After orthopaedic surgery (or any type of surgery), swelling in the area or nearby tissues is completely normal. The problem comes when swelling persists over time or becomes chronic: Lymphoedema. Understanding the key differences between normal post-op swelling and lymphoedema is crucial for prevention, timely management and treatment. In this blog, we show you how to know the difference and when to seek medical advice. Let´s have a closer look…

What is pos-orthopaedic (post-op) swelling?

Post-op swelling is a natural inflammatory response to surgery. It covers the treated area and near tissues. This swelling is caused by your immune system in order to help the tissue heal properly. How to recognise it:

• Develops immediately or within a few days after surgery.
• Is temporary, generally improving within weeks or a few months (according to the surgery) as tissues heal.
• May feel soft, a little bit tight and can fluctuate in intensity.
• It is located near the scar.

What is post-orthopaedic lymphoedema?

Lymphoedema develops when swelling is caused by blockage or damage in the lymphatic system during surgery (trauma or removal in lymphatic vessels or nodes). As a result, lymph and other fluids can not move and drain out of the area, so swelling turns into a chronic condition that needs immediate treatment to relieve symptoms and avoid progression. How to recognise it: 

• Persistent swelling: it lasts more than three months or might develop gradually over time.
• May have a feeling of heaviness, tightness, pain or fullness in the treated area and spreads to the major part or the entire limb.
• Initially, you might feel a tight sensation on the skin, but can harden as the condition progresses.
• Unlike normal swelling, lymphoedema is chronic and can worsen without treatment.

Post-orthopaedic Swelling vs. Lymphoedema: key differences

These are the most common differences between common swelling and lymphoedema (when it is not prevented with MLD)

When to seek help

It’s important to consult a healthcare provider (surgeon, GP, certified lymphoedema therapist, swelling treatment  specialist) if swelling:

• Persists beyond 3 months after surgery or worsens instead of improving.
• Is accompanied by a sensation of heaviness, tightness, or persistent discomfort in the limb.
• Affects mobility or daily activities.
• Shows skin changes such as thickening, redness, easy bruising or even infections.
• Develops suddenly or is very pronounced without obvious cause, causing pain, discomfort and joint mobility issues.

Prevention through MLD eases swelling and enhances the healing process. Also, early diagnosis allows proper assessment and management by a certified  lymphoedema specialist through physical examination, limb measurements, and sometimes imaging (prescribed by a health care provider). Lymphoedema treatment can include compression therapy, Manual Lymphatic Drainage, exercise, diet, skin care, and lifestyle changes.

A final word

While normal post-orthopaedic swelling is part of the healing process and resolves over time, lymphoedema is a chronic condition caused by lymphatic damage that requires ongoing management. Recognising persistent or unusual swelling, especially beyond three months, and consulting a healthcare provider early can avoid condition progression and ensure better outcomes and quality of life.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

 References:

https://www.ncbi.nlm.nih.gov/books/NBK537239/

https://www.lymphapress.com/blog/lymphedema-vs-edema-whats-the-difference/

https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/introduction-lymphoedema-service-face-face-consultation

https://www.facs.org/for-patients/the-day-of-your-surgery/breast-cancer-surgery/after-your-operation/preventing-swelling/

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Persistent swelling and mobility issues after orthopaedic surgery?  It might be lymphoedema. This swelling condition requires a holistic treatment plan. In our previous blogs, we have talked about the different techniques and tips that help you in managing post-orthopaedic lymphoedema, and today, we´ll  give you some of the most effective exercises for starting to manage this condition. These exercises are focused on promoting lymph flow, reducing swelling, and improving mobility, strength and flexibility. Most of them involve gentle, low-impact movements. Here are some of them:

Be ready for your exercise session 

• Wear your compression garments or bandages if prescribed by your surgeon or physiotherapist. These reduce fluid build-up and enhance lymphatic return.
• Warm up by mobilising your joints. Gently and slowly extend and contract  each joint.
• The non-affected limbs and body parts (neck, shoulders, elbows, wrists, hips, knees, ankles, toes) should be mobilised too.

Deep breathing exercises

Deep breathing exercises (diaphragmatic) improve lymphatic flow through the body while improving your general well being. It works by changing the pressure in your abdomen and chest (by the diaphragmatic movement up and down). This encourages lymphatic flow and blood circulation. It is also highly relaxing. You can do these breathing exercises in any position and place. 

