• image
  • image
  • image
  • image
  • image
Previous Next
Lymphoedema treatment


Manual Lymph Drainage aims to redirect fluid from swollen areas to healthy lymphatic vessels, transporting it back to the normal circulatory system . With gentle, light but precise hand movements applied to the skin, the therapists exerts different intensities of pressure to increase the activity of normal lymphatic vessels. This encourages the fluid away from congested areas by bypassing ineffective or injured lymph vessels. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and the affected extremity (in that order), lasting approximately 40 to 60 minutes. The technique was pioneered by Doctor Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders.

According to the International Society of Lymphology, Combined Decongestive Therapy (CDT), also known as decongestive lymphatic therapy (DLT), is the treatment of choice for Lymphoedema . Here CDT is combined with Manual Lymph Drainage (MLD), correct breathing, compression therapy, skin-care and decongestive exercise. Initially, CDT involves frequent visits to a certified therapist with a doctor's/consultant's prescription. Once the lymphoedema is reduced, increased patient participation is required for on-going care. The Therapist will teach SLD (simple lymph Drainage) and the patient will learn all about the use of elastic compression garments. In this maintenance phase visits to the therapist are less frequent but still essential to ensure the reduction of the oedema . CDT is generally effective . It is not a 'cure' in itself but helps to manage the condition and prevents further complications.

Conditions for which MLD therapy is helpful include:
  • It is an effective component in the treatment and management of primary and secondary lymphoedema (stages, I, II, III)
  • Post-traumatic oedema (hematomas, dislocation of the shoulder, torn muscle fibres, Sudeck's Distrophy).
  • Post-operative oedema (plastic or venous surgery)
  • It promotes the healing of wounds and burns and can improve the appearance and texture of old scars.
  • It is successfully being used to help heal leg ulcers.
  • It also assists in conditions arising from venous insufficiency.
  • The healing process of broken bones, torn ligaments and sprains can be accelerated or enhanced, and pain can often be eased.
  • Chronic inflammatory conditions such as sinusitis, diseases of the Rheumatic Form-Cycle, Acne and acne rosacea can be improved with the application of MLD.
  • Many female related conditions such as PMT and pregnancy related swellings respond well to MLD.
  • Lipedema/cellulite
  • It has a calming effect on the autonomic nervous system that leaves you deeply relaxed. It can help improve the quality of sleep, relieve constipation and generally aid digestion.
Brief introduction to the lymphatic system:


The lymphatic system is a one-way drainage system, which works in close synergy with the cardiovascular system. Via an extensive network of lymphatic vessels, ducts and lymph nodes it recycles excess tissue fluid. This fluid accumulates between layers of tissue, because of normal capillary leakage. The walls of the lymph vessels act as one-way valves, only letting fluid (lymph) enter. Once in the vessels, the lymph is advanced towards the systemic circulation. Movement of lymph fluid depends on movement of muscles, contraction of the lymphatic vessels themselves and respiration. Along the way the lymph is filtered through several lymph nodes where it is inspected for foreign substances. This is an important part of the immune system, as here lymphocytes are produced, which help fight off invading bacteria. Upon reaching the thoracic duct the lymph re-enters the blood circulation.


Lymph:
A clear fluid that contains proteins, fats, lymphocytes (white blood cells that fight infection and the growth of tumours), and plasma.

Lymph vessels: A network of thin walled tubes which help lymph flow through the body and return it to the bloodstream.
Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are in the underarm, pelvis, neck, abdomen, and groin. Spleen, thymus, tonsils, and bone marrow are also part of the lymphatic system.

What is Lymphoedema?


A transport disorder of the lymphatic system: Lymphoedema (swelling) occurs when lymph flow is impaired. Either damage, obstruction or absence of vessels can lead to dysfunction of the lymphatic system. This can result in the accumulation and stagnation of lymph in the tissues. Most often limbs are affected, but lymph oedema can also occur in the face, neck, abdomen or genitals. Tissues with lymphoedema are at risk of infection and susceptible to progression. Lymphoedema is a treatable and manageable condition.


