Lymphedema and Complete Decongestive Therapy

What is lymphedema? Lymphedema is the swelling of a body part, usually an arm or leg, caused by an abnormal accumulation of lymph fluid. Primary lymphedema is due to a congenital defect in the lymph vessels, whereas secondary lymphedema is caused by an obstruction to normal lymph drainage. In the U.S., it is most frequently a result of cancer treatment. Other causes include surgery, radiation therapy, trauma, infection, obesity, and self-inducement. There are three stages of lymphedema. In Stage I there is an excess of high-protein fluid in the affected limb that is reversible because you can return the limb size to normal by elevating it. Stage II is spontaneously irreversible, consisting of an excess of protein-rich fluid as well as connective tissue damage, hardening of the tissue, and heaviness. Stage III is lymphostatic elephantiasis. In addition to the symptoms present in Stage II, you will also see hardening of the skin, large protruding skin folds, and skin eruptions. To classify the severity of the swelling, simply measure the limb in comparison to the opposite limb. Minimal swelling is an up-to-3 cm difference, moderate swelling is a 3–5 cm difference with hardened tissue around the fingers or toes, and severe swelling is a difference greater than 5 cm with hardened tissue around the fingers or toes. Lack of treatment will cause further tissue destruction and increased limb size and can be fatal.

How can physical therapy treat lymphedema? Complete decongestive therapy is the most current treatment approach for lymphedema at all stages. A physical therapist trained in complete decongestive therapy will complete an evaluation that will include a medical history, the phase and the severity of the lymphedema, complications, skin and connective tissue assessment, and strength and flexibility measurements. A treatment program is only as effective as your commitment to it; therefore, you will be asked to give your commitment to such an involved program. Some physical therapists may choose to align connective tissue using a manual therapy technique called Matrix Repatterning prior to beginning the complete decongestive therapy program. The daily “initial treatment phase” will consist of skin care education, manual lymph drainage, short stretch compression bandaging, limb clearance exercises, and self-care for all the above. You will be educated in skin care to prevent further tissue damage and infection. Manual lymph drainage will improve the production and flow of lymph fluid and lymph vessel function as well as assist in breaking down the connective tissue damage. Short stretch bandaging assists in maintaining the effects of the manual lymph drainage, decreases the amount of lymph fluid lingering in the interstitial space, breaks up the damaged tissue, increases the natural effects of muscular activity on the lymph vessels, and improves lymph vessel activity. The limb clearance exercises will increase lymph vessel activity, improve lymph circulation, and increase the volume of lymph fluid transported to the major lymphatic ducts. During the treatment phase, your physical therapist will teach you to do these techniques at home. To further assist you, you may purchase a DVD on self-performed manual lymph drainage that is available through this Web site. The home “maintenance phase” consists of daytime wear of a compression garment, daily manual lymph drainage, compression bandaging at night if indicated, limb clearance exercises, and ongoing management of skin care. Aside from contraindications, commitment to the treatment program produces excellent results. Commitment to an ongoing home program will continue to reduce the limb size.