♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
- Hi folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- All right, Brad, today, we're gonna talk about
the top 10 exercises for leg lymphedema.
This is swelling or edema in your leg.
- Sure.
- And these are something you can do
two to three times
everyday, if you want to.
Good time to do it is right away,
you know, in the morning.
And then of course at night.
- Right, right.
And then maybe start to slip one during the day,
if you take your little nappy, Brad.
- I gotta have the nap, Bob.
- All right, let's go ahead and start off, right?
- Well, I don't- I just wanted to briefly mention
some people do get swelling confused with lymphedema,
because they're two separate things.
Like if you sprain your ankle or your knee and
things swell up, that's different than edema.
Like someone that, that may have
that you see their-
- Well lift node were maybe removed
from a leg and that's that's causing it or
or even like congestive heart failure.
- Right? So you have this
it's swelling up and getting larger
but it's not from trauma
it's because the fluid is not going back
through its natural past to re circularly,
so to speak, into your system.
So you get this build up of fluid
but not from an ankle sprain.
It's a little different treatment than what we're talking.
- Yeah. It's really important
for you to understand that the fluid,
when you build it up- get it built up in the leg,
it doesn't go out through your toes.
It's gotta go back up into your, into your trunk here,
get processed, and then you're gonna urinate it out.
- Right?
- So that's, you know,
you may actually end up going to the bathroom more often.
- Right? That, that is one of the-
with a true lymphedema patient that has a lot,
and we go through a full massage treatment.
A lot of times it's a good sign.
If they have to say, I need to go urinate, you know
you're doing your work.
- And this has to be approved by your doctor
because you could overload your system
if you're having heart problems.
- Exactly.
- So this is something that should be
you know, doctor approved.
And by the way, if you're new to our channel, Brad
please take- you're not new to our channel.
- Well, I might be though.
- All right, if you're new to our channel,
please take a second to subscribe to us.
We have the subscribe button over there.
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And we upload every day.
Let's get started, Brad.
- Say no more.
- All right. So you're gonna start in what we call
the supine position on your back,
and you'd like to elevate your legs in some fashion.
This is gonna make it a lot more effective, right?
- So you get, so your legs here, you know
even if they're this high, you're fine.
You need to get 'em higher than your heart.
So higher than the chest level.
- Right? If you can, you know,
if it, if it's through pillows
or if you can get one of those
wedges that we always tell Brad.
So, but you're gonna start
off with just by curling your toes, Brad.
- Right? So he's just simply wiggling his toes up and down.
And to do that, the muscles for your toes
are actually up in this part of your leg.
So you're getting movement from here
and here to help get that fluid moving.
That's what we're looking for.
- All right. Then we're just
gonna go to ankle pumps, ankle pumps.
- Yeah. Look at those ankles pumping.
You know, I think every therapist
in the world calls these ankle pumps.
Yeah. Because you're just working
and pumping and you can just,
you can actually see the movement in the leg.
Now we're getting more muscles working
up in this part of the, the leg
which is gonna help push that fluid this direction.
- And these, you can do a good 15, 20 times.
- Sure.
- And then you go into circles.
- Yep.
- 15, 20 times.
- They're great to exercise the ankle.
Good range of motion.
So you're not just working with the
the lymphedema movement
but you're working a good joint exercise and muscle.
- So now we're gonna go into a little hip and knee flex.
- Okay.
- You still can do that from this position here.
- Sure. Right.
- So we're gonna just work this side, you know
we could do it 10, 15 times
and then we can go to the other side 10 to 15 times.
- Right. And you know, use your judgment.
If you got a bad knee or a hip, do the best you can with it
but you should not be pushing yourself into any pain.
These should be all pain free.
- Now at this point, Brad, it's gonna be a lot easier if
if this is out of the way.
- Right.
- So whatever you're using to lift your legs up
we're gonna go on the more supine, true supine position.
So now we're doing what we call clam shells
but we're doing 'em a little bit differently,
but it looks like a clam
is going to opening and closing here.
- Right.
- So, so you put your feet
your feet together, your ankles together.
Yep. And you go ahead and open the clam, close the clam.
- Exactly. Just abduction, abduction.
Back and forth with those.
- So then you can also do it this way, Brad,
where you just go out this way
and do abduction and abduction.
- Right. That, that one takes a little more strength
up in the hip because it does, it does being suspended.
If you can do it, go ahead and do it.
If, if you're not strong enough, that's okay.
You can skip that one.
- So at number seven, number eight
we're gonna do, butt squeezes, Brad.
- Okay.
- Believe it or not. It's just what we're talking about.
- Yeah.
- We're squeezing the butt together, in this position.
- Squeezing those butt cheeks
those big gluteus max muscles are working
and they're gonna get some fluid movement.
- All right. Then we're gonna go to bridging Brad.
- Yep.
- So I'm, I'm lifting by mid, mid section up here.
- Sure.
- And down again.
Yep. Now on this one, you know, Bob's holding his head
up like that just so we can talk to the camera
but you wanna be laying down and relaxed.
- Relaxed, yep.
- And go ahead and do your bridges.
- Okay.
- And also with this, you got gravity working to
get that fluid going the right direction.
- In the last one that, and we
by the way we skipped one, Brad, we
we were supposed to start off with diaphragmatic breathing.
We'll show that one too.
