A Renu therapist's hands working around a client's knee and lower thigh on the treatment table

Remedial exercises for leg lymphedema: a seated and standing sequence

Seated and standing remedial exercises for leg lymphedema: ankle pumps, circles, toe curls, marching, knee bends, at least twice a day, stocking on.

By The Renu lymphatic and massage team · 7 min read

The remedial exercises for a swollen leg are gentle pumping movements you can do in a chair, at a desk or in the car: ankle pumps and circles, toe curls, seated marching, slow knee bends and hip semi-circles, each 5 to 10 times, with your compression garment on. Cancer Research UK asks for them at least twice a day and suggests doing them while watching television; the NHS foot drill of 30 ankle bends and 8 circles each way, written for pregnancy swelling, is a useful standard for anyone. Pair each set with breathing and a few minutes with the leg up.

A swollen leg needs its calf and foot muscles working several times a day, and the remedial exercises are how you do that without standing up. Cancer Research UK and Macmillan both publish short seated routines: ankle pumps and circles, toe curls, marching in the chair, slow knee bends, hip semi-circles, each repeated 5 to 10 times, at least twice a day, with the compression garment on. The NHS adds a countable foot drill from its pregnancy advice, 30 bends and 8 circles each way, that works for anyone with a heavy leg. This page sets out a seated sequence, a standing one for queues and counters, and a way to thread them through a day spent mostly sitting.

What the exercises are doing

Moving fluid with muscle. Cancer Research UK explains that exercise makes the muscles contract and pushes lymph through the lymph vessels; the National Lymphedema Network describes remedial exercise as active, repetitive, non-resistive motion of the involved body part, done with compression so the body’s natural muscle pump increases venous and lymphatic return out of the swollen area, and it reports that remedial exercise has been shown to reduce limb swelling. Macmillan’s standing advice makes the target muscle explicit: rising onto the toes and lowering tenses and relaxes the calf.

The garment matters for the same reason. Cancer Research UK says to wear your compression garment when exercising if you have one; Macmillan says you usually need to and to speak to your specialist if it is uncomfortable. The stocking gives the calf something to squeeze against.

The seated sequence

Cancer Research UK’s suggestion is a chair in front of the television; its instruction is to start with deep breathing and repeat each movement 5 to 10 times. Sit with the legs uncrossed, which Macmillan asks for whenever you sit.

Breathe. Hand below the ribs, slow breath in through the nose so the abdomen rises, slow breath out through the mouth until it is flat. Five times. Cancer Research UK says this changes the pressure in the abdomen and chest and encourages lymph back into the blood.
Ankle pumps. Heel on the floor, point the toes away, then pull them toward the chin. Cancer Research UK notes you can do this in a recliner or in bed. For the countable version, the NHS foot drill is 30 up-and-down bends.
Ankle circles. Lift the foot off the floor and circle the ankle clockwise, then anticlockwise. The NHS count is 8 circles each way, each foot.
Toe curls. Curl the toes up, then stretch them out.
Seated marching. Lift one knee, put it down, lift the other. Cancer Research UK gives this as both a knee exercise and a hip one.
Knee straighten and bend. Lift the foot off the floor, straighten the leg, bend it, lower. Macmillan’s version rests the leg on something so it is supported behind the knee while you bend and straighten.
Hip semi-circles. Bring the foot forward and draw a semi-circle on the floor, the other knee slightly bent. Hold a stable surface if balance is a concern.
Heel raises. Raise the heels so you feel the calves squeeze, then lower until the feet are flat.
Breathe again. Five breaths.

At 5 to 10 repetitions this takes about seven or eight minutes. Done twice a day it meets Cancer Research UK’s floor.

The standing sequence, for queues and counters

Macmillan asks you to avoid standing still for long periods, and gives three movements for the times you cannot avoid it:

Rise onto the toes and lower, tensing and relaxing the calf muscles.
Shift weight from one leg to the other, and from heels to toes, as if walking on the spot.
Rock back on the heels and forward onto the toes a few times.

The NHS says its foot bends and circles can be done standing as well as sitting, so the 30-and-8 drill transfers to a kitchen counter. Cancer Research UK’s marching on the spot is the fourth option when there is room.

Pairing each set with elevation and breathing

The sources describe three habits that belong together: pump, lift, breathe.

Lift. Cancer Research UK: when at rest, do not sit with the legs down; lie on the sofa or put the leg up on a stool or chair, fully supported with a cushion or pillow under the knee. Macmillan: raise your legs as often as you can when sitting, and lie with them up on a sofa or fully supported on a footstool. The National Cancer Institute: elevate a leg with lymphedema while lying down by resting it on a pillow or rolled-up blankets. The set-up details are on how to elevate an arm or leg to reduce swelling.

Breathe. Macmillan asks you to include deep breathing in any daily exercise routine; our five-minute breathing routine is the longer form of steps 1 and 9.

