Lymphedema is a condition in which the lymphatic system of the body is unable to properly transport lymph fluid from the tissue spaces back to the blood stream. This compromised transport leads to swelling, and can present itself in the extremities, trunk, genitalia, head or neck. Lymphedema is unlike normal edema or swelling, in that it is made up of protein rich fluid (lymph) that can only be drained by the lymphatic vessels.
If the lymph system is not functioning properly, then the fluid and proteins will remain in the tissue spaces despite elevation, and may turn into a chronic condition. Finding and addressing lymphedema early helps ensure faster, more successful outcomes, however, those with lymphedema can also benefit significantly from intervention in later, more chronic stages of the disease. Because lymphedema is often mechanical in nature (meaning that the structure of the lymphatic system is compromised), lymphedema is a life-long condition. There is no cure, but the condition can be successfully managed
Lymphedema has a variety of causes including, but not limited to: congenital anomaly, trauma, surgical intervention (most well-known is lymph node resection during surgery for breast or other cancers), infection, or radiation treatment. The most common cause of lymphedema in this country is surgical removal of lymph nodes in the axillary (armpit) region due to breast cancer. Having radiation after such a surgery increases risk.
Symptoms of lymphedema
Swelling is the main symptom of lymphedema, and often this swelling is localized to one body region or limb. One has increased risk for lymphedema if she has a history of one or more of the above known causes. To determine whether swelling is truly lymphedema requires a discussion with one`s health care provider. It is important to rule out swelling that may be caused by other organ systems (especially the heart and kidneys) prior to onset of lymphedema treatment.
It is the job of physical therapists to help people regain function and movement due to effects of various conditions, and lymphedema is no exception. Physical therapists with special training can help control and manage lymphedema through complete decongestive therapy. Initial management of lymphedema is often quite intense, and patients work closely with their therapists in developing a treatment plan that will best address the swelling and fit the patients` needs. This initial phase of treatment is often comprised of manual lymphatic drainage (which feels like a light form of massage) followed by compression bandaging. The size of the limb is closely monitored, and once the limb has decreased to the desired size, the patient enters the maintenance phase of treatment. It is at this point in treatment that the patient takes over her care. As previously mentioned, lymphedema is a life-long condition, and commitment to maintaining the decreased limb size is essential to success. Maintenance is most often achieved by wearing compression garments. There are many styles and options to choose from, and the patient and her therapist work together to find the garment that best meets the needs of each patient. At this point in treatment, the patient is often well educated in lymphedema, and is knowledgeable in behavioral changes and exercises that will promote successful ongoing management of her condition independently.
Treatment options for lymphedema
Complex Decongestive Physical Therapy (CDPT) - this is known as the recommended treatment for lymphedema and has four components. It starts with an intensive therapy phase, during which the patient receives daily treatment and training. This is followed by the maintenance phase, when the patient is encouraged to take over their own care using techniques that have been taught to them.
MLLB (multilayer lymphedema bandaging) - muscles surrounding lymph vessels and nodes move the fluid through the lymphatic system. Unlike the circulation of blood there is no central pump (heart). The aim here of bandages and compression garments is to support the muscles and encourage them to move fluid out of the affected body part. MMLB is utilized after MLD to stop fluid from building up again in the limbs.
Patients will also be taught how to apply their own bandages and compression garments correctly so that MLLB can continue during the maintenance period.
Compression garments may include long sleeves or stockings which compress to encourage the flow of the lymph fluid out of the affected limb. Even when swelling is reduced, the doctor may recommend that the patient continues wearing them to prevent recurrence of swelling. It is important to get garments that fit properly.
Remedial exercises - these are light exercise aimed at encouraging movement of the lymph fluid out of the limb. The exercises involve moving the affected limb. It is important that the exercise not be strenuous or tiring. They should focus on gentle muscle contractions. Each patient is given his/her own personalized exercise plan. This is done with a fully qualified physical therapist
The four CDPT components are - MLD (manual lymphatic drainage) - the lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. It is crucial that this is done by a fully trained Physiotherapist, and not just a regular masseur. The therapist needs a thorough knowledge of the lymphatic system for this to work.
The therapist also teaches several massage techniques that can be used during the maintenance phase.
Patients who have a history of heart disease, deep vein thrombosis or kidney disease may not be suitable for MLD.
Skin care - good skin care reduces the risks of skin infections, such as cellulitis. Patients are taught how to keep their skin clean, and also how to check for cuts, abrasions and signs of infection.