• Sit, lay or stand comfortably.
• Relax your shoulders, chest and tummy.
• Place one hand below your ribs and the other on your abdomen.
• Close your mouth.
• Take a slow, deep  breath through your nose, what you should feel is that your abdomen rises.
• Hold for a short period of time.
• Exhale slowly through pursed lips.

Note: while exercising, try to do deep breathing, it will improve your performance and reduce fatigue.

Upper Limb (arm) lymphoedema exercises 

• Move your shoulders up and down.
• Lift your arms gently and slowly (like trying to reach your ears), then, bring them back to normal position.
• Scratch your shoulders: try to make your hands reach each other behind your back.
• Bend and extend your elbows (gentle and slow movements)
• Arm circles. Raise slowly your arms to the sides, making small forward and then backward circles (it enhances lymphatic and blood circulation while strengthening them).
• Regular joint movement facilitates lymph propulsion and prevents stiffness.
• All movements should be slow and gentle. Do them 8/10 times and repeat 2/3 times.

After a couple of weeks, and monitored by your therapist, you can start with:

• Light resistance training. Using elastic bandages to do your exercises, gives resistance to the movement, strengthening your muscle without risks; in addition muscle pumps improve lymphatic flow.
• Light weights (start with 0,5-pound dumbbells), you can  perform controlled arm lifts, bicep curls, and shoulder raises to build muscle without overloading the limb. 
• All exercises should be prescribed and supervised by your lymphoedema therapist, she will monitor your progression and add weight to your lifts if needed.

Lower limb (leg) lymphoedema exercises

• Ankle pumps. Point your toes downward, then flex them upward to stimulate lymph flow in the lower leg.
• Heel-to-toe raises. Raising your heels off the ground, gently, slowly and assisted if needed; then, go back to normal position.  It helps to engage calf muscles for lymph and blood circulation (muscle contraction pumps fluids).
• Calf stretches. Stretch against a wall to release tension and support lymphatic function.
• Knee-to-chest stretch (if knee can be bent). It mobilises hip and knee, promoting lymphatic drainage.
• Leg lifts. Lye on your back and slowly lift each leg to strengthen thigh muscles and improve circulation.
• Seated marching. Alternating knee lifts while seated to improve circulation with minimal strain.
• Step-ups. Step onto a low platform to engage muscles and improve mobility.
• Butterfly stretches. Sit on a flat surface with soles of feet together to stretch inner thighs, then start doing up and downward repetitive movements (like wings of a butterfly). These movements improve pelvic lymphatic drainage.
• Squats
• 2/3 sets of 8/10 rep, 2/3 times per week.

General ideas for low impact aerobic exercises to start with

Low impact exercises 

Low-impact aerobic exercise supports overall lymph flow and well being, you can start with walking, swimming, cycling, dancing, etc. Do it gradually and enjoy it!

Isometric exercises

Muscle pumping aids lymphatic return and muscle strength. Muscular contractions without joint movement, for example:

• Pressing the hand against a wall ( upper limb) 
• Squeezing a pillow between the knees ( lower limb).
• Hold for 5–10 seconds, repeat 5 times.
• Exercise should be done gradually, avoiding fatigue or overuse of the affected limb.

General recommendations

• Regular joint movement facilitates lymph propulsion and prevents stiffness.
• Compression garments are often worn during exercise to aid lymphatic flow (if prescribed by your surgeon and lymphedema therapist).
• It is essential to work with a lymphedema specialist or physical therapist to tailor exercises safely. They’ll advise you on the number of sets, repetitions and type of exercises you are able to do on each step of your recovery process.
• Regular gentle movement combined with breathing exercises helps promote effective lymphatic drainage.
• Exercise should be done gradually, avoiding fatigue or overuse of the affected limb.

A final word…

All these exercises improve lymphatic flow by activating muscle pumps and enhancing joint mobility while minimising the risk of exacerbating swelling or discomfort. They should be part of a comprehensive physical therapy program to manage post-surgical orthopaedic lymphoedema effectively.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!

References:

https://www.cancerresearchuk.org/about-cancer/coping/physically/lymphoedema-and-cancer/treating/exercise

https://pereaclinic.com/the-role-of-compression-therapy-in-managing-post-orthopaedic-lymphoedema/

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31962

https://pmc.ncbi.nlm.nih.gov/articles/PMC3001918/

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