I'll show that next, but it would be trunk rotations.
- Sure.
- But, but before you even start any of these
it's great for you,
while you're with your legs up in that position,
is to work on diaphragmatic breathing.
- So diaphragmatic, what-
that's maybe we should get into.
- A lot of people think that when you take a deep breath
that you're supposed to expand your chest
like this and then breathe out.
What we really want is the diaphragm that
if you want effective breathing
is the diaphragm's gonna expand
while you're breathing in.
So your stomach actually comes out
while you're taking a deep breath in.
- All right. Because,
can you see that Brad do it, do it somewhere.
Let's get that belly going.
So you're gonna let that stomach raise.
Now this is something, especially in our society
in the United States, anywhere
everyone thinks the stomach should be in tight,
so you look good.
So naturally people breathe in their chest, especially men
you don't get their chest breathers, their chest breathers
which is not gonna do anything
for what we're looking for here.
- Yeah, in order to get that lymph flowing,
the lymphedema flowing you need to have the,
the proper breathing going on here.
- Right.
And actually I'm even gonna go as far as the diaphragm,
if you're not familiar with it is a, a big, broad muscle
kinda like a big pancake that separates the lungs
from the visceral or the internal stomach,
and the intestines.
And when that muscle expands and you get air
into your lungs, it pushes down, therefore the
the abdominal contents have to rise
up and you get that belly.
- Right.
- You know, that big bulge belly.
- And, well I think what you'll find is,
you know, you wanna breathe in through the nose
and then out through the mouth.
- Kinda a lot of times
like you're blowing air out, you know, purse, purse, lips.
- It's a great way to relax when you do this,
and you think about it.
Everything has to relax to have this happen.
- But again, thinking about the fluid has to go
into the abdominal area that that's really gotta be relaxed.
So you wanna do this, you know
you wanna do it to start off with
and then you wanna do it throughout the exercises too.
- So you maintain that
that breathing in that same level of yeah.
- How we doing for time, Bron?
- Seven.
- Okay. Why don't you go ahead
and let's talk a little bit about the massage.
- Sure.
- So you wanna do it?
- Yeah. Well actually, no, stay there, Bob.
This will work out well.
I just wanna talk about the flow of the, the fluid.
Why don't you bring your legs down?
- Okay.
Again, like Bob mentioned
you got lymphedema willing to bring it
from the toes and the feet
and it's gonna go travel all the way up.
And this is the air in our, our,
our expert at this talked about,
think of having a drain right here like in a bathtub
right there at your belly button.
And all this fluid has to get up there
and drain down into that drain.
And then it gets into your system
and your body recycles it
and works with it as it's supposed to.
Now the, how you work with this as far as
how are we gonna get it there?
If it's down here, how are we gonna get it up there?
Are we gonna start doing a massage and pushing it here?
And we're gonna push that fluid up like that.
That's how I used to think. That makes sense to me.
It's just the opposite.
Think of this fluid, it's going right underneath the skin
and it doesn't go deep
it's it's underneath the skin
and it's flowing, flowing flowing
goes through your lymph nodes
in this area, filters it.
And then it goes into the drain.
So what we need to do, think of it like a dam.
We need to clear the area
up in here before the fluid here can get up there.
So we're gonna do a massage like this, your hands are here.
- I, I got my weird hand here, Brad.
- Yep. Yep.
- And we're gonna start here
and then pull it up to that drain.
So you're pulling from your femoral crease
right in your pocket.
So you're going up to the belly button where
that drain is and you're clearing-
now, you don't have to push real hard.
This is when you just put some mild pressure on there.
Just enough to remember the fluids right below the skin.
And you're gonna get that fluid moving from there.
Now you have an empty spot here.
It's like a vacuum
and it's gonna help pull the fluid from this direction.
- Gotcha.
Now you're gonna reach down as far as you can
- If i was sitting up here, wouldn't that work better?
- You're right, actually.
That way you can get to this.
Now this is assuming for yourself
if you're doing a self massage, right.
And people that get total knees
and some of the surgeons will instruct this massage,
right, in the groin area.
And you're pushing it up to that femoral crease.
So you started here in the stomach
and then you're going here.
And then if you have someone to do this for you
the next place, you know, would be working from the
the ankles to the knee and the feet.
So you're actually working in a backwards-
- Sure. Manner.
- Right. So this is just a big concept just to
give you the idea.
- But certainly again, on your own
you could do this.
- Yep.
- And you could do this.
- Right. Exactly.
- And that'll, that'll help a lot.
- Exactly.
- In breaking that dam loose.
So the other thing, by the way Brad,
a lot of times the old fashioned way
of thinking was they'd use ACE wraps and
and they really shouldn't.
You should use comprilan wraps.
- Yep.
And I'll put the spelling down below.
There's no stretch
to a comprilan wrap or very little,
- Well, they- they don't stretch one way at all,
and the other way they do
but you don't put much pressure on it.
- Right.
- I always thought, well, tape it down tight
get that fluid out of there,
but that's not gonna help.
- That's not the, you know, so
that alone too is another thing you should, you
you make sure that they're using comprelin wraps
when they're wrapping you.
- Sure.
- As opposed to an ACE wrap.
So, oh, I know this is all just very basic
and it's mostly about the exercises, but hopefully it helps.
- Right.
- So thanks for watching.
- Enjoy and take care.