Lymphedema: How Physical Therapy Can Help
The lymphatic system is a part of our circulatory system. Some of its functions include: collecting and transporting tissue fluids from all the tissues of the body back to the venous system, absorbing and transporting fatty acids from the digestive system, and it plays a role in our immune system by filtering the lymph to remove microorganisms and other foreign particles. White blood cells are built and stored in lymphatic tissues. There are lymphatic vessels that run all over our body. They are similar to our veins and arteries, but these lymph vessels all drain to collections of lymph nodes that are present in multiple areas of the body such as the groin, underarms, and the neck.
When a person is diagnosed with lymphedema, there has been actual damage to this lymphatic system. Damage to the lymphatic system is most often caused by surgery and/or radiation for various types of cancers. Commonly, lymph nodes are removed when surgery for cancer is performed so that they are able to assess the aggressiveness of the cancer, and also whether or not it has started spreading to other areas of the body. When lymph nodes are removed, there is an upset in this system and swelling can occur. Lymphedema can also be hereditary/congenital or developing without an apparent cause at different stages in life.
This swelling from lymphedema can occur in the upper and lower extremities, trunk, abdomen, head and neck, external genitalia, and internal organs. The onset can be very sudden, evident immediately after surgery or trauma, or it can occur many years later. It is a very common and serious condition that requires lifelong medical management. If left untreated, it will continue to progress and can lead to fibrotic tissues, infections such as cellulitis can occur, and the limb will continue to grow in size making movement very difficult and sometimes, nearly impossible.
Physical therapists, specifically certified lymphedema therapists (CLT) play a vital role in the management of lymphedema. CLT's use the gold standard to treat the swelling, which includes manual lymphatic drainage, compression therapy with short stretch bandages and/or compression garments, gentle exercise, and patient/family education. Manual lymphatic drainage is a manual technique that serves to move lymph fluid in the appropriate direction to optimize reabsorption by the lymph nodes to reduce swelling in the limb. With the compression therapy, it is very dependent upon the severity of the swelling. As mentioned before, short stretch bandages could be used on a daily basis which requires the patient to see the CLT 3-5 days per week for wrapping, or compression therapy can be as simple as wearing a compression garment that has been sized and ordered for that particular person.
In 2017, Medscape published an online article regarding lymphedema treatment and management. In this article, there were several studies referenced that looked at how physical therapy could influence the management of lymphedema. The authors recommended therapy for lymphedema treatment to start as early as possible to avoid the irreversible and fibrosclerotic changes that can occur in the interstitium. They specifically mention "complex physical therapy" as being the "first line of treatment" in lymphedema management, and it should include manual lymphatic drainage, compression therapy (garments and/or bandaging), and exercise. It states that the "best available nonsurgical therapy is manual lymphatic drainage" with "compression garments being essential between treatments".
Lymphedema is a diagnosis that seems to be overlooked and under-reported, yet it affects at least 3 million people in the United States. It is a prevalent condition that can turn very serious very quickly if not managed appropriately. Good communication with health care providers is essential if you or someone you know may be suffering from this serious, yet manageable condition.
Content provided by Heather Stone, PT, DPT
Norton, S., Zuther, J.E. (2018). Lymphedema management. The comprehensive guide for practitioners. New York, NY: Thieme Medical Publishers, Inc
Rossy, MD, K.M., et al. (2017, April 10). Lymphedema treatment and management. Retrieved from https://emedicine.medscape.com/article/1087313-treatment#d12