Lymphoedema Therapy can help with the initial diagnosis and ongoing management of secondary lymphoedema, primary lymphoedema, lipoedema, chronic and complex oedema, and venous conditions. Although lymphoedema cannot be cured it can be improved and well managed.
Aims of treatment:
Lymphoedema Therapy is aimed at reducing oedema, preventing progression and maintaining improvements. By reducing oedema it can also help alleviated associated symptoms, reduce the risk of infections (i.e. cellulitis), improve function and improve quality of life1.
Early diagnosis and intervention for lymphoedema is recommended for optimal results as symptoms may worsen if lymphoedema goes untreated2. Individualised treatment plans will be influenced by the stage, location and severity of lymphoedema as well as the individual circumstances of the client
Gold-Standard Treatment for lymphoedema is Complex Lymphatic Therapy (CLT)3 which includes:
- Manual Lymphatic Drainage
- Exercise and movement
- Skin care and scar management
- Compression Therapy
- Other modalities - including kinesiology taping, intermittent pneumatic compression pumps, and low level laser therapy
Treatment is individualised for each client as they may not require all components of CLT.
CLT can also be broken down into two phases. Phase 1 involved intensive treatment by a qualified lymphoedema therapist to reduce limb volume. Phase 2 is a self-management phase, where the client can maintain limb volume at home.
Graduated Compression Garment Prescription:
Compression Garments are used to help maintain improvements in limb size. Specialist prescription is available for both Custom-Made and Ready to Wear graduated compression garments for upper limb, lower limb and trunk oedema from some of the leading manufacturers including Jobst ,Elvarex, Haddenham, Medi, Second Skin, Juzo and Sigvaris. We can also prescribe Compression Wraps, Sequential Intermittent Pneumatic Compression Pumps, Limb Pillows and Mobiderm. Clients who require these products may be eligible for a QLD Health Prescription to assist with costs of garments.
More information regarding compression garment scheme for QLD can be found at: https://www.health.qld.gov.au/ahwac/html/compression
Massage Therapy - Manual Lymphatic Drainage:
This is a specialised and effective type of massage for the lymphatic system to help reduce oedema. It works by increasing the uptake in the superficial lymphatics, softens fibrosis, reduces scar tissue and facilitates collateral lymphatic drainage pathways. After Manual Lymphatic Drainage you may require compression bandaging in the area treated. Once the swelling is under control, you may also require a compression garment to wear.
If intensive lymphoedema treatment is required you may benefit from a course of compression bandaging. Bandaging affects oedema by reducing capillary filtration, increasing lymphatic drainage, shift of fluid to non-compromised areas, breakdown of fibro-sclerotic tissue, assists with reshaping the limb and can assist with wound healing. There are different types of bandaging available including the Coban 2 system by 3M, Compri2 by Jobst BSN or multi-layer lymphoedema bandaging (MLLB). Bandages should be changed regularly as the swelling reduces-how often will be determined by the type of bandage used and how quickly the oedema reduces. Each option will be discussed with every client to ensure optimal clinical decision making.
Therapeutic Exercise and Movement:
Exercise should be embedded as part of standard practice in cancer care and is to be viewed as an adjunct to therapy as it helps counteract the adverse effects of cancer and its treatment4. There is strong research evidence that shows exercise has no adverse effects on lymphoedema, exercise can also improve lymphoedema and decrease symptom severity. There is also strong evidence that weight management can improve lymphoedema and an inactive lifestyle can increase the risk of lymphoedema. Many factors can affect exercise prescription including clinical presentation, surgical history, co-morbidities, exercise history and goals. Therefore, exercise programs are individualised with a holistic focus.
Lymphoedema increases the risk of skin breakdown, infection, and delays wound healing, therefore skin care is a vital part of management. We can recommend products for you as endorsed by the Australasian Lymphology Association (ALA).
Cording (or Axillary Web Syndrome) can develop as a side effect of sentinel lymph node biopsy or axillary lymph node dissection and tends to be painful and restricts movement. Cording can be treated with stretching, manual therapy, heat, and laser therapy.
Scars may disrupt the network of lymph capillaries that lie just under the skin. Scar treatment can help soften and flatten scar tissue, reduce sensitivity and discomfort as well as improve the appearance of the scar.
Low Level Laser Therapy:
Low Level Laser Therapy is used to target cells in the lymphatic system. It can help reduce the volume of lymph fluid in the affected area, any thickened skin and any pain. There is evidence that laser treatment works well when used in conjunction with lymphatic drainage and compression therapy.
There is some research suggesting that kinesio taping can help lymph fluid drain from the affected areas to working lymph nodes. This tape is different from strapping tape and is individualised for each client.
1. Framework, L. (2006). Best practice for the management of lymphoedema. International consensus. London: MEP Ltd, 3-52.
2. Hayes, S. C. (2008). Review of Research Evidence on Secondary Lymphoedema—Incidence, Prevention, Risk Factors and Treatment. Surry Hills, NSW: National Breast and Ovarian Cancer Centre.
3. Haghighat, S., Lotfi-Tokaldany, M., Yunesian, M., Akbari, M. E., Nazemi, F., & Weiss, J. (2010). Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy alone and in combination with intermittent pneumatic compression. Lymphology, 43(1), 25-33.
4. Kwan, M. L., Cohn, J. C., Armer, J. M., Stewart, B. R., & Cormier, J. N. (2011). Exercise in patients with lymphedema: a systematic review of the contemporary literature. Journal of Cancer Survivorship, 5(4), 320-336.