Treatment of Lymphedema

Evaluation: A comprehensive evaluation is conducted to determine the need for therapy and treatment intensity. The evaluation consists of patient history, sensory evaluation, ROM and muscle testing, girth measurements, functional status in work/ADLs, skin condition, posture and skeletal alignment.

Skin Care: Condition of the skin on the affected limb is examined on each visit. The goal is to keep the skin clean, dry, moisturized, and infection-free. Participants are instructed in skin care. Specialized skin cleansers and moisturizing lotions are recommended for use.

Manual Lymph Drainage: A specialized, very light pressure massage is used to re-route lymph around blocked or damaged lymph node collection sites, to develop permanent collateral drainage areas, and to soften fibrotic tissue. As fluid is moved out of the affected limb, the susceptibility to infection and injury is reduced and an increase in functional abilities results.

Multilayered Compression Bandaging: The participant is wrapped with 3 to 4 layers of low-stretch bandages that are worn up to 22 hours a day. Once the tissue has been remodeled, excessive proteins removed, and the lymphatic drainage increased, the patient can reduce wearing the compression bandages to overnight and during other precautionary activities. The bandaging provides a firm external support to tissue which acts as a counterforce to muscle contraction, promoting lymphatic pumping during even the slightest muscle contraction. Because low-stretch bandages don’t compress the lymphatics when the limb is at rest, they have a low resting pressure and high working pressure.

Therapeutic Exercise: Participants are instructed in specific exercises that facilitate lymph drainage. Exercises are performed while bandaged, unless exercising in the water. If not contraindicated, aquatic-based exercise is optimal due to the promotion of further lymph movement through hydrostatic pressure. Participants are also taught physical conditioning, range of motion, and strengthening exercises as individually needed.

Deep Oscillation Therapy: When appropriate, the HIVAMAT 200 is used to reduce edema, muscle spasms, pain, inflammation, and improve wound healing. With physician approval, this modality can be used to augment therapy.

Compression Garments: Participants are fitted for custom-made compression garments after completing the course of treatment. These are worn during the waking hours. Compression garments do not promote further reduction, but are used to maintain goals made in treatment.

Education: One of the goals of this program is to give the participant the tools needed to control the lymphedema once it is reduced through treatment. Training in self-care is provided to prevent infection, increase tissue integrity, and reduce or eliminate exacerbation of the condition. Skin hygiene and care is stressed. A home program of self-massage, bandaging, and exercise is provided to maintain the health of the limb.