Lymphedema medical therapy
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Editors-in-Chief: Benoit Blondeau, M.D. [1]; C. Michael Gibson, M.S., M.D. [2]
Overview
The most common and accepted treatments of choice for lymphedema are Sequential Gradient Pump Therapy and Complete Decongestive Therapy (CDT).
Complete Decongestive Therapy (CDT)
CDT consists of manual lymphatic drainage (MLD), short stretch compression bandaging, therapeutic exercise, and skin care. MLD was pioneered by Dr. Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders, and is now recognized along with pneumatic pumps, and compression sleeves, as a primary tool in lymphedema management. Therapists can today receive certification through special classes conducted by various organizations specializing in MLD.
According to the Academy of Lymphatic Studies, the MLD technique, also known as the Vodder Technique, is a gentle manual treatment that improves the activity of the lymph vessels. It re-routes the lymph flow around areas that are blocked, into more centrally located lymph vessels that drain into the venous system.
Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription. Once the lymphedema is reduced, increased patient participation is required for ongoing care, along with the use of compression garments to further reduce the swelling.
Sequential Gradient Pump Therapy
Sequential Gradient Pump Therapy has been utilized for over 30 years throughout the world. Lympha-Press helped pioneer and perfect this technology with by utilizing a 12 chambered pneumatic sleeve with overlapping cells, to gently move the lymph fluid. There are several other manufacturers of these devices such as Bio Compression Systems, and Wright Linear. All of these devices are recognized treatments and approved by Medicare and most insurance plans in the USA. Patients may often receive treatment on a pump for 10-15 minutes before an MLD session to help break up fibrotic (hard) tissue. By softening or breaking up the fibrosis, the MLD Therapist can be even more effective with the given treatment. After completion of the appropriate number of MLD sessions, some patients will benefit from a home use of a sequential pump. A recent Stanford University medical studyshowed that patients receiving the combined modalities of MLD/CDT and pneumatic pumping had a greater overall reduction in limb volume than patients receiving only MLD/CDT.[1]
The MLD component of treatment consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system. In the blood’s passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination. The treatment is very comfortable and nonaggressive. A typical session will involve drainage of the neck, trunk, and involved extremity (in that order), and lasts approximately 40 to 60 minutes, depending on the severity and extent of the lymphedema.
Compression bandaging
Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the higher tension necessary to safely reduce Lymphedema and may in fact end up producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas. Norton School of Lymphatic Therapy states that short stretch bandages provide limb support without having to "squeeze" because the fabric doesn't contain the elastic material the long-stretch bandages have.
Therapeutic exercise
In addition, specific therapeutic exercise while compression bandaging is worn is a valuable part of therapy, not only because it aids in the elimination of excess fluid, but also because some patients with chronic lymphedema or large, swollen areas will have poor strength or range of movement. Pool therapy using manual lymp drainage techniques will help to keep the tissue soft and assist in moving the lymphedema fluid. These patients benefit from exercise prescribed specifically for them by their physician to help improve their function and comfort.
Skin care
Skin care is an important component of CDT. People with lymphedema or who have had lymph nodes removed are at a higher risk for infections of the affected areas, and so need to be taught a specific regimen of thorough but gentle cleansing followed by moisturizing in order to keep the skin in the best health possible. Teaching higher risk sufferers about the signs and symptoms of infections is also important, since awareness is the key to early identification and treatment. Untreated infections can further damage an already impaired lymphatic system and lead to more severe lymphedema and skin ulcers.
Skin care
Compression pumps are often used in the treatment of lymphedema, but special care needs to be taken to ensure that the involved trunk quadrant is properly treated with manual lymphatic drainage before the application of a compression pump. If adequate treatment of the trunk is not carried out beforehand, the edema may be pushed into the upper portion of the arm or leg, or into the genitals. If a patient's lymphedema worsens during a course of compression pump therapy, reassessment for adequate trunk MLD is necessary. However, newer compression pump garments provide compression well into the trunk and/or abdomen and groin areas. Although very beneficial, many patients find it inconvenient or expensive to attend regular MLD treatment sessions. A 2002 Stanford University article suggests that for patients with upper-limb lymphedema, those who received both MLD and compression pump therapy experienced greater overall limb reduction.
Even after MLD, the patient may only be bandaging or receiving compression up to the axilla (arm pit area) or groin. Unless the patient is monitored during post MLD self bandaging, there is a possibility of the lymph fluid pooling in the truncal regions. For this reason, reassessment for adequate trunk MLD may need to be re-evaluated as necessary.
Kinesio Taping
A new adjunct treatment is being taught to therapists utilizing a special type of tape called Kinesio Taping. It is used to help soften edemas.
Reference
- ↑ Szuba A, Achalu R, Rockson SG (2002). "Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression". Cancer. 95 (11): 2260–7. doi:10.1002/cncr.10976. PMID 12436430.