Mastectomies - Risk Of Lymphedema Contra Indications
Consider screening for women who have had mastectomies.
In many cases, the under arm lymph nodes have also been removed. Apart from avoiding heat and using compression bandages, it is VITAL to build up weight bearing moves EXTREMELY GRADUALLY to prevent Lymphedema (“Elephant Arms”).
In a Group Class situation at a gym where individual screening is difficult, when running through the public checklist (ie Pregnancies, Oesteos etc), a tactful way to ask would be “if anyone is at risk of Lymphedema – you’d know if you were – please let me know”
My wife Sarah is a volunteer therapist for a Cancer Care Charity in Adelaide - Massage, Oncology Massage, Bowen, Kinesiology. (Bituva White Witch my Sarah….sshh, hush – she’s sitting next to me and if I type this too loud she’ll turn me into a handsome toad). She has seen many cases where under arm Lymph nodes are removed as a standard part of mastectomies and this puts these women at very high risk of Lymphedema.
Given my Pilates Teaching means it’s possible I may come into contact with a lady in this situation, Sarah’s has been insistent I screen for this.
I do a bit of cover work at Fitness Centres where individual screening isn’t really tenable in a class with 40 people. (Yeah, I know – tell me about it, these numbers scare the crap out of me too). So when running through a public listing of conditions you need to know about to the assembled throng (if anyone Pregnant, in fourth Trimester, got Oesteo etc etc) you really can’t go asking and “who’s had a mastectomy” (especially when you are a guy).
Instead, Sarah came up with the following way of phrasing the question:
“… and finally, if there’s anyone who would be a RISK of Lymphedema – you’d know if you were – please please PLEASE let me know – it’s utterly vital you tell me”.
Lymphedema (“elephant arms”) is extremely painful. There is NO (known) cure.
In several cases, Sarah told me she has tried her best to help women with this condition and it was heart braking to see their pain – especially when it could have been so easily avoided.
Even if the Surgeons/Doctors who suggest/encourage patients to start rehab by doing Yoga/Pilates DO warn about the ‘gotchas’ (sorry, I’m an IT Nerd by profession, I mean ‘contra-indications’, it may be the case that the patient is too stressed to comprehend.
Which is why I’m sharing the following suggestions with my fellow Pilates Teachers.
For someone who is at risk of Lymphedema:
1) Avoid getting too hot 2) Avoid over stretching around the affected limb 3) Wear compression bandages around the affected limb and ….. saved the ‘biggie for last’…. 4) BUILD UP ANY WEIGHT BEARING EXTREMELY SLOWLY. If any under arm lymph nodes have been removed, it is absolutely ESSENTIAL to start weight bearing ACTIVITY (ie upper body) E-X-T-R-E-M-L-Y slowly.
So, PLENTY of regressions – ie no full push ups – start with plank on elbow/knees, several MONTHS later, then progress to plank on elbows/straight legs, several months later, then progress to push ups (on knees) and so so.
Obviously no hard and fast rule regarding how long before a full push up (for example) can be performed but it wouldn’t be inside of 6 months!… (Again, individual circumstances etc – if the person was extremely fit beforehand, maybe a bit sooner).
Moves like Side Lift and Twister are OFF THE CARDS FOR A L-O-N-G TIME
Compression garments on the arm at risk should also be always be worn during ANY exercise – not just weight bearing.
STOP immediately if any of the following are noticed: Odd sensation in finger/hand/arm, feeling of heaviness in finger/hand/arm, swelling in fingers
Heat: People at such risk must AVOID saunas, hot baths, showers – heat in general. Do NOT let them over-heat in your class!