Types of lymphoedema and causes:


1.
Developmental (inherited) disturbance of the lymphatic system (primary lymphoedema)

2. Acquired damage of lymphatic vessels and/or lymph nodes (secondary lymphoedema)

1. Primary Lymphoedema.


Primary lymphoedema occurs in women more often than men. In most cases it is found on one side and is pronounced more distal. If it occurs on both sides, there is normally and asymmetry. Primary lymphoedema can be further classified according to the type of occurrence (congenital: already manifest at birth - lymphoedema praecox: occurring before the age of 35 - lymphoedema tardum: occurring after the age of 35)


2. Secondary Lymphoedema.
Secondary lymphoedema can occur following surgical removal of lymph nodes or radiation therapy in the treatment of cancer. Secondary lymphoedema can also occur as a result of the following:

  • Post-operative (e.g. after plastic or venous surgery).
  • Post-traumatic (e.g. trauma which leads to injury of large lymph collectors such as open fractures, burns, wounds).
  • Post-inflammatory (e.g. rheumatic diseases, sinusitis, recurrent phlebitis).
  • Post-infection (e.g. recurrent cellulitis, inflammation of the lymph vessels, inflammation of lymph nodes).

Staging: Lymphedema develops in a number of stages, from mild to severe, referred to as Stage 1, 2 and 3:

Stage 1 (spontaneously reversible):


Tissue is still at the "pitting" stage, which means that when pressed by fingertips, the area indents and holds the indentation. Usually, upon waking in the morning, the limb(s) or affected area is normal or almost normal size.


Stage 2 (spontaneously irreversible):


The tissue now has a spongy consistency and is "non-pitting," meaning that when pressed by fingertips, the tissue bounces back without any indentation forming). Fibrosis found in Stage 2 lymphedema marks the beginning of the hardening of the limbs and increasing size.


Stage 3 (lymphostatic elephantiasis):


At this stage the swelling is irreversible and usually the limb(s) is/are very large. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery called "debulking" at this stage.

When lymphedema remains untreated, protein-rich fluid continues to accumulate, leading to an increase of swelling and a hardening or fibrosis of the tissue. In this state, the swollen limb(s) becomes a perfect culture medium for bacteria and subsequent recurrent lymphangitis (infections). Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the limb(s), skin breakdown, chronic infections and, sometimes, irreversible complications. In the most severe cases, untreated lymphedema can develop into a rare form of lymphatic cancer called Lymphangiosarcoma (most often in secondary lymphedema).

Treatment: According to the International Society of Lymphology, Combined Decongestive Therapy (CDT), also known as decongestive lymphatic therapy (DLT), is the treatment of choice for lymphoedema.

COMBINED DECONGESTIVE THERAPY


1. Manual Lymph Drainage
– Patients receive Manual Lymph Drainage (MLD) to remove excess fluid and protein from the tissues. The MLD is performed to open lymphatics in the unaffected regions so these can help to drain the affected area. MLD stimulates lymphangions to increase their activity, which results in a decompression and emptying of obstructed lymphatic channels.


2. Compression Therapy
– Multi-layered bandaging of the affected limb follows each MLD session. This is a precise and accurate procedure using specific bandages and interfacing materials.The bandages are applied exactly to conform to the patient’s tissues and are reapplied on a daily basis. They are short-stretch bandages that resist muscle contraction and are applied with comfortable padding underneath. The bandages help to maintain the reductions achieved with MLD and may even cause further reduction.


3. Exercise
– Effective lymph flow depends on sufficient muscle and joint activity, especially if the functionality of the lymphatic system is compromised. Decongestive exercises are most effective if performed while the patient wears compression garments or bandages, which are also essential components in lymphedema management.


4. Skin Care and Hygiene
– Good skin care plays an essential part in the treatment of lymphoedema. Daily skin cleansing with antibacterial washes and neutral balanced pH lotions will help to eliminate possible bacterial and fungal growth and so minimise the possibility of repeated attacks of cellulitis or lymphangitis.


5. Breathing
- The lymph transport in the Thoracic Duct (Ductus Thoracicus) is mainly caused by the action of breathing. Taking into consideration that this duct transports 4 litres of lymph per day explains the importance of diaphragmatic breathing to help increase transport of lymphatic fluid.


Go Back

Picture Gallery