Mobilizing lymph flow

Annette Dunker knows from her own experience how important it is for patients suffering from lymphatic disorders to receive targeted information, decongestion to be carried out properly and to be active. Together with Bauerfeind, Germany’s first Licensed Specialist Trainer In Outpatient Rehabilitation Sport For Lymphatic Decongestion Exercises has created a digital movement program to help others who are affected.

Annette Dunker was diagnosed with breast cancer on the right side at only 41 years old in 2007. The standard procedure followed: breast-conserving surgery with removal of the lymph nodes in the right armpit, medication, chemotherapy and radiation. “Afterwards, I didn’t get typical lymphedema in the affected arm, but both arms swelled up. So no difference was visible and I was initially labeled as a hypochondriac,” she remembers. Lymphatic drainage? Not a chance. Even when the swelling in her legs got bigger and bigger. Annette Dunker went from one hospital to the next, but even inpatient rehabilitation provided no improvement.

Her personal turning point

“As much as two years later, when I applied for retirement, did the pension insurance company send me to Bad Nauheim Edema Hospital. That was the best thing that happened to me,” says Annette, who is 55 years old now. That is where she was diagnosed with secondary lymphedema and received the appropriate treatment. “That was also the first time I heard about complex decongestive therapy (CDT).” From that point onwards, Annette Dunker soaked up all the information she could get on lymphatic treatment. She received lymphatic drainage and wore, and still wears, compression garments. “I’ve also developed an idiopathic edema in other areas of my body, that’s why I wear pantyhose, thorax, arm and hand garments.” And she exercises a lot. “That has always been a part of my life,” Annette Dunker says, who was a trainer for grassroots sport in her youth. After her illness, she first completed training for outpatient rehabilitation sport for the specialist fields of orthopedics and cancer follow-up care. Twelve years ago, she added Specialist Trainer for Rehabilitation Sport in Internal Medicine and Neurology, and since 2013, she has been permitted to instruct patients suffering from lymphedema in outpatient rehabilitation sport. She is licensed by the German Olympic Sports Confederation, together with Behinderten- und Rehabilitationssportverband Nordrhein-Westfalen e.V., the sports association for disabled and rehabilitation sport in her area. “I have also trained other trainers, but the offer for patients is still quite sparse. That makes other forms of information and instruction all the more important – such as curaflow, the app for patients suffering from lymphedema,” she emphasizes.

Helpful companion throughout treatment

Together with Bauerfeind, Annette Dunker developed the app’s exercise program, and she provided helpful input. “The app is a mixture of background information and suggestions to get active,” she explains. “We thought it was important to present all the pillars of CDT because one element alone would not lead to success. We especially focused on decongestion exercises because the lymph flow has to be mobilized.” This includes flowing movements in the lymphatic system’s drainage direction, designed to support decongestion. “Our goal is to mobilize the congested edema fluid that’s high in protein, and to drain it via the lymph vessels, including those that were rarely used before. The idea is for the body to be stimulated so it activates these ‘secondary pathways’ and soften hardened and scarred tissue,” Annette Dunker explains. “Ideally, all this should happen wearing compression garments because these are most effective during movement.”
The app shows, for example, simple muscle contractions for the arms and hands or arm movements in the shape of a recumbent figure of eight. Overall, the entire body is activated thanks to these exercises. “The important thing is to find the right rhythm. Lymph is sluggish. That’s why the movements should neither be carried out too quickly nor too slowly to encourage ideal drainage.” The instructional videos in the app also help with the right speed. “We also made sure that little space is needed for the exercises and that objects commonly found in the home can be used,” the Sports Therapist for Rehabilitation reports. “There are exercises to be carried out when sitting, others when standing and others again to include a few steps. We start in such a gentle way that everyone can join in. And those who can’t get enough can work out several times per day.” She does her decongestion exercises every day herself: “For the best results, integrate a few exercises in your everyday life. Exercise should become a standard activity like brushing one’s teeth.”
Annette Dunker would have loved to have such extensive information in 2007. Today, she wants to help educate others and motivate them to be more active.

Images: Julian Wiesemes, Bauerfeind (4)