Does LANA Even Matter Anymore?

John Fuller Beckwith5/14/2025

What is the value of a LANA certification at this point? Does it really signify anything of value? I will offer the opinion that while LANA once had meaning and value, it has strayed from its initial purpose, but more, the significance of the LANA designation has lost its meaning.

LANA was created when the American Cancer Society requested that stakeholders in the CDT world come together to create an agreed upon standard for the training of lymphedema therapists. With the exploding demand in the mid-90s for trained lymphedema therapists on the German model of CDT, training schools had popped up that took short-cuts and did not have comprehensive curricula, such that patients and referring doctors had trouble determining who was properly trained. Most of the stakeholders coalesced around the National Lymphedema Network at the time, so when LANA was created its criteria reflected the position papers on training and treatment of the NLN.

The purpose of LANA was to create a certification exam that was national and beyond the individual schools. Ostensibly a therapist with the LANA designation would have met a higher standard. Therefore it was an exam that measured training and knowledge, however in terms of actual clinical interventions it did not evaluate and standardize treatment practices. The presumption was that if a therapist was devoted enough to the therapy to attend the more comprehensive training and had done the extra work to pass the exam, they would more likely treat to the highest standard as well. Patients and referring PCPs could look for the LANA designation with confidence. However, LANA has only ever measured training and theoretical knowledge while never grading actual treatment practices.

But what was the value of LANA initially? I would argue that even from the beginning the benefits of the LANA certification have been marginal at best. Initially a goal of many therapists was to be listed on the LANA website so they could be found by patients and to distinguish themselves from other lymphedema therapists. In 25 years the number of lymphedema therapists serving any communities I have been aware of has never been enough to meet the needs of patients. So there has not really been a need for a therapist to separate themselves from the competition through a higher certification. The other value initially was to provide patients and doctors a resource for finding good quality lymphedema care by seeking out LANA therapists. I do think initially this was actually the case. But as is now painfully obvious, much lymphedema care in the US is substandard, not provided at the gold-standard as the students are instructed in the training schools. This means many therapists with the LANA designation simply don’t provide gold standard lymphedema treatment. That directly contravenes the original purpose of LANA which was to be the gold standard for therapist preparation, but if that preparation still yields substandard care, well – then - what’s the point?

I want to take a moment to wade into a fraught political issue in our community: giving proper credit and respect to practicing massage therapists devoted to lymphedema care. Massage therapists have been deeply involved in lymphedema treatment since the advent of CDT in the US. In fact, the icons of our field are all massage therapists, meaning the leaders of the best schools are amazing massage therapists as well as talented and devoted teachers. We PTs and OTs who love this work are fully indebted to the generosity, intelligence and hands-on instruction of these visionary leaders. Yet for all of my 27 years in this field, there has been a significant cohort on the PT side who are against MT’s receiving certification as lymphedema specialists. Their rationale for this is that PTs have more education and can make more informed clinical judgments. I am not so sure about this, but be that as it may. In my experience teaching classes for the Norton school, I saw many MT’s who were smarter than the PTs in class (which is not a knock of PTs per se, but rather a marker that MTs are in many cases at least equal to PTs) and I have always been impressed with the holistic knowledge a massage therapist brings not only to the classroom but also clinical practice. I have learned important skills from the massage therapists I have been fortunate to meet. I know, I know, many of the PTs out there will consider this a blasphemous statement. The point in a discussion about LANA is that massage therapists have been largely kept from qualifying for the certification while PTs earn their LANA and then too many provide substandard care, illustrating in another way that the LANA certification is not that clarifying. I know this sentiment is sacrilege to some and I will take some heat for it, but I stand by it.

What has also changed is that LANA now accepts as qualifying to sit for the exam students who are graduates of schools that actually provide a good portion of their instruction remotely. This is to say a person can ‘attend,’ and ‘receive real-time instruction’ in manual skills remotely while not actually physically present in the class. Manual skills are the foundation of being a CLT. As someone who took my initial training decades ago, this would have been considered absurd. For those of us who practiced on each other in class, felt different hands and pressures, and even had the instructor demonstrate on us, to assert that remote instruction is equivalent defies logic. Somehow, somewhere, someone (or someone’s) has designated this training to be equal to in-person training. A colleague took the original in-person MLD training and then secondarily took a remote instruction also in MLD. She appreciated the knowledge bestowed by the remote instruction but also said it was not as complete as the in-person instruction. The sad thing here is students who take this remote training can feel like they had an amazing experience, since yes, the content is amazing, but they can’t compare since they have not done the in-person training. Additionally, now one of the original great training programs has just a few less hours than required for the LANA exam, so graduates of this program do not qualify to sit for the exam unless they take additional hours. Yet if a patient were to ask me if they would receive better care from one or the other school graduates, I would without hesitation suggest the quality school with in-person training and less total hours, than the diluted training of so-called ‘remote synchronized learning.’

So we come back to the question: what is the value of LANA now? I don’t need the LANA accreditation to stand out from my peers. In my opinion the standards for the schools have been lowered. Does LANA distinguish the quality of therapy a patient will receive? No, I would argue LANA does not given all the substandard ‘dosing’ of lymphedema we see out there. LANA does not now and never has offered real educational opportunities like we see from LE&RN or the NLN. But I do receive regular emails from LANA directing me to some sort of industry marketing event. However, those companies can reach me in other ways anyway and in those cases LANA is nothing but a conduit for industry. My LANA certification is up at the end of 2025, and after 24 years with a LANA credential, I choose this year to give it up. Sadly, in my opinion LANA has become a distinction without a difference.

I can see already many will be unhappy with my opinion here. They might say, okay, some criticisms are valid, but how about some recommendations for improvement? Fair enough. Why doesn’t LANA create a space, that is easily accessed, with clinical pearls, short clinical educational videos, space for debating issues important to our field such as the relative value of CDT vs. lymphedema surgery, documents that highlight helpful suggestions for managing wounds in the clinic, or dealing with barriers to care that crop up so often, a forum where surgeons and CLTs can communicate easily. The whole point of LANA is to promote the highest quality lymphedema care and there are many ways LANA can lean into ideas. I know there are many amazing, creative clinicians on the LANA board and others who are motivated to help to increase the value of LANA. How about it?