Treatment aims to reduce the swelling, keep it from getting worse, and decrease the risk of infection. The treatment is prescribed by the doctor and should be given by an experienced therapist. Mild lymphedema should be treated by a physical therapist or other health care professional who has gone through special training.
Moderate or severe lymphedema is most often treated by a therapist with special training and expertise who will help you with skin care, massage, special bandaging, exercises, and fitting for a compression sleeve. This is sometimes known as complex decongestive therapy, or CDT. Manual lymphatic drainage, or MLD, is a type of massage used along with skin care, compression therapy, and exercise to manage lymphedema. "ca-pub-1319526422906106";
Although most insurance companies will pay for lymphedema treatment, some do not cover the cost of compression garments and dressings. Check with your insurance company about coverage for these therapies.
Seeking and getting treatment early should lead to a shorter course of treatment to get your lymphedema under control
Light exercises that require movement of the affected arm or leg and encourage movement of the lymph fluid out of the limb. These exercises shouldn't be strenuous, instead, they should focus on gentle contraction of red the muscles in the arm or leg. Exercises help pump the lymph fluid out of the affected limb.
Complete Decongestive Therapy (CDT)
Phase 1 is also known as an intensive decongestive phase, or an intervention. The primary goal of this phase is to reduce the swelling in the affected area. During this phase, which usually lasts one or two weeks (or longer), the patient is seen daily by a therapist daily and usually wears bandages (wrapping) for 23 hours a day, 7 days a week.
Phase 2 is also known as the maintenance phase, optimization phase or self-care phase. During this phase the patient takes over the responsibility of performing this daily treatment that is required to control the lymphedema. If the patient is unable to do this, a caregiver is trained to take over this role.
These treatments include:
Self-Massage to move stagnant lymph out of the tissues.
Compression to prevent the swelling from returning to the tissues again.
Skin care to maintain the health of the tissues so that breaks in the skin will not allow infections.
Exercise to maintain the flow of lymph, increase mobility, control weight, and improve the patient’s general health and sense of well-being.
The purpose of massage is to gently guide excess fluid out of the swollen tissues so that they can return to the circulatory system. To learn more about this massage read the article Manual Lymph Drainage.
None of the above massage techniques should be attempted by an individual who is not properly trained in the use of that technique for a specific patient.
Manual Lymph Drainage (MLD)
Performed by the patient’s appropriately trained lymphedema therapist.
Self-massage is performed by the patient as instructed by his or her lymphedema therapist during phase 1 of the treatment.
Simple lymph drainage (SLD) is performed by the patient’s caregiver. The patient’s lymphedema therapist trains the caregiver how to perform this modified massage technique.
The use of compression, at all times, is an important factor in maximizing gains between professional visits. The goals of compression are to:
Retain the progress in reducing swelling that was made during the massage treatment.
Prevent, or minimize, additional swelling.
Support natural draining of lymph from the tissues.
Three different varieties of compression are used in the treatment of lymphedema. Although different methods are used the goals of this type of treatment are to:
Reduce the swelling.
Prevent, or minimize, additional swelling.
Support the natural draining of lymph from the tissues.
Stimulate the flow of lymph by providing resistance that
enhances the effectiveness of muscle and joint movements.
Aid in softening fibrotic (hardened) tissues.
Three major types of compression are used to effectively meet the compression needs and goals of the patient with different needs and at different levels of activity.
Bandaging, which is also known as wrapping, is the most effective and flexible form of compression particularly in the early stage of treatment. Bandages have the advantages that they:
Can be worn when the patient is active or resting up to 24 hours a day.
Are adjustable to fit properly, with appropriate compression, as the affected limb changes in size.
Knit compression garments are also known as "day garments" because are worn during the day when the patient is awake and active.
These garments are not worn while slepping because they provide too much compression when the body is at rest. Also if the garment moves out of place during sleep, it can cause constriction that damages the circulation.
