Exercises following Lower Limb Node Dissection

What is lower limb node dissection?

Lower limb node dissection is a surgical procedure that opens the pelvic area to identify, examine or remove lymph nodes.  Lymph nodes are small glands that are part of the lymphatic system, and filter fluids.  These nodes are normally removed in order to determine the necessity of further treatment based on cancer cell spread.

Why do the exercises?

The aim of these exercises is to regain normal leg movement after node surgery or radiotherapy in the pelvic area.  It is important to move the leg, so the tissues around your hips don’t get tight and cause pain. 

The exercises should always be done slowly.  You may feel some discomfort but it should not be painful.    If you develop lasting pain for 30 minutes or more you might need to change the exercises by doing less of them or doing them more gently.

If pain continues consult your Exercise Physiologist or Nurse.

When do you start?

It is best to start these exercises as soon as possible after surgery, so if possible aim to start the day after your surgery.  Always check with your Surgeon that they are happy for you to start. 

Week 1        Start with the Level 1 exercises

Week 2-4     Move on to doing Level 1 and then Level 2 exercises

Week 4+     If you have full range of motion start with gentle
                   strength exercises
                   (Seek further advice about which exercises are 
                   suitable)

Perform the exercises in the order shown below.

When do you need to seek further advice?

Before starting these exercises check with your nurse or surgeon that they are happy for you to start.

If you notice any excessive oozing, redness or severe pain please stop the exercises and consult your doctor or nurse as soon as possible.

If you are in doubt about the exercises and how to do them, or if you feel you are ready to progress, you can contact the CanMove programme for further advice or assistance.

How often should I do the exercises?

Start by running through them twice a day and if you can aim for 3 times a day.   Pick times of the day when it will be easy for you to remember to do the exercises.  When you first wake, after lunch and before bed can be good times to get in the habit of doing the exercises.

Always focus on having good technique during the exercises so if you notice you are tiring during the exercises and can’t do them properly it is better to have a break and try again later.  Little and often is better than doing one long session.

Over time the exercises should start to become easier.  If you notice you can regularly do an exercise fully you need to move on to one of the more advanced exercises in this book or consult with a healthcare professional to find the next step.   

It is important to continually progress exercises so you get stronger.  Continue to exercise even if symptoms or side effects have reduced.

If you have not regained full range of motion within 3 weeks or would like further assistance please contact your Nurse or Exercise Physiologist.

LEVEL 1

Legs elevated

Before starting the exercises lie on your back with your feet elevated.

Toe curls and extension

Aim for 3 sets of 15 repetitions per day

Keeping your legs and ankles relaxed and elevated curl the toes towards the sole of your foot then extend them back as far as you can. Each foot can be done either together or one at a time.

Pointing Foot

Aim for 3 sets of 15 repetitions per day

Keeping your legs relaxed and elevated point your feet keeping the toes extended then flex them back as far as you can. Repeat.

Ankle Circles

Aim for 3 sets of 15 repetitions per day

Keeping your legs relaxed and elevated move the feet in clockwise circles trying to get the ankle working at its full range in every direction. 

Repeat anticlockwise.

Knee to chest

Aim for 3 sets of 15 repetitions per day. Hold for 5 seconds.

Keeping one leg elevated pull the other leg by the shin towards your chest and hold.

 LEVEL 2

Knee roll

Aim for 3 sets of 15 repetitions per day

Lie with both knees at 90 degrees and roll both knees to the left and right slowly. 

Keep the upper body still.

If you are comfortable you may lift the feet off the ground with the knees at 90 degrees and roll them to either side.

Leg Raise Aim for 3 sets of 15 repetitions per day. Keeping one leg elevated brace your stomach muscles and lift the other leg off, pause for a couple of seconds then lower it gradually.

Leg extension Aim for 3 sets of 15 repetitions per day Raise alternate legs, with knee bent at 90 degrees, one at a time while maintaining the contraction.

Side leg raise Aim for 3 sets of 15 repetitions per day Clench buttocks and raise top leg and return to start without touching the top leg on the ground.

WEEK 4+

Once you have regained full range of motion in your pelvic area and your wound has healed it is beneficial to start some gentle strength exercises.  Strength exercises will help further improve and maintain function in the area.