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Welcome to the mercy lymphedema program
self massage for the upper extremity DVD
presented by Sandy miles and Cindy Hardy
this technique is beneficial for women
who have active lymphedema and also for
those who are at risk of developing
lymphedema and want to be proactive in
preventing the development of swelling
in their affected arms this massage
technique performed regularly will help
to optimize the function of your
<font color="#E5E5E5">lymphatic<font color="#CCCCCC"> system and help to develop </font>
collateral drainage pathway to exclude
<font color="#E5E5E5">that might otherwise become trapped in </font>
<font color="#CCCCCC">your tissues causing swelling on the </font>
<font color="#CCCCCC">affected side for demonstration purposes </font>
<font color="#E5E5E5">we will be<font color="#CCCCCC"> performing the massage on the </font>
<font color="#E5E5E5">left side of<font color="#CCCCCC"> the body and the left arm </font>
<font color="#E5E5E5">for those whose the right side of the </font>
<font color="#E5E5E5">fact that this practice really need to </font>
be reversed this DVD is you along with
<font color="#E5E5E5">the self-massage for the upper extremity </font>
lymphedema handout provided by your
<font color="#E5E5E5">therapist when done at home the massage </font>
<font color="#CCCCCC">should be done on their skin and not </font>
over clothing the first step in the
sequence is an abdominal breathing
<font color="#CCCCCC">exercise this exercises<font color="#E5E5E5"> little jumpstart </font>
for your deep abdominal emphatic and
<font color="#E5E5E5">helps prepare the system to handle the </font>
<font color="#CCCCCC">fluid you will be mobilizing the massage </font>
<font color="#E5E5E5">the most difficult<font color="#CCCCCC"> part of this exercise </font>
is becoming comfortable with the actual
abdominal breathing so let's practice
this part alone before incorporating it
<font color="#E5E5E5">into the exercise place your hands on </font>
your stomach and inhale deeply through
your nose as you breathe in your abdomen
<font color="#E5E5E5">should expand pushing your hands out </font>
<font color="#E5E5E5">then exhale strong is at the same time </font>
pushing in on your stomach with both of
<font color="#CCCCCC">your hands practice this a couple of </font>
<font color="#E5E5E5">more times take a deep breath into your </font>
<font color="#E5E5E5">abdomen your stomach should expand </font>
pushing your hands out then below the
<font color="#E5E5E5">arrow strong legal proceeding with your </font>
<font color="#E5E5E5">hands and again breathe in then blow out </font>
hard pushing in with your hands this
<font color="#E5E5E5">often takes some practice and you may </font>
<font color="#CCCCCC">need to stop the DVD and practice this </font>
abdominal breathing techniques before
incorporating it into the
<font color="#E5E5E5">besides if you have back problems </font>
performance exercise just as
demonstrative if you're able is most
<font color="#E5E5E5">effective if you combine this breathing </font>
exercise with a strong abdominal muscle
contraction as follows lie on your back
<font color="#E5E5E5">on the floor or bed and bend your knees </font>
so your feet are flat on the supporting
<font color="#E5E5E5">surface place your hands on your thighs </font>
<font color="#E5E5E5">and breathe in deeply through your nose </font>
so your stomach expands then as you blow
<font color="#E5E5E5">out forcefully do a mini sit up sliding </font>
<font color="#E5E5E5">your hands up towards your needs this </font>
combines the forceful exhalation with
<font color="#CCCCCC">contraction with your<font color="#E5E5E5"> stomach muscles </font>
<font color="#E5E5E5">return to the starting position and </font>
repeat this exercise two more time
<font color="#CCCCCC">breathe in pushing me coming<font color="#E5E5E5"> out that </font>
<font color="#CCCCCC">exhale while doing the new sit-ups and </font>
<font color="#E5E5E5">again breathe in and blow out while </font>
<font color="#CCCCCC">contrasting your stomach muscles </font>
this exercise is repeated in total three
<font color="#E5E5E5">times now we're ready to proceed with </font>
