Lymphedema Treatment

John Fuller Beckwith3/12/2024

It is important that an individual with lymphedema receive comprehensive, effective treatment. The gold standard for lymphedema therapy is a combination of modalities called Complete Decongestive Therapy (CDT). This therapy approach is endorsed by the International Society for Lymphology, the National Lymphedema Network, the International Lymphedema Framework and by the committee that advises Medicare and Medicaid on evidenced -based treatment of specific diseases.

Complete Decongestive Therapy

CDT is comprised of 4 parts delivered in two phases. The four parts are:

• compression (bandages or garments)
• manual lymph drainage
• meticulous skin and nail care
• and exercise.

All four parts are present in both phases of treatment. The first phase is the intensive treatment provided in the clinic by the certified therapist. During this phase treatment visits are 3-5 days per week and most visits are 1-2 hours. The second phase is the life-long self-management or optimization phase done at home by the patient or caregivers. Instruction in self-care for lymphedema is provided by the therapist in the transition from the intensive to the optimization phase.

Compression Bandaging

Lymphedema treatment requires specialized compression bandages applied in a skilled technique that is modified to best suit each patient. The bandaging is based on sound anatomical and physiological principles, helps to move fluid out of the limb or body part, and can be surprisingly comfortable to wear (they should not cause pain). The compression bandages also have the effect of softening and reducing the fibrosis associated with lymphedema. Once treatment begins, the bandages are kept on for 23-24 hours per day. In the optimization phase compression garments take the place of the compression bandages.

Manual Lymphatic Drainage

MLD is a specialized massage technique that stimulates fluid to move more effectively through the lymphatic system and to bypass impairments in flow, helping to reduce the accumulation of fluid in the tissues that characterizes lymphedema. MLD is unique in that it is the lone intervention that helps to evacuate stagnant tissue proteins. This technique can take from 30-45 minutes each session. It is a surprisingly light and very comfortable massage technique. When combined with compression bandaging, it forms the core of lymphedema treatment.

Meticulous Skin and Nail Care

This is vital to the care of anyone living with lymphedema, since infection is an ever-present concern. Daily attention to skin and taking action to prevent infection is the best way to avoid infection. Attention to skin care will be a part of each treatment session during phase one of CDT and should be daily during phase two.

Exercise

Exercise generally is good (with a few caveats) and individuals with lymphedema are encouraged to engage in the exercise of their choice. However in this case we are referring to a program of remedial exercises which work with the other elements of CDT, especially compression, to help reduce lymphedema. Muscle contraction is one of the ways fluid is mobilized in the body and when combined with compression the effect is much greater.