title: Yoga protocol for treatment of breast cancer-related lymphedema.
abstract: BACKGROUND
  Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL).
  
  
  METHODS
  The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL.
  
  
  RESULTS
  Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain.
  
  
  CONCLUSIONS
  Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL.
authors: Institute of Applied Dermatology, Kasaragod, Kerala, India.
authors: S R
authors: SR
authors: Narahari
authors: Institute of Applied Dermatology, Kasaragod, Kerala, India.
authors: Madhur Guruprasad
authors: MG
authors: Aggithaya
authors: Department of Physiotherapy, Bispebjerg Hospital, 2400 Copenhagen, Denmark, UK.
authors: Liselotte
authors: L
authors: Thernoe
authors: Institute of Applied Dermatology, Kasaragod, Kerala, India.
authors: Kuthaje S
authors: KS
authors: Bose
authors: Department of Dermatology, Churchill Hospital, Oxford, UK.
authors: Terence J
authors: TJ
authors: Ryan
keywords: Breast cancer-related lymphedema; breathing; integrative medicine; range of movement; yoga