, but one with lifelong implications. Lymph nodes are necessary to keep the body’s lymphatic fluid circulating. When lymph nodes are removed, it can make the circulation of this fluid more difficult. Women can experience lymphedema, which is a swelling of the arm with lymph fluid. Lymphedema is a chronic condition; you may be able to prevent it from getting worse if you are careful, but it is not likely to go away. Several things can trigger lymphedema, including lifting something heavy (without taking precautions ahead of time), excessive heat (from, say, sitting in a hot tub or sauna), and the cabin pressure change in an airplane.


I had approximately 12 lymph nodes removed from both armpit areas, since I had cancer in both breasts. About four months after my surgery, I was doing some moderate resistance training with exercise bands, when my right arm began to swell suddenly. I knew about lymphedema and recognized what was happening to me. Still, I felt slightly panicked and dismayed. I had been gradually building up my level of resistance training and hoped that I was fit enough to avoid this chronic problem. (Being fit is not insurance against lymphedema, though.) I quickly raised my arm in the air and began massaging it, and the swelling started to decrease, although it has never gone away entirely.

I had been receiving physical therapy to increase the range of motion in my right arm and was working with two terrific therapists, Linda and Melissa of Hamilton Physical Therapy Services (HPTS) in Hamilton, NJ. Both are cancer survivors themselves and trained to work with women who have had breast cancer surgery. In addition to the therapy they gave me in their office, they helped me do two very important things.

First, I was fitted for and ordered a pair of lymphedema sleeves. I wear these stretchy lycra-blend sleeves, which cover me from my hands to my shoulders, every single time I exercise. This includes any type of exercise, whether I am “working” my arms or not. I wear the sleeves when I run, use the elliptical trainer, work my core muscles, or even go for a brisk walk. If my heart rate is elevated, the sleeves are on. If I forget to put on the sleeves (which never happens anymore) and I begin to exercise, I will feel my right arm start to swell. My health insurance paid for these $196 sleeves and will cover a new pair every six months, which is the standard replacement time. I also wear the sleeves when I fly in an airplane.

Second, they taught me how to do Manual Lymphatic Drain (MLD) massage on myself. It takes about 2 minutes to go through the whole technique, is relaxing and feels good. I am also convinced that by doing it daily for 5 months, I was able to reduce the swelling in my right arm further. I will confess that I no longer do the complete technique due to the time it takes, but I do a modified version of it throughout the day. I’ll do it in the car (holding the steering wheel with my right hand and gently massaging the arm with my left hand – not dangerous, I promise!) and throughout the day when I have a few moments where I am not active. My colleagues and students have become used to having me do it in meetings. I even do it in my Sunday School class at church when I’m not teaching.

This was an area where, in a healthy way, I felt the challenge to buck tradition and not accept the limitation of never lifting anything heavy again. Having lymphedema is another challenge to overcome, and I feel stronger for being able to weight train and bodybuild despite the condition. I was also very encouraged to come across the work of Dr. Kathryn Schmitz, an epidemiologist and exercise physiologist at the University of Pennsylvania.  Dr. Schmitz has studied the effects of weight training and lymphedema among breast cancer survivors, with some very encouraging results.  Here's a link to a great NYTimes article about her work:

http://www.cceb.upenn.edu/news/swelling.pdf

So, to summarize, I train six days a week and have gradually worked my way up to using a heavy amount of resistance.  That I did it gradually is key; increasing the resistance too quickly would have exacerbated my lymphedema.  I wear my sleeves EVERY time I exercise and I keep them on through the stretch and cool down.  I follow this with MLD massage on my arm.  This system has been working very well for me.