Lymphedema Management

What is Lymphedema?

Lymphedema is a condition where excess fluid collects in the tissues of the limbs causing swelling (edema). Lymphedema is a common complication after removal or damage to the lymphatic system. The lymphatic system is a group of small vessels in the body that is an important part of the immune system. It is there to work together with the circulatory system to remove toxins, waste and other unwanted materials from the body. It also has a large role in fighting against bacteria and viruses and for maintaining fluid balance throughout the body. If there is damage/disruption to the lymphatic system then it is not able to drain the fluid properly and results in excess fluid build-up. Lymphedema can occur either due to a congenital abnormality in the lymphatic system or it can occur as a result of cancer surgery, radiation therapy, infections, inflammatory conditions, cardiovascular diseases and injury and trauma. 

What are the Symptoms of Lymphedema?

Lymphedema symptoms include: 

  • Swelling of either a part or whole leg or arm including the fingers and toes
  • Limb may look cold, shiny and white
  • May have difficulty wearing jewellery or watches, difficulty fitting into clothing or shoes
  • Heavy or tight feeling in the limb
  • Loss of range of motion in the swollen limb
  • Aching in the affected limb
  • Tingling/numbness in affected limb
  • Thickening and hardening of the skin
  • Fatigue 

Who is at Risk of Lymphedema? 

There are certain factors that can increase someone’s risk of developing lymphedema and may indicate progression, severity or outcome of lymphedema. Risk factors Include: 

  • Surgery with dissection of lymph nodes in the armpit 
  • Scar formation 
  • Radiation of the breast, axillary, internal mammary, sub clavicular or inguinal lymph nodes due to cancer
  • Varicose Vein Stripping 
  • Poor nutrition
  • Thrombophlebitis 
  • Immobilization 
  • Air Travel 
  • Drain and wound complications/infections
  • Axillary Web Syndrome 
  • Seroma formation 
  • Advanced Cancers 
  • Obesity 
  • Congenital Predisposition 
  • Trauma to the at risk limb 
  • Chronic skin disorders and inflammation 
  • Hypertension 

What can I do to Decrease the Risk of Developing Lymphedema? 

If you are at risk of developing Lymphedema due to a congenital abnormality in the lymphatic system or as a result of cancer surgery, radiation therapy, infections, inflammatory conditions, cardiovascular diseases and injury and trauma, the following are some things to try to help reduce the risk. 

  • Take care of nails and skin and keep them clean (watch out for hang nails and cuts)
  • Doing daily skin checks for cuts/sores/wounds and tending to them quickly and appropriately 
  • Maintain an optimal body weight (BMI < 30 Kg/m2
  • Eating a balanced diet 
  • Avoiding trauma to the area at risk 
  • Avoid wearing tight clothing and jewelry 
  • Avoiding exposure to extreme cold and heal 
  • Avoiding blood pressure tests on at risk arm 
  • Using sunscreen and bug repellent to prevent trauma in terms of sunburn or bug bites
  • Wearing lymphedema garments if they have been prescribed to you 
  • Activity/Exercise as tolerated
  • Elevating limb and avoiding a dependent position of the limb for too long 
  • Wearing comfortable and support shoes 

Signs of Cellulitis

Having lymphedema makes you more susceptible to infections. A common infection that affects people with lymphedema is Cellulitis. Cellulitis is a potentially serious bacterial infection of the deep layer of the skin. If you notice the following signs and symptoms of cellulitis it is important to seek medical attention immediately. 

  • Redness of the skin 
  • Swelling 
  • Warmth 
  • Pain and tenderness 
  • Drainage and leakage of the skin 
  • Tender lymph nodes 
  • Fever
  • Increase in fatigue/tiredness compared to usual

What is Lymphedema Treatment and How Will it Help?

Lymphedema is a chronic disease that can have a significant impact on quality of life as movement can become harder and more fatiguing but it is manageable. Physiotherapy treatment can be a useful tool in the management of the symptoms of lymphedema. During treatments physiotherapists can help provide you with tips and education that can help reduce the risks of developing lymphedema, help with possible prevention and/or help manage symptoms so that if you develop lymphedema is can be less severe. 

When you are first coming for treatment your physiotherapist will start with an assessment. A lymphedema assessment at BodyTech Physiotherapy will include a detailed subjective history of causes, symptoms as well as an examination of your functional abilities and measurements of the affected limb. Physiotherapy treatments will be individualized based on the assessment results and will focus on teaching how to manage the lymphedema at home through the use of education, individualized exercise programs, lymphatic massage/self-lymphatic massage and bandaging when appropriate. Physiotherapy treatment can help with decreasing lymphedema severity, improving the condition of the skin and limb shape, improving the function of the affected limb, decrease symptoms of lymphedema and improve overall function and quality of life. 

References: Jodi Steele: Lymphedema Workbook 2015 (Cited January 28, 2021)

BodyTech Physiotherapy

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