Old Yet Still True

New Is Not Always Better

John Fuller Beckwith6/8/2026

Don’t we see this a lot in the lymphedema world, where someone comes along and states they have a new understanding and therefore the old thing we thought we knew is not true anymore? Of course we see this, it happens all the time. Whether its ‘all edema is lymphedema’ or ‘Starling is debunked’ or asserting it is just fine to treat lymphedema with velcro wraps and self-MLD.

And do we fall for it? Sadly, many do. And they pull our field off in a different direction. There seems to be some sort of attraction or mesmerizing effect of the feeling of ‘new discovery.’ Yet so many times these are not really great ideas or even new ideas. These new ideas just serve to elevate a few people for a little while. In fact, if we step back and pay attention these detours help to clarify the ongoing truth of much of the original understanding of lymphedema treatment as developed by the Foeldis. CDT is still the best approach. The old remains true.

This all came to mind when a patient shared an unfortunate occurrence in her treatment. She had fallen for the notion that old was, well, just old, and that newer must be better. She had breast cancer, I saw her shortly after her medical treatment and treated her with full CDT, which included my educating her on the claims and my views of precautions regarding surgeries for lymphedema. She absorbed all of that and I discharged her to phase II of CDT. Then over about five years she was lost to follow-up, not seen or in contact with me or another CLT. Recently she came back to the clinic and recounted this story: within the past year she was recommended to have bilateral mastectomies. The surgeon performing the mastectomies suggested that she might also benefit from a vascularized lymph node transfer (VLT). For those who may not understand this procedure, it is the surgical removal of a functioning lymph node with attached blood vessels from an unaffected lymph territory that is then implanted in the territory affected by the lymphedema under the premise that it will restore some or all of the lymph drainage in that region. And in fact in some cases it does restore some lymph flow, however not all lymph flow and not in all cases. As my patient told me later, the thought that went through her mind at that time was, “well, it has been five years, maybe what John taught me is not true any more, this is a surgeon after all, so they know so much more than a physical therapist, so the old must not be true anymore and now this new thing the surgeon is telling me is true.” So she went ahead with the VLT. And the outcome was: no change in the lymphedema in her left arm, but now she has chronic lymphedema (the surgeon of course would not call it that) in the lower trunk/inguinal region on the right. And she is quite angry about this, feeling misled. Her comment was “the old is still true.”

We see this in other aspects of our profession. Research always has to be new. And before the research scolds get up in a lather, of course there is always a value in new research. But there is this admonition that the new research is always more valuable than the old, that a presentation at a conference should only reference literature from the last five years and not older. There are two problems with this: first that the old, validated research is valid for a reason and is typically the foundation on which most treatment leans; second that just because a paper is new does not mean it replaces or invalidates what was known to be true, many times it is weak or the conclusion from the paper is poorly drawn.

We also see this in lymphedema treatment with new modalities that are periodically introduced and recommended for patients. Not that these modalities don’t have some value, as most of them introduce something helpful to the process. But often they are promoted as, ‘the new method,’ with the idea that the old, is well, old. So we see therapists substituting kinesiotaping, or low-level laser or red-light therapy or cupping or a new pump. In many cases these modalities then replace MLD and/or short-stretch compression bandaging. The rationale always seems to be that MLD is so old and even passe’ while this new method is more sophisticated and technologically advanced. In fact this is one of the main arguments for surgery over CDT, that there are new special surgical techniques with sophisticated high-tech machines while MLD and cotton bandages haven’t improved in decades (centuries?). Yet, as surgeries are concerned, we are back to my patient’s experience as noted above. Another recent example is a patient who was treated by a previous ‘lymphedema expert’ with an emphasis on red-light therapy. When asked the patient could not identify any perceived benefit from that intervention. Yet in three successive days of comprehensive short-stretch bandages and full sequence MLD she felt arm was markedly improved and she could see the difference.

So, yes, CDT hasn’t changed in decades. And yes, there are these new ideas and approaches. But new is not always and perhaps is seldom better. And CDT may be old at this point, but it has not been surpassed, so it is still the true and most effective way to treat lymphedema.