What is Lymphoedema?

Lymphoedema is a chronic condition involving a build-up of protein-rich fluid in the affected region of the body. Areas often affected include the upper or lower limbs, less commonly the trunk, breast/chest wall, genitals or face/neck may be affected.

Similar to the circulatory system, the lymphatic system is a series of vessels which transport fluid (lymph) from all tissues back to the bloodstream. The lymphatic system also plays a role in immune response as well as digestion of fat.

 

Causes of Lymphoedema

Lymphoedema may be the result of anatomical differences which happen during development or from damage to the lymphatic system.

Lymphoedema from damage to the lymphatic system is the most common form of lymphoedema, and is called secondary lymphoedema. This type of lymphoedema may be due to surgery for example breast cancer surgery with axillary lymph node dissection, trauma, obesity, immobility or vascular insufficiency.

Swelling develops as the lymphatic system is unable to keep up with the normal lymphatic load.

Signs and Symptoms:

  • Heaviness of limb.
  • Aching.
  • Tightness of jewellery, watches, sleeves or shoes at the end of the day.
  • Stiffness.
  • Swelling which may or may not resolve over night.

Treatment of Lymphoedema

Graphical description of Lympoedema management

Complex Lymphoedema Therapy is the best practice treatment for lymphoedema which requires a multifaceted approach and may include treatments such as lymphatic massage, compression, skin care and exercise. CLT aims to help improve lymph flow away from congested areas, decrease the size of the affected limb and to reshape the limb.

All of our treatments are individualised to the client’s needs and not all components of CLT are necessary for all individuals. Early intervention is recommended.

A Typical Session may Involve:

  • Assessment of the skin and measurement of affected limb
  • Lymphatic drainage massage.
  • Decongestive exercise prescription.
  • Serial bandaging may be indicated using Coban 2 to reduce limb volume and improve skin condition prior to fitting a new compression garment.
  • Measurement and fitting of custom made or ready to wear compression garments.
  • Measurement and fitting of prophylactic compression garments for overseas flights.

Manual Lymphatic Drainage

Also known as lymphatic massage, Manual Lymphatic Drainage is an important component of Complex Lymphoedema Therapy.

Manual Lymphatic Drainage is a full body massage which uses a combination of Swedish massage techniques as well as Foldi and Vodder techniques to aid in the removal of fluid from swollen areas of the body by using the superficial lymphatic system and alternative lymphatic system pathways.

Manual lymphatic drainage can also be combined with deep breathing and decongestive exercises.

The Benefits of MLD Include:

  • Stimulation of lymphatic vessels.
  • Increased uptake of lymph fluid in the swollen body part.
  • Movement of lymph fluid away from the affected area for effective return to body circulation.
  • Soften areas of swelling and fibrosis.
  • Improve scar quality.

Exercise and Lymphoedema

Lymphoedema is a chronic, visible swelling of a body part as a result of an impaired lymphatic system leading to the accumulation of fluid (also called ‘lymph’) in a region of the body, commonly the arm or leg.

Complex Lymphoedema Therapy is a term used to describe the conservative management of lymphoedema to increase the removal of lymph and augment the lymphatic system. This involves a combined approach, including exercise.

In the past, clinical opinion has raised concerns that strenuous activity could worsen pre-existing lymphoedema or even trigger lymphoedema in individuals following breast cancer treatment – individuals were advised to rest and not to exercise their affected limb. These practices lead to deconditioning and muscle weakness contributing to overall poorer physical function.

New research challenges this opinion and has found exercise to be not only safe, but very beneficial for individuals with lymphoedema and those at risk of lymphoedema such as after breast cancer treatment.

Benefits of Exercise:

  • improvement in lymph clearance from the affected limb.
  • increased lean muscle size.
  • reduction in body fat.
  • muscle endurance and strength.
  • improved bone mineral density.
  • improved ability to perform everyday tasks.
  • decreased exacerbation of lymphoedema and volume of fluid.

During all forms of exercise, the muscles act as a “pump” to help move stagnant fluid. When a muscle contracts this creates a pressure to squeeze lymphatic vessels and help transport the lymphatic fluid from the swollen limb and returns it to the cardiovascular system.

It is important to exercise regularly and to find an exercise which suits you and your interests.

Suitable Options may Include:

  • Resistance training – lifting weights improves strength and endurance as well as helps to manage lymphoedema.
  • Cardiovascular exercises, e.g. walking, cycling, swimming.
  • Pilates.
  • Yoga.

The Australian National Guidelines recommend all adults should be physically active 150 minutes of moderate intensity activity per week. This works out as 30 minutes MOST (5) days of the week. In addition, resistance training is recommended at least 2 days a week.

Important Things to Consider:

  • Before starting a program seek advice about what would be appropriate for you.
  • Exercise programs should be tailored to the individual.
  • When weight training, start slowly with light weights.
  • To begin with, activity should be of low to moderate intensity.
  • Monitor for signs or heaviness or tightness – you should not have increased pain.
  • Wear compression if it has been prescribed for you.

Compression Bandaging and Garments

Compression is an essential component of Lymphoedema management. Compression bandaging and garments work to apply increased pressure to the affected body area. This pressure helps to improve the efficiency of the muscles acting as a pump, in turn increasing the removal of lymphatic fluid. Lymph is shifted from areas of congestion and returns to normal circulation.

Compression bandaging is a treatment used to reduce the affected limb volume/size, reshape the limb, and soften areas of swelling and breakdown fibrous tissue.

Two Forms of Bandaging are Commonly Used:

  • Multi layered bandaging (MLB) uses layers of short stretch bandaging and padding layers which provides high pressure to the tissues when they are working, but allows for comfort during rest. MLB requires replacing daily for best results.
  • Coban 2 bandaging is a thinner, lightweight bandaging material which allows for good mobility. Coban 2 bandaging requires replacement only twice a week. Unlike MLB, Coban 2 bandaging is not reusable.

Bandaging may be used before measuring for a new compression garment and fitting of a new garment so a smaller limb volume is maintained.

Bandaging is not a suitable treatment for those with certain heart and vascular conditions, when active infection is present or DVT.

Compression garments are used in the home maintenance phase of lymphoedema management.

Compression garments are available in ready to wear sizes or custom made to your exact measurements; it’s very important that garments are measured and fit correctly for safe use.

Discuss your individual needs with a lymphoedema therapist.

Ashley Wiley Profile Picture

Ashley Wiley holds a Masters of Physiotherapy and Bachelor of Applied Science, Human Biology and is our resident specialised practitioner of Complex Lymphoedema Management.