Lymphedema is a chronic progressive medical condition that occurs due to the increase in the collection of lymphatic fluid in the body. It occurs due to the blockage in the lymph nodes thus preventing proper drainage of lymph fluid. This lymph fluid transports bacteria to the lymph nodes where they are destroyed. Blockage of lymph nodes causes swelling which can occur anywhere in the body, such as arms, legs, genitals, face, neck, chest wall, and oral cavity. The proper functioning of these lymph nodes requires proper drainage. Physiotherapy is one of the effective treatment options for lymphedema because it is an exercise-based therapy that can reduce swelling and other side effects of this condition. In this blog, we have mentioned the interventions used by a well-trained physiotherapist to restore function and improve the quality of life in patients suffering from lymphedema.

 

CLASSIFICATION OF LYMPHEDEMA:
Lymphedema is classified into two types:

Genetic or Primary lymphedema is an inherited condition that causes a malformation of the lymphatic system, occurring due to genetic mutation. It causes hyperplasia, hypoplasia, or aplasia of the lymphatic vessels.

 

Acquired or secondary lymphedema, occurs due to cancer, tumor, injury, surgical interventions, infection, and radiation treatment. Filariasis is the direct infestation of lymph nodes by the parasite, or obstruction to the lymphatic system, due to damage or dysfunction of the normally functioning lymphatic system.

Lymphedema causes swelling in the extremities including the arms, hands, legs, feet, pelvis, groin, shoulder, etc., pain and joint mobility, restricted range of motion in the joints, heaviness in limbs, skin discoloration, altered sensation, and difficulty in fitting into clothes. Early diagnosis is needed to ensure the correct treatment. Diagnosis is done by taking the history and by physical examination.

 

PHYSIOTHERAPY MANAGEMENT:

Lymphedema is a progressive disease, physiotherapists can help individuals with lymphedema regain function and movement.  The treatment plan includes manual lymphatic drainage, compression bandaging, movement, and skincare. 

 

Elevation:

Elevation and treatment with air-compressed bladders may also be used to normalize the size of the limb. 

 

Pneumatic Compression or Pressure Therapy (PC/PT):

Pressure therapy is a technique that comprises compressed air pumps. These compressed air pumps are used for pressuring the limb with edema.

 

Decongestion lymphedema therapy (DLT):

Decongestion lymphedema therapy is done for moderate to severe lymphedema. This therapy mobilizes lymph and dissipates fibro sclerotic tissue. Two-step procedure involving manual lymphatic drainage, gentle massage, followed by compression bandaging.

 

Manual lymph drainage (MLD):

Manual lymph drainage is a light lymph massage designed to increase lymph flow, it can be also done by the patient. It helps to improve the flow of lymph from the affected arm or leg (proximal to distal).

 

Garment fitting:

Self-bandaging and the use of compression garments can be worn by the patient. Low stretch compression garments are worn following lymphatic drainage.

 

Compression pumps

Compression helps in the drainage thus decreasing the swelling.

 

Skincare and skin hygiene:

Skin hygiene is advised by cleaning the skin of the arms or legs daily and lotion is used to keep it moist. For skincare, fastidious skincare cream is used to prevent secondary skin infections.

 

Exercises:

Low-intensity exercise promotes lymph drainage and protein absorption by muscle contraction. Exercise helps to improve cardiovascular health and decrease swelling in some cases. Exercises are included in the program to increase or maintain the range of motion and strength of the affected area, improve lymphatic drainage, and improve cardiovascular fitness.

 

Light massage:

Gentle massage and exercises are also found to be effective in reducing the volume of the affected limb.

 

Strengthening exercises:

Strengthening exercises are recommended with elastic bands with variable resistance. Stage-specific and severity-specific cardiovascular exercises are very effective like walking, cycling, and running.

  

Lifelong education regarding adherence to compression stockings is mandatory to obtain relief from the pain and swelling along with weight loss and skincare is highly recommended.