the actual massage sequence it's easy to
<font color="#E5E5E5">remember if you think of it as three </font>
<font color="#E5E5E5">separate lymphatic pathways the chest </font>
<font color="#E5E5E5">the trunk and the affected arms before </font>
and after each pathway you will clear
your lymph nodes in your neck armpits
and groin we begin by clearing the lymph
<font color="#CCCCCC">nodes in the neck this is step 2 on<font color="#E5E5E5"> your </font>
<font color="#E5E5E5">hand up there located just behind the </font>
collar bone feel for the hollow spot
<font color="#CCCCCC">just above the collarbone cross your </font>
hands and use your index and middle
<font color="#E5E5E5">fingers stroked 10 times down and </font>
towards the breastbone imagine you're
<font color="#CCCCCC">directing fluid under the collar bone if </font>
<font color="#CCCCCC">you have a port in place you may need to </font>
<font color="#E5E5E5">do this on only one side if you don't </font>
<font color="#CCCCCC">want to massage over the line run into </font>
<font color="#E5E5E5">your port </font>
<font color="#E5E5E5">then we'll clear the woods notes in both </font>
<font color="#E5E5E5">armpits this is step three on your </font>
handout do the involve side first in
this case the left side and then we on
affected side massage deep into the
<font color="#E5E5E5">armpit moving from the armpit towards </font>
<font color="#E5E5E5">the truck ten times<font color="#CCCCCC"> on the affected side </font>
<font color="#CCCCCC">then 10 times on the unaffected side </font>
<font color="#E5E5E5">you may want to raise<font color="#CCCCCC"> your arm or </font>
support it against the wall to better
<font color="#E5E5E5">get up into the ortho </font>
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<font color="#CCCCCC">once you've cleared the nose<font color="#E5E5E5"> in your </font>
<font color="#E5E5E5">neck and on test we begin first massage </font>
Catholic remember the whole massage
sequence is made of three separate
<font color="#E5E5E5">sections or drainage path with the first </font>
<font color="#E5E5E5">pathway promotes drainage from your </font>
affected arm towards the lymph nodes on
<font color="#E5E5E5">the unaffected society this corresponds </font>
to step four five and six on your hand
up begin by stroking across your upper
chest to just below the level of the
<font color="#E5E5E5">collarbone moving from the affected side </font>
the unaffected side in a series of short
strokes keep your entire hand flat on
<font color="#E5E5E5">your chest as you do this using the palm </font>
of your hand and your fingers not just
your fingertips about halfway across it
<font color="#CCCCCC">easy as the switch hands notice that<font color="#E5E5E5"> you </font>
start out with co in motion and when you
switch hand to doing the pushing
locomotion remember you're directing
fluid from your affected side to the
<font color="#CCCCCC">unaffected armpit repeat this step five </font>
times
<font color="#E5E5E5">step 5 on your handout is the same as </font>
<font color="#E5E5E5">what you just performed accepting move </font>
<font color="#E5E5E5">your hands down slightly on your chest </font>
massaging from the affected armpit
towards the armpit on your unaffected
side this is repeated five times as well
<font color="#CCCCCC">step 6 is<font color="#E5E5E5"> the famous step four<font color="#E5E5E5"> and five </font>
<font color="#CCCCCC">that you again move your hand position </font>
slightly lower on your chest massage is
directly over the dress if you have
significant scar tissue in this area it
<font color="#E5E5E5">would be beneficial to spend a little </font>
more time massaging across the scar
tissue as it has it's difficult for
fluid to move across scar throughout the
massage sequence the number of
repetitions given our guidelines only it
<font color="#E5E5E5">is always beneficial to spend a little </font>
more time of areas where who attends to
<font color="#CCCCCC">pool or scar tissue is present obviously </font>
this varies from person to person
<font color="#E5E5E5">this completes the first of the three </font>
<font color="#E5E5E5">drainage pathways repeat steps 2 & 3 </font>
<font color="#E5E5E5">clearing the lymph nodes in your neck </font>
