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Lymphedema Treatment

Lymphatic System

The components of the lymphatic system include lymph, lymphatic load, lymphatic vessels, and lymphatic tissues. The most important function of the lymphatic system is to drain and transport excess fluid from the intercellular fluid and body tissues back into the venous blood circulation after cleaning proteins, bacteria, viruses, and large molecular cells. The lymphatic system is a crucial part of our immune system.

Lymphedema

Lymphedema is defined as "the abnormal accumulation of lymph fluid, causing swelling in a part of the body, often an extremity." It is a chronic and progressive condition resulting from the excessive accumulation of protein-rich lymph fluid in the interstitial space.

Pathological changes in the lymphatic system include blockages in lymph flow, dermal backflow, lymph node insufficiency, lack of collateral lymph flow, and decreased lymphatic transport capacity. These changes result in increased protein concentration, raising the colloidosmotic pressure of interstitial fluid.

Lymphedema is categorized into two main types: Primary and Secondary.

Primary Lymphedema: It occurs without a specific cause, either at birth or later in life. It is more common in females and lower extremities.
Secondary Lymphedema: It can develop due to injury, trauma, or chronic infections in the lymphatic system. It typically appears after surgical intervention and/or radiotherapy in the lymph nodes of the neck, axillary, inguinal, or pelvic regions.

Lymphedema is a chronic and progressive condition. With proper care and adherence to essential guidelines, it can generally be controlled. In severe cases, thickening of the skin, fibrosis, limited movement, lymph leakage, excessive swelling, and elephantiasis can occur.

Symptoms of Lymphedema:

Swelling in the hand, arm, and/or torso
Fullness and heaviness sensation
Restricted movement
Discoloration
Loss of visibility in vein pathways
Reduced number and increased depth of skin fold lines at the wrist
Tightness of jewelry and clothing, leaving marks
Positive Stemmer’s sign
Increase in circumference measurements

Physiotherapy for Lymphedema

Complex Decongestive Physiotherapy (CDP) is used for the treatment of lymphedema. This method consists of six approaches:

Skin Care and Hygiene: Preventative methods and effective treatment must be rigorously applied throughout life.
Manual Lymphatic Drainage (MLD): Special manipulative techniques are applied based on specific principles and a "roadmap."
Compression Bandaging: Applying compression to tissues is both a treatment and a preventative method in lymphedema.
Exercise: Both preventative and decongestive exercises are utilized:
- Using the muscle-joint pump against gravity
- Facilitating venous return
- Maintaining posture
- Increasing muscle tone in weak muscles
- Relaxing and rhythm regulation through breathing
- Improving cardiovascular performance
- Utilizing hydrostatic pressure and bandage compression
Compression Garments: These garments are used for continuous support.
Self-Drainage: If the edema is in the arm region, the therapist will teach the patient simple lymphatic drainage techniques they can perform on their own.

Understanding the "normal flow direction" of lymph fluid within the body and ensuring that treatments are administered by specialized physiotherapists are critically important.

"The goal of lymphedema treatment should be to restore the disrupted balance between lymphatic protein load and lymph transport capacity." - M. Földi

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