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.
Lymphoedema can be either primary or secondary. Primary lymphoedema is a genetic condition whereby the lymphatic system has developed in a way that prevents it from functioning normally. Secondary lymphoedema may be a side effect of damage to the lymphatic system following the treatment of cancer or other intensive surgical procedures.
Signs & Symptoms:
- Aching, pain and heaviness of a limb
- Gradual increase in limb size and volume
- Tightness of jewellery, watches, sleeves or shoes at the end of the day
- Indentation from clothing
- Stiffness of the affected area which can restrict normal mobility
- Swelling which may or may not resolve overnight
Treatment of Lymphoedema
Lymphoedema therapy is a multifaceted approach to assist in the movement of lymph fluid away from congested areas; it aids in supporting the lymphatic system and improving the function of the affected area. Treatment includes lymphatic massage, compression garments or bandaging, skin care and exercise.
Early intervention is recommended for those who have only recently noticed changes in symptoms. Those who have had lymphoedema for many years will also benefit from assessment and treatment.
Pre/Post-breast Cancer Surgery Screening
Bioimpedance Spectroscopy (LDex) is a machine/device that assists in objectively measuring fluid levels in a limb by non-invasive means. This measurement tool is particularly important for the early detection of even pre-clinical levels of lymphoedema (Stage 0), even before visual signs of lymphoedema are noticeable such as pitting, changes in circumferential measurement, or changes in the fit of clothing or jewellery.
Early intervention would be implemented at this stage which may prevent the progression of lymphoedema. This would be a valuable measurement for those undergoing treatment or following treatment for breast cancer.
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.
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 & Lymphoedema
In the past, it was believed that strenuous activity could worsen pre-existing lymphoedema or even trigger lymphoedema in those at risk. People were advised to rest and not to exercise their affected limb in fear of causing lymphoedema. 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
- Increased lean muscle size
- Reduction in body fat
- Improved muscle endurance and strength
- Improved bone mineral density (stronger bones)
- Improved ability to perform everyday tasks
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 return it to the cardiovascular system.
Compression Bandaging & Garments
Compression is an essential component of Lymphoedema management. Compression bandaging and garments apply increased pressure which improves the efficiency of the muscles acting as a pump; this, in turn, improves the removal of lymphatic fluid.
Compression bandaging is a treatment used to: reduce the affected limb’s volume/size, reshape the limb, 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. This may occur once a year.
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 is very important that garments are measured and fit correctly for safe use
