- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous
physical therapists on the internet.
- And our opinion, of course Bob.
- Brad, today we are its our pleasure.
- It is our pleasure.
- Our guest lecturer, Aaron Cass.
Come on in Aaron. We'll put em between us.
- Yeah. Have a seat Aaron.
- Aaron is a physical therapist assistant who
congratulations need to be extended to him
because he's just been accepted
to the University of Wisconsin-La Crosse.
And he's gonna be start when?
- May.
- In May.
- May 26th.
- Oh, he's got a little bit of ways to go,
but Aaron has a unique ability here
and that he's got some special skills
in the handling of edema, lymph edema.
So today we're gonna do the top three exercises
for upper extremity or arm lymph edema or edema.
- Correct.
- Does that sound right to you?
- That sounds great yeah.
- So Aaron, you wanna get going on?
- Sure.
- Three exercises.
- Sure. The, the first exercise that I do with many, if not
I would say probably all of the people
that I work with that have edema, especially in their arms
is gonna be an exercise called diaphragmatic breathing.
Deep breathing.
The key to this one is that you, that you always
want to push out your belly button.
So you wanna push out your belly button
while you're taking a breath in
this exercise is great.
You can do it sitting.
You can do it lying down.
You can do it standing up.
You can do it from any position.
So the key to it is, I'm not sure.
- Why don't we do it laying down.
- Okay.
- That's how I've taught a lot of people.
Haven't you Brad?
- Yeah, actually I always have Aaron do it for me
because he's better at it.
Okay. Well do you wanna do it on Aaron
or do you wanna do it on you?
- Well, why don't you explain it to me
and then yeah, stand up there.
- All right.
- I wanted to lay down anyway.
Another thing is Aaron took a week long course
to get certified in this and he's been doing it.
That's why I have him do it.
Cause he knows what he is doing.
- Should we explain this real quickly
for the extremity or for the arm,
for the fluid to go out of the arm.
It's not gonna go out of the fingers.
It's not gonna go out into the ear.
It's gonna go back into the lymphatic system, into the body.
And that's why we're working on lymphatic breathing.
- Right, basically, one of the most important things
about edema and lymphedema is you want to get it back
into the torso into the trunk area of your body.
So that can be processed
and ultimately taken outta your body
through your urine and excreted.
So what we're trying to do is get everything moving
in your trunk, get everything out of the way
so that the fluid from your arm can go there.
We want to create a vacuum.
We want to get this out of the way.
So it'll try to suck that fluid from your fingertips
from your arm into your stomach.
So it gets out of your body.
- So you're saying the fluid in my arm
literally is gonna go into my system in this physical area.
- Literally. Yes, it's gonna work its way through
a network of veins and things just like your blood does
and go into your trunk where it'll be filtered
and then expelled from your body.
- Okay.
- [Bob] All right.
Let's start with the diaphragmatic breathing
- So what I want you to do now
Brad is when you take a deep breath in
I want you to really try
and push your belly button up towards the ceiling.
I want you to get it up as high as you can.
Good. And then when you breathe out
I want you to keep your lips tight.
Like you're blowing up a balloon.
Good. Now try and do 10 of those.
This will be very relaxing
and it'll also help milk those vessels
in your trunk to get that fluid moving.
- Now this is a little bit unnatural isn't though
people when they tend to breathe in
think they need to suck their stomach.
- Right? Right.
- So it's the opposite of what you think
when he was breathing in the stomach is going out
and when he is breathing out
the stomach's going down, correct?
- That's correct. That's exactly correct.
We want to, and the reasoning for this is
because we want to change the pressure inside your
inside your abdominal cavity. Yep.
- So then you get that lower pressure there and it helps.
- Yep. And it helps sucking that fluid in
that's your vacuum that you're doing.
- [Bob] So how many of those would you do
and how often would you do those?
- I would say a minimum of three times a day, 10 times.
Each time you'd start doing 'em 10 repetitions
three times a day, but I try to tell people to do it
as often as you think of, if you're watching TV
you see a commercial break, go ahead, do a few of 'em.
- [Bob] So you can do this in the seated position.
Why don't you sit up Brad?
- So doing two or three is better then doing nothing.
- That's right.
And with this one, the great thing about it is
you're not really gonna have any soreness or anything.
If you do a lot of them
you're not gonna feel sore the next day from it.
Cause it literally is just breathing.
- [Bob] All right. Let's move on to exercise number two.
- Sure.
- Number two is gonna be a chicken wing.
We're just flapping the arms.
You can sing the, what's the wedding song
that everybody sings?
- The chicken dance.
- There you go.
- I think that's a Midwest thing.
- This one is great because there's a lot of lymph nodes.
Big vessels in your armpits
that carry a lot of fluid from your arms and your trunk.
So we want to kind of, we're doing the same thing.
We're milking that area.
Getting the fluid to go from your arms
to your abdomen where it'll be expelled out.
- Sure. He was doing it right?
- Yep.
- Just like that. You know, the first time
I saw some therapist doing this
I just shook my head and I thought, what kind of, you know?
Yeah. So if you're in a store at church
you may not want to do this.
- Right, right. That may, that may be socially awkward
a little bit but effective at the same time.
So some people might be okay with it.
- 10 of these three times a day or more.
- That's right. Yep.
- Okay. All right. Number three.
- Number three is squeezing your shoulder blades together.
So for this one you may want to turn around
so the camera can see you.
But basically what I'm gonna have Brad do
is try and pinch his shoulder blades together.
Yep. Just like that.
And then relax.
Same thing 10 times again.
- Is breathing sequence with this important?
- Not necessarily whatever makes you comfortable
with this one.
- Okay.
- We're doing the same thing.
This will help keep fluid moving back here as well.
You want to try and keep all the fluid in your trunk
moving and being processed.
If the fluid isn't moving, it's gonna get thick.
It's gonna harden up and it'll be much harder to move.
It's like water.
The more you keep it moving, the easier it is.
We don't want it to turn into a thick liquid
that doesn't flow through the filter well.
- Again, just to verify Aaron,
this is to get fluid outta your arms.
I know we didn't do really much with the arms
besides this one but all this is clearing the way
so it can come out of the arms.
- That's right. A lot of times when you have fluid in an arm
it's because there's a block somewhere.
Naturally the fluid from the arm will flow in the back.
It'll flow in the front.
And if there's a blockage back here
the fluid can't go that way.
So it's gonna go where gravity's gonna pull it.
So gravity's gonna pull it
towards your fingertips towards your hand.
So we want to clear that block.
We want to get it moving this way or this way
whichever way we can.
And if it can't go that way, by doing these exercises
we're gonna facilitate it going whichever way it can
to get it out of that arm.
- [Bob] All right. Very good.
Well, I'll tell you what, we're gonna go ahead
and stop this video right now.
And we're gonna go ahead and do another video
on how to get the fluid outta the legs.
So if you're having trouble with that
you're gonna wanna make sure you watch.
And I'm also gonna try to figure out
how to get the fluid outta my head.
- Block your neck. Yeah. Like that.
- All right. Well, thanks for watching.
We'll see you on the next video.
- Be careful.