The lymphatic system is an important part of the body’s immune system.  The term lymphedema refers to swelling of a body part caused by abnormal accumulation of lymph fluid.  It usually affects the arms or legs but can also occur in the head, neck, genital and trunk regions.  Lymphedema occurs when the lymphatic system is deficient or damaged, altering the transport of the lymph fluid.
In North America, lymphedema is still not a widely known condition.  Many people are told that there is no treatment and that they must learn to live with it.  Although it is a chronic and progressive condition, lymphedema can usually be brought under control by good care and attention to certain basic guidelines.  Lymphedema is compatible with a normal and active lifestyle.

What Causes Lymphedema?

There are two types of lymphedema, Primary and Secondary, which both occur when normal drainage is impaired.

• Primary Lymphedema is due to a defect in the lymphatic system, either from sporadic or hereditary causes.  The majority of primary lymphedema occurs before the age of 35.
• Secondary Lymphedema is the most common type, and can develop as a result of surgery, radiation, infection or trauma.  This condition is common in cancers of the breast, uterus, bladder, ovary, prostate, or testicle, and for malignant melanomas and lymphomas.  Lymphedema can occur immediately post-operatively,  or develop within months or even years after.

What are the Signs and Symptoms of Lymphedema?

• Persistent Swelling
• An increase in size of the limb
• A feeling of heat in the limb
• Aching limb or arching of the back of the shoulder
• Arm or leg feels full or heavy
• Red patches which may indicate an infection- should seek immediate medical attention
• Puffiness
• Decreased flexibility in hand, wrist or ankle
• Difficulty fitting into shoes or clothing
• Ring/watch/bracelet/ankle tightness
• Leakage of lymph fluid

Early diagnosis and treatment is important in the management of lymphedema as it will help both the prognosis and the condition.  Treatment should ideally begin as soon as the problem is diagnosed or even better as a preventative program after radiation or removal of lymph nodes.  If you have, or are at risk of getting lymphedema, it is important to practice good skin care techniques.  Look after your skin by preventing anything from piercing the skin layer which could allow bacteria to enter the body.

• Avoid cuts, scratches, pin pricks, needle pokes, insect bites and burns if possible
• Avoid hot environments  i.e. Saunas, steam baths, and hot tubs
• Exercise the affected body part.  A good exercise program of stretching and strengthening may help to control your lymphedema.  You should wear a compression garment during exercise.
• Maintain an ideal body weight.

How can Physiotherapy /Massage Therapy Help?

Although there is no cure for lymphedema, there is treatment available to prevent or decrease the severity of the condition.
Physiotherapists or massage therapists with training in the management of lymphedema can prescribe an individualized treatment program that will involve:

• Patient evaluation in consultation with the physician to determine the optimal treatment plan
• A home exercise program to improve lymphatic drainage, increase or maintain range of motion of the affected area, and improve cardiovascular fitness
• Treatment to decrease pain
• Education in effective skin care
• Manual lymphatic drainage that will reduce and control the swelling. A comprehensive program will include compression therapy (bandaging or compression garments) and massage, or a combination of therapies
• Assistance in obtaining and fitting a compression garment with instruction on frequency and use

The best type of exercise for people with lymphedema is swimming and other water exercises where the body weight is supported.  However, for other exercises such as resistance training, biking, walking and running, it is recommended to wear either bandages or compression garments.

A Collaborative Effort

The physician, physiotherapist, massage therapist, and patient can work together as a team to achieve better success in managing lymphedema.