FREE Physical Therapy - Vol. 6- LYMPHEDEMA, December 2006
OVERVIEW
Lymphedema is the swelling of an extremity caused by an insufficiency in the lymphatic system. The lymphatic system is most often associated with a common cold where lymph nodes are commonly swollen and can be felt in the neck when a person is ill. The lymphatic system is also responsible, in conjunction with the venous system, for transport of metabolic waste products and carbon dioxide away from the organs and back to the heart for reprocessing and use by the body's tissues. Lymphedema can be primary, meaning that the structural impairment is found in the actual lymphatic system. It can be secondary, which means that the lymphatic system itself is sufficient, but has become has become damaged by an external influence, such as surgery, injury, or exposure to radiation. Secondary lymph edema is frequently seen in the extremities of individuals who have had lymph nodes removed from the armpit as part of breast cancer surgery.
SYMPTOMS AND STAGING
As previously stated, the most common symptom of lymphedema is swelling. However, many symptoms are also associated with lymphedema, such as pain, achiness/heaviness of an extremity, loss of motion, and loss of strength. Lymphedema is most commonly seen in the extremities, but can also affect the head, neck, trunk, and genitals. Lymphedema is broken into four stages:
- Stage 0: The lymphatic system functioning is already impaired but no swelling is present.
- Stage I: Soft swelling is present and can be reduced by elevation. Physical therapy intervention is most effective at this stage.
- Stage II: Swelling is more severe and fibrosis (hardening of the skin caused by build-up of proteins) is present.
- Stage III: Swelling is extreme and the skin becomes even more hardened, with the presence of wart-like growths often noted. At this stage, the skin is very vulnerable to wounds and inflammation.
PHYSICAL THERAPY INTERVENTION
Physical therapy intervention for lymphedema consists of four components: manual lymphatic drainage, compression bandaging, exercise, and skin care/risk reduction practices.
Manual lymphatic drainage
Manual lymphatic drainage is a very gentle massage technique that a physical therapist will both perform and instruct patients in to assist the flow of lymphatic fluid.
Compression Bandaging/Garments
Compression bandaging is also used to assist the flow of fluid through the use of various pressures. Patients are instructed in application of temporary bandages to help decrease fluid levels; once an acceptable level is achieved, patients are fitted for a compression garment to help maintain fluid reductions.
Exercise
Patients are instructed in exercises, including range of motion, strengthening, and conditioning which assist the movement of fluid. Maintaining a healthy weight and lifestyle are also recommended in the treatment of lymph edema.
Skin Care/Risk Reduction Practices
The final component of lymphedema treatment is education. Patients are taught the importance of proper skin care to avoid infection, as well as ways to prevent the onset or exacerbation of lymphedema.
CONCLUSION
It is very important for individuals with lymphedema to seek the appropriate medical care. Through the help of physicians and physical therapists, lymphedema can be very manageable.