These garments are sleeves, gloves, gauntlets, and stockings that are constructed of knit two-way stretch fabrics.
They are designed to assist in controlling swelling and to aid in moving lymph from the affected area.
The amount of compression provided by the garment is constructed into the knit of the fabric and is based on the needs of the patients.
Compression aids are also known as “night garments” because they are usually worn when the patient is resting or sleeping. They are designed to control swelling, enhance the flow of lymph, and assist in softening fibrotic tissues.
These aids are custom-fitted sleeves, stockings, or pads made of a fabric covering a layer of foam that are stitched in a pattern to channel lymph away from the affected area.
An outer sleeve, or bandages, are placed over the garment if increased compression is required.
Compression Aids are constructed of foam and fabric that are available in a variety of styles that can be worn at night or during the day. They are available in a variety of styles some are padded custom-fitted garments with stitching to guide the flow of lymph. Other styles have features to soften fibrotic tissues.
These types of garments are made with flat foam and stitched in a channeling pattern that is designed to guide the flow of lymph into alternate pathways around obstructed areas.
An outer sleeve can be worn over these garments to increase the pressure.
A specialized variety of this kind of garment can be used as a base for bandaging. This replaces the many layers under the short-stretch bandages and reatly speeds the process of wrapping a properly fitting bandage.
Garments made with egg-crate foam has bumps similar to an egg carton. This type of garment is worn to soften fibrotic (hardened) tissues.
Compression aids should not be worn over with knit compression garments unless this has been approved by a therapist.
The ReidSleeve is a custom-fitted compression aid named for the inventor Dr. Tony Reid. These garments are made for arms or legs and they are fitted with adjustable straps and Velcro closures that make it possible to apply precise pressure where needed along the limb.
JoVi Pak manufactures compression aids that are ready-made, or custom designed, for use on the extremities. Although sleeves are shown here, similar garments are available for use on the legs.
Shown above is a JoVi Sleeve made of fabric stitched over flat foam to create channels to direct the flow of the lymph.
Shown on the right is the same sleeve covered with a JoVi Jacket that is added to increase the compression pressure of the sleeve.
Contour Pads are compression aids used in treating truncal lymphedema. These pads, which are worn to control swelling and to soften fibrotic tissue, are usually held firmly in place by a bra that opens in the front. The pad wraps from the anterior (front) midline to the midline in the posterior (back) midline of the affected side.
There are currently two other treatment options that are not part of Complete Decongestive Therapy but are generally accepted (with some qualifications) as adjuncts to lymphedema therapy.
Pumps (also referred to as Intermittent Pneumatic Compression or Pressotherapy) have been used as standard treatment in the past, but poor results coupled with a growing understanding of the mechanics of the lymph system have made pump use suspect. As a result of that new understanding, newer versions of this old therapy stand-by have been developed that operate in a way that corresponds to the movements of Manual Lymph Drainage (one popular example is the Flexitouch). A devise such as the Flexitouch is not a substitute for Manual Lymph Drainage performed by a lymphedema therapist, but it may have its place for certain patients. If your therapist uses a pump as part of your treatment or recommends one to you for home use, be sure to discuss with her the specific reasons why she thinks it appropriate for you.
Kinesio taping is a recent addition to lymphedema therapy that is quickly gaining credibility among therapists trained in its application. If you and your therapist agree to try it, be sure she tests it on a part of your body that is not at risk for lymphedema before applying it to any affected area. Skin reactions and adhesive allergies can create an infection risk.
Besides pumps and Kinesio taping, there are a variety of other treatment ideas that some therapists use or recommend. Some – like the Acuscope, Gas Ionization Lymph Drainage XP tuning forks, magnets, and some herbals – fall into the category of alternative treatments. Others – including the laser, surgical interventions like anastomosis and node transplant, and prescription drugs – can be considered experimental, without sufficient research as yet to evaluate their long-term effectiveness or safety. Before agreeing to interventions like these, you will want to ask questions and do your own background research.
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