• Tatum Gould

Lymphoedema

Lymphoedema is a chronic condition characterised by localised fluid retention and tissue swelling caused by a compromised lymphatic system. When the lymphatic system is compromised, due to a blockage or damage, including lymph node dissection surgery, lymph fluid cannot be effectively removed from a region or limb and therefore accumulates and can subsequently cause long‑term swelling.



How Does Lymphoedema Occur?

  • Inherited (genetic)

  • Lymph node dissection

  • Other surgery

  • Radiation therapy

  • Accidents or diseases that inhibit the lymphatic system from functioning


Symptoms

  • Swelling

  • Feeling of heaviness

  • Soreness in affected area

  • Skin changes

  • Clothing or jewellery may feel tighter


Grading

  • Grade 1: Mostly pitting oedema; spontaneously reversible with elevation

  • Grade 2: Mostly non-pitting oedema; non-spontaneously reversible with elevation

  • Grade 3: Gross increase in volume of Grade 2 lymphoedema; eight stages of severity


Staging

  • Stage 0: Lymphatic vessels have sustained some damage that is not yet apparent; transport capacity is sufficient; lymphoedema not present

  • Stage 1: Swelling increases during the day and disappears overnight with limb elevation; tissue still at the pitting stage; treatment not yet required

  • Stage 2: Swelling is not reversible overnight and only reduces with proper management; spongy tissue consistency; oedema considered non-pitting; fibrosis at this stage marks the beginning of hardening of the limbs and increasing size

  • Stage 3: Swelling is irreversible; tissue is fibrotic and unresponsive

  • Stage 4: Size and circumference of limbs become increasingly large; knobs (bumps, lumps and protrusions) begin to appear

  • Stage 5: The affected limb becomes grossly large; one or more deep skin folds present

  • Stage 6: Knobs cluster together; mobility of the patient becomes increasingly difficult

  • Stage 7: Patient is unable to independently mobilise and perform activities of daily living


Physiotherapy Management


Unfortunately, lymphoedema cannot be prevented or cured. Symptom management via Physiotherapy can help to reduce the uncomfortable effects.


Goals of Lymphoedema Physiotherapy

  • Increased range of motion/flexibility

  • Decreased swelling

  • Decreased pain

  • Increased strength

  • Restore function and improve the quality of life


Techniques Used by Physiotherapists to Manage Lymphoedema

  • Complete decongestive therapy: Manual manipulation of lymphatic ducts + short-stretch compression bandaging + therapeutic bandaging + skin care

  • Compression garments: Measured to fit; inelastic to contain and reduce oedema

  • Compressive bandaging: During movement, enhance pumping action of the lymph vessels; encourage lymphatic flow

  • Intermittent pneumatic compression therapy: Multi-chambered pneumatic sleeve promotes movement of lymph fluid

  • Low-level laser therapy: Theories suggest that laser therapy can potentially decrease fibrosis; stimulate macrophages and the immune system; and a possible role in encouraging lymphangiogenesis

  • Exercise: Resistance and other types of exercise, usually in conjunction with wearing compression garments; appropriate assessment is required prior to commencing an exercise program


Other Treatment Techniques

  • Skin care: Due to the compromised lymphatic system, there is an increased risk of infection and delayed healing. Taking care with risky tasks such as gardening, cooking and shaving is important. Should cuts and grazes occur, cleanse the area and apply clean dressings until the wound has healed

  • Various surgical techniques


If you have been diagnosed with, or are at risk of developing lymphoedema, book an appointment with one of our Physiotherapists for an assessment and appropriate management.

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