Winning Hands Massage
Precautionary Measures for Lymphedema
Copied from “Silent Waves” by Bruno Chikly, pages 247-248.
“In lymphedema remember that the few remaining lymphatic vessels are very
fragile and will not tolerate any heavy massage pressure, e.g., deep tissue
massage, Neuromuscular Therapy (NMT), Rolfing, Hellerwork, etc.
Be aware that in primary lymphedema other limbs may also be at risk and
observe the same precautions for them.
Avoid the four “I’s.”
Injury and Infection
- Increased temperature
- Increased pressure
- Do not let skin remain wet or damp. Dry the limb thoroughly,
especially between the toes. Use lotion after bathing.
- Pay very close attention to hygiene of skin and nails in
order to avoid infections. Use fragrance-free, low pH,
hypoallergenic lotion. Treat any infection actively. Clean even
small wounds very thoroughly. Cover the wound with antibacterial
ointment and a bandage. Change the bandage if dirty or dry.
- Prevention of infection: teeth and gums, skin, bladder,
- Avoid invasive care on the affected arm: shots, vaccination, drawing of
blood, needles of any kind, lymphography, fluid extraction, acupuncture,
- Avoid any deep tissue massage or manipulation on the
affected limb; it may destroy the few functioning lymphatic vessels
- Cut nails straight and slightly smooth on the corner. Do not
tear the cuticle of the nail (use cuticle cream). Have manicures
- Prevent getting scratches from cats, dogs, or other animals.
- Use long mitts when cooking or handling hot dishes.
- Use an electric shaver for shaving. Avoid blades.
- Use leather gloves and sunscreen while gardening.
- Use gloves when applying or working with harsh chemicals.
- Use a thimble while sewing.
- Be careful when handling a cigarette or cutting object with
the affected side.
- Use insect repellent to prevent insect bites
- Do not wear slippers or open toe shoes such as sandals. See
- Prevent irritation. For example, pay attention to what
deodorant you use – does it cause a rash?
- Avoid saunas, hot baths, hot tubs, hot showers, UV, etc.
Use beach umbrellas.
- Avoid sunburn: long exposure to sun from outdoor
activities or sunbathing.
- Avoid long car or bus trips in hot weather.
- Avoid burns from working with fire or cooking.
- If you are burned lightly, use ice and cover right away,
disinfect and don’t let the blister break.
The skin is the body’s first line of defense. It protects the body from
trauma and infection and aids in temperature regulation. Therefore it is
essential to keep the skin healthy. Individuals who have had any impairment
of the lymphatic system are especially at risk for developing an infection.
A small cut or abrasion can allow bacteria to enter the skin, and the
stagnant lymphatic fluid is a perfect environment in which bacteria can
- Avoid doing vigorous exercises with the affected limb,
strenuous tasks, excessive lifting, etc.
- Do not wear tight clothes (including sleeves), “over the
shoulder” bags, brassiere straps, belts, jewelry (rings,
bracelets, elastic band, etc.) or heavy breast prostheses.
- Hold the limb in different positions. Especially do not
always leave it hanging. Lift the limb and do periodically
short duration exercises; whenever you have your limb
immobilized for a long period of time elevate it if possible.
- Do not sleep on a n affected arm. The arm should be
- Plane flights may require additional external compression to avoid
increased swelling. The cabin pressure and/or the lack of oxygen delivered
to the bloodstream may aggravate the lymphedema considerably.
- Do not have your blood pressure taken on the affected
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