and both armpits however we now only
need to do this two to three times at
each site
the second pathway drains fluid from the
armpit on the affected side down to the
<font color="#E5E5E5">groin notes on the same side this </font>
pathway is especially effective if you
have any pooling of fluid in the armpit
<font color="#E5E5E5">or upper chest region on your effective </font>
side we begin and end this section by
<font color="#E5E5E5">sparing the lymph nodes in the groin on </font>
<font color="#E5E5E5">the effective side this can be done </font>
<font color="#CCCCCC">laying down or in standing but you can't </font>
reach your growing house while sitting
<font color="#CCCCCC">mr. step 7 on your handout your groin </font>
nodes are located where your leg attach
it to your torso or just deep to the
panty line place both hands one on top
<font color="#CCCCCC">of the<font color="#E5E5E5"> other just below the pan you </font>
errands and stroke in upward motion
across the pen light toward the belly
<font color="#E5E5E5">button and scooping motion begin close </font>
<font color="#CCCCCC">to the midline and work your way out </font>
repeat this time
now stroke the abdomen on the involved
side toward the growing notes on that
<font color="#E5E5E5">side of the body again in the series of </font>
short stroke use both hands placed flat
<font color="#E5E5E5">on your stomach and along your side </font>
repeat this five times
next stroke from around the back of your
waist on the involved side towards the
<font color="#E5E5E5">noise nose in your growing five times if </font>
<font color="#CCCCCC">you have trouble reaching around<font color="#E5E5E5"> back of </font>
<font color="#E5E5E5">your ways you can use a towel or a </font>
<font color="#CCCCCC">long-handled bath brush if cindy is </font>
<font color="#E5E5E5">demonstrating </font>
now we move up to the armpit to bring
the fluid down stroke the upper and
lower areas of the chest starting at the
<font color="#CCCCCC">armpit and working your<font color="#E5E5E5"> way down towards </font>
<font color="#CCCCCC">the groin nodes in a series of short </font>
strokes repeat this five times or more
<font color="#CCCCCC">if this is a particular<font color="#E5E5E5"> area of swelling </font>
for you
again clear the groin notes the nodes in
<font color="#CCCCCC">the neck and the nodes in the armpit two </font>
<font color="#CCCCCC">to three times beach these are<font color="#E5E5E5"> steps 72 </font>
<font color="#E5E5E5">and three on<font color="#CCCCCC"> your hand up </font>
<font color="#E5E5E5">now we're ready to begin the<font color="#CCCCCC"> third and </font>
final drainage pathway the affected are
<font color="#CCCCCC">the single most important thing to </font>
<font color="#E5E5E5">remember when massaging me on is that we </font>
<font color="#E5E5E5">want to direct the<font color="#CCCCCC"> fluence up and around </font>
the back of your shoulder toward the
<font color="#E5E5E5">nodes in the neck we do not want to </font>
<font color="#E5E5E5">direct fluid to the nose and<font color="#CCCCCC"> the </font>
<font color="#CCCCCC">affected arm tip as these have already </font>
<font color="#E5E5E5">been compromised by surgery and for some </font>
<font color="#E5E5E5">people by radiation begin by stroking </font>
<font color="#E5E5E5">the bath of your involved shoulder up </font>
<font color="#E5E5E5">and over towards the nose in your neck </font>
five times
<font color="#CCCCCC">if you're unable to reach over to the </font>
<font color="#CCCCCC">block<font color="#E5E5E5"> of your affected shoulder you can </font>
use a word handle bath brush secure a
<font color="#CCCCCC">soft cloth over the head of the bath </font>
brush so it will glide clearly over your
skin
now struck the outside of the upper arm
up to the back of the shoulder toward
<font color="#E5E5E5">the nose in the neck repeat this five </font>
times
the next step number 16 on handout can
be confusing when stroking the inside of
the upper arm the part closest to your
body when sitting normally you want to
encourage the fluid around to the
<font color="#CCCCCC">backside of your arm and up over your </font>
shoulder rather than directing it up to
