Study examines use of yoga therapy to address lymphedema

Vanderbilt University School of Nursing

Cancer is bad enough. But cancer patients who receive surgery, radiation and chemotherapy may suffer from side effects that run from irritating to crippling — problems that are postural, musculoskeletal and respiratory, along with lowered self-esteem. Many suffer from lymphedema, swelling caused by retained fluid in a compromised lymphatic system.

One answer may be the ancient practice of yoga. Researcher Sheila Ridner, Ph.D., MSN, R.N., Martha Rivers Ingram Professor of Nursing, is conducting a pilot study, in which head and neck cancer patients are receiving yoga therapy. It's designed to increase the mobility of affected parts in order to address lymphedema symptoms, postural problems, and breathing issues, in addition to improving mood.

"Breathing, particularly diaphragmatic breathing, helps move the fluid and standing upright clearly takes away restrictive bends in the body that might keep fluid from moving," Ridner said.

For the last year, study participants have been coming to the Vanderbilt University School of Nursing for 90-minute, one-on-one sessions with Sujatha Yarlagadda, yoga therapist and assistant in Nursing. Each session includes awareness practice, postures that focus on improving mobility in the neck, jaw and shoulders, breathing exercises, relaxation and meditation.

They come three times a week for a month, while Yarlagadda helps determine which of 16 yoga poses are effective "to loosen the entire body and facilitate free flow of energy," she said. The sessions are filmed, and participants can leave with a DVD of the session that they can use to practice yoga at home.

Ridner compares the participants' physical measurements taken after the four weeks of treatment to before. Then, the patients come two times a week for another four weeks, a similar regimen to what they would receive if they received traditional physical therapy, Ridner said.

So far, more than 20 people have participated, out of a pool of 40 that Ridner hopes to recruit. Though the study is not scheduled to end until July 31, Ridner is encouraged by the changes she's seeing in patients.

"They walk better," she said. "They're standing up straighter. They say hi when they see people and they have a smile on their face that they literally didn't have when they first came in the door."

Michael Walsh, a neck cancer survivor who is finished with his part in the study but continues to practice yoga, said he's much improved. He's resumed playing ice hockey on weekends, something he had to give up after the cancer treatments rendered him unable.

"It feels a lot better, and I know that because I'm not getting my headaches that I used to get," he said.

Ridner is closely measuring the effectiveness of each yoga position, and combinations of positions. Her hope is that this is one step toward a more comprehensive study that will lead to targeted yoga therapies that patients can do at home.

She emphasized that the postures are carefully chosen and are safe, and haven't resulted in injury. This isn't group yoga or hot yoga, which is practiced in a room heated to about 105 degrees.

Ridner has been passionate about head and neck patients since she treated them as a bedside nurse in the late 1970s. She said that often, lymphedema sufferers are either not diagnosed or asked to live with their conditions until they get much worse.

"These may be things that we can fix," she said. "It's not like you just have to accept that people have to be impaired after having head and neck cancer. We don't have to accept that for them. We do not have to accept that's just what happens."