A simple rhythm: the seated sequence, then ten minutes with the leg up and five slow breaths, then a walk to another room. If you have been taught self-lymphatic drainage for the leg, the breathing and the exercises sit naturally on either side of it.

Fitting it into a day of sitting

The Canadian 24-Hour Movement Guidelines limit sedentary time to 8 hours or less and ask you to break up long periods of sitting as often as possible; Macmillan’s version for a swollen leg is to get up and move about at least once an hour, not to keep the leg in the same position for too long, and not to stand still for long either. A workable day:

When	What
Before getting up	Ankle pumps and circles in bed (Cancer Research UK says the pumps can be done lying down)
Mid-morning, at the desk	The seated sequence, stocking on, legs uncrossed
Every hour	Stand, walk to the kitchen or the printer, a few heel raises
Lunch	Ten minutes with the leg up on a chair, cushion under the knee
Mid-afternoon	The NHS 30-and-8 drill under the desk
Evening, television	The full seated sequence, then legs up on the sofa

Long drives and flights are the hard case. In the car, stop and walk when you can; on a plane, ankle pumps and knee flexion in the seat are the NLN’s own suggestion for the lower limb, and our flying checklist has the rest. For the days you can walk, the walking program for lymphedema builds the big-muscle version of the same pump.

Stop and call

Stop the exercises, and contact your lymphedema therapist or doctor before the next set, if:

Any movement is painful. Cancer Research UK says the exercises should not hurt; stop, and contact your doctor if the pain does not settle.
The leg becomes more swollen, hot or painful, or feels heavier. Macmillan says to stop straight away if swelling gets worse; the NLN lists heaviness and a sense of increased size among symptoms to report immediately.
The skin becomes red, sticky and hot. Macmillan: stop and rest.
You have a skin infection. Macmillan says not to exercise during cellulitis. The NCI’s signs are pain, tenderness, redness and swelling, skin warm to the touch, and fever, and it says to call your doctor right away.
You are pregnant and the swelling rises suddenly in the face, hands or feet, or comes with a severe headache, vision problems, pain below the ribs, persistent heartburn, vomiting or feeling very unwell. The NHS page the foot drill comes from says to get urgent medical advice, because these can be signs of pre-eclampsia; our swollen feet and ankles in pregnancy page covers it.

The wider red flags are on when swelling needs medical care.

Learning the counts on the table

Macmillan says your lymphoedema specialist will explain some gentle exercises and that what is right for you depends on your level of fitness; the NLN’s position is that remedial exercises are part of both phases of complete decongestive therapy and are folded into a fitness program with your certified lymphedema therapist as you move into self-management. At Renu, that is Meeghan Mackenzie, our Certified Lymphedema Therapist, within complete decongestive therapy. Bring your stocking; the exercises only pump well against a garment that fits, and a compression fitting with Meeghan Mackenzie, a Certified Compression Fitter, is 30 minutes for $25. A Certified Lymphedema Therapist’s broader tips are on our journal: five ways to decrease leg swelling.

Questions people ask

How often should I do leg exercises for lymphedema?

Cancer Research UK asks you to try to do them at least twice a day, repeating each 5 to 10 times, and suggests doing some sitting in a chair while watching television. Macmillan simply says to do them regularly while sitting down. Because they are short, a third set in the middle of a long day of sitting is easy to add; Macmillan also asks you to get up and move about at least once an hour.

Can I do these at my desk or in the car?

The seated set was written for a chair, and ankle pumps, circles and toe curls need nothing but shoes with room to move. The NHS foot exercises can be done sitting or standing. Macmillan's advice for anyone who has to stand for a long time, rising onto the toes and shifting weight from heel to toe, works in a queue or at a counter. A long drive is the hardest case; stop and walk when you can.

Do I keep my compression stocking on?

Yes. Cancer Research UK says to wear your compression garment when exercising if you have one, Macmillan says you usually need to, and the NLN describes remedial exercise as performed with compression so the muscle pump moves fluid out of the swollen area. If the garment is uncomfortable during a movement, Macmillan's advice is to speak to your specialist rather than leave it off.

Should I put my legs up afterwards?

It is a good pairing. Cancer Research UK says that at rest you should avoid sitting with the legs down and instead lie on the sofa or put the leg on a stool, fully supported with a cushion under the knee. The National Cancer Institute suggests elevating a leg with lymphedema while lying down on a pillow or rolled blankets. A set of pumps, then ten minutes up, then a walk to the kitchen is a sensible rhythm.

Why does the NHS say 30 ankle bends?

The number comes from the NHS pregnancy page on swollen ankles, feet and fingers: bend and stretch the foot up and down 30 times, then rotate each foot in a circle 8 times each way, sitting or standing, to help circulation and prevent calf cramps. It was written for pregnancy swelling, not lymphedema, and we borrow it as a clear, countable standard; Cancer Research UK's 5 to 10 repetitions is the lymphoedema-specific guidance.