<font color="#E5E5E5">the armpit on the same side this can be </font>
done with your arm and your side
massaging either was the fall or the
<font color="#E5E5E5">backside of your<font color="#CCCCCC"> offices here to see you </font>
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or you can raise your affected arm in
<font color="#CCCCCC">massage towards the back of the shoulder </font>
whichever is more comfortable for you
now stroke the front part of the upper
<font color="#E5E5E5">arm towards the outside and not both of </font>
<font color="#CCCCCC">the back of the shoulder toward the net </font>
<font color="#CCCCCC">nodus<font color="#E5E5E5"> part time </font>
once you've completed the upper arm you
<font color="#E5E5E5">again clear the lymph nodes in the neck </font>
<font color="#E5E5E5">and arm pit two to three times at each </font>
site
as we proceed down the arm there are two
<font color="#E5E5E5">sets of lymph nodes located near the </font>
inside of the elbow one set just above
<font color="#E5E5E5">the elbow bone and one set just below </font>
<font color="#CCCCCC">the elbow both using the thumb of your </font>
opposite hand stroke in an upward
<font color="#CCCCCC">direction five times just above the </font>
<font color="#E5E5E5">elbow bone and five times just alone </font>
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with the problem of your involved arm
facing up joke all of the surfaces of
your forearm in four directions toward
<font color="#E5E5E5">the elbow pay special attention to any </font>
areas where fluid hence the pool for
<font color="#CCCCCC">many people this is the<font color="#E5E5E5"> front part of </font>
<font color="#CCCCCC">the wrist and you may need to spend a </font>
<font color="#E5E5E5">little extra time in this area </font>
if you have swelling in your hand gently
<font color="#E5E5E5">stroke the back of your hand toward the </font>
risk then massage the fingers gently
working from the nails back towards the
<font color="#CCCCCC">hands make sure you massage along the </font>
sides of each finger existence where the
<font color="#E5E5E5">lymphatic vessels collect and run we </font>
<font color="#E5E5E5">find it works well to place your thumb </font>
and middle finger along the sides of
<font color="#E5E5E5">each finger with your index finger over </font>
<font color="#CCCCCC">the top and cindy<font color="#E5E5E5"> is doing this way you </font>
cover all three services with each
<font color="#E5E5E5">stroke once you have worked on each </font>
digit do a general sweeping stroke up
the entire arm remember to clear the
<font color="#CCCCCC">nodes at the inside of your elbow on the </font>
<font color="#E5E5E5">way up and as you<font color="#CCCCCC"> get up towards the </font>
fill the shoulder again encourage the
<font color="#E5E5E5">fluid around the back side of the </font>
<font color="#E5E5E5">shoulder up and over toward the nose in </font>
<font color="#CCCCCC">your left </font>
<font color="#E5E5E5">finally remember to clear the lymph </font>
nodes in your neck armpits and groin to
<font color="#E5E5E5">the three times at each side </font>
you may repeat the breathing exercise
<font color="#E5E5E5">from the beginning if you wish and if </font>
time permits lie and relax with your arm
<font color="#E5E5E5">elevated I'm Attila for five to ten </font>
minutes occasionally opening and closing
<font color="#E5E5E5">your fifth this completes the </font>
self-massage for upper extremity with
Aviva we hope it is helpful once you
<font color="#CCCCCC">become familiar with the massage it </font>
<font color="#CCCCCC">takes about<font color="#E5E5E5"> five to ten minutes to </font>
<font color="#CCCCCC">perform although the strokes are done </font>
very lightly if performed daily it does
<font color="#E5E5E5">help to optimize the function of your </font>
lymphatic system and prevent or reduce
<font color="#E5E5E5">the severity of upper extremity </font>
lymphedema following surgery or
radiation treatment for breast cancer if
you have any questions about the massage
<font color="#E5E5E5">please contact your therapist at the </font>
<font color="#E5E5E5">mercy sports medicine and we have some </font>
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