Management of Lymphedema
By
Paula Lawrence
, PT
Lymphedema is the swelling of a limb or body part that is
caused by a problem in the lymphatic system preventing the normal transport of
lymphatic fluid back into the circulatory system. Causes of lymphedema include trauma to the
lymphatic system from surgery or radiation to treat cancer, damage from
accidents, chronic inflammation or infection that damages lymphatics. Cancer cells may block vessels, or parasites
or other foreign material can also impede the lymphatics. In the United
States there are between two and eight
million people affected with lymphedema.
The
lymphatic system is responsible for removing wastes not removed by the blood
circulation, and taking these wastes to larger blood vessels for disposal. Lymph fluid is a clear and slightly sticky
liquid made up of protein molecules, water, bits of dead cells, and foreign
cells such as bacteria, viruses, fungus cells and anything else not belonging
in the body.
Lymph nodes
are located along the lymph vessels and have several jobs. They identify things that don’t belong in the
body (such as bacteria or viruses), and make special cells to fight these
invaders, thus beginning the immune response.
They also store things that should not be in the body, such as coal dust
or cancer cells. The lymph nodes also
remove a portion of the water from lymph fluid.
The effects
of lymphedema are not just cosmetic. A
swollen limb can impede clothing from fitting, sometimes preventing a
post-mastectomy patient from wearing long-sleeved blouses. In addition, other limitations can include
weakness, loss of range of motion, debilitating pain, altered sensation, and
problems with functional activities.
The current
standard of treatment for lymphedema is called “Complex or Complete
Decongestive Therapy,” and has been the recommended protocol in
Europe
since 1995 and in the
U.S.
since l998. Complex Decongestive Therapy
(CDT) is a multiple modality treatment that comprises ALL of the following:Manual
Lymph Drainage
- Compression
therapy (bandage systems, compression garments, manually adjustable compression
devices)
- Lymph
stimulating exercises while under compression
- Meticulous
skin care
Treatment is administered by a specially trained medial
practitioner, usually a Physical Therapist, and is utilized in a two phase
program. Phase 1 consists of a
specialized massage technique to open lymphatics and increase flow, followed by
medical compression bandaging. Phase 2
consists of all the components of Phase 1 with the addition of exercises to
increase lymph flow. Heavy emphasis in
this phase is on patient education to become independent in self care.
Compression
pumps or Jobst pumps are no longer used.
Most research points to these having adverse effects and possibly
damaging initial lymphatics.
