Physiotherapy Intervention for Lymphoedema

One in every 200 people suffer from Lymphoedema. It is a quite common condition that is a side effect of Cancer and several other conditions. Lymphoedema is a build up of protein rich fluid that results in swelling of the affected area. The most common area affected are the limbs but it can also occur in the trunk, breasts, head and neck or genitals.

The Lymphatic system is a delicate network of vessels and nodes which lie directly beneath the skin. The system collects fluid and transports it to other parts of the body where the nodes are located. If some of the nodes are removed or the system is damaged the fluid needs to find a detour but is quite often unable to, resulting in Oedema.

Lymphoedema is unfortunately an incurable condition, but it can be controlled with the proper management. It is important to find someone who has knowledge and training in the field. The longer Lymphoedema is left without treatment, the harder it is to treat.

Lymphoedema can be classed as either Primary or Secondary depending on the mechanism of onset.

Primary: One in 6,000 births result in a congenital condition where the lymphatic system does not develop properly. This is most commonly seen in the lower limbs and usually bilaterally. Primary Lymphoedema has been shown to have a genetic link

Secondary: Secondary Lymphoedema is a result of damage to the Lymphatic system either by surgery, infection, infiltration of cancer into the Lymph nodes, or obstruction. Other causes of secondary Lymphoedema are damage to the venous system, dependency oedema (eg- following heart failure), obesity and cardiac disease.

Preventing Lymphoedema

The easiest way to treat Lymphoedema is to prevent it in the first place. Those at risk of developing Lymphoedema should follow limb precautions for the rest of their lives as swelling can occur at any stage in the future

Dos

• Keep limb clean and moisturised – dry skin is prone to cracking which can lead to infections

• Keep mobile

• Stay hydrated

• Wear gloves in the garden and while doing washing up

• Avoid extreme temperatures and sunburn by wearing long sleeves and sunscreen

• Avoid mosquito and insect bites by wearing repellent and long sleeves

• Take care when flying – there is no evidence of flying causing lymphoedema, however being immobile for long periods of time, dehydrated and lifting/pulling heavy suitcases can increase the load on the lymphatic system. It is advisable to be obtain compression garments before long haul flights.

Don’ts

• Have any needles, injections or blood pressure taken from the affected limb

• Get any Tattoos

• Undertake any repetitive heavy activity with affected limb

• Gain significant amounts of weight

• Wear tight clothes, bra straps, handbag straps that can restrict lymphatic flow

Diagnosis of Lymphoedema

Early warning signs include heaviness, aching, watches and rings becoming tighter, and puffiness.

A qualified Physiotherapist or Health Professional can conduct an initial observational assessment where they will ask specific questions and observe for swelling, pitting, redness and whether they can see prominent bony landmarks. They can then assess which stage of Lymphoedema you are in.

The Stages of Lymphoedema

Lymphoedema is described as progressing through the “Three Fs”

1.       Fluid

2.       Fat

3.       Fibrosis

The swelling becomes more ‘solid’ as the condition progresses. It is much easier to treat and drain oedema that is in the fluid stage before it becomes firmer and harder to shift.

The most widely accepted form of staging Lymphoedema is from the International Society of Lymphology

·         Stage 0 – Subclinical oedema, no swelling is visible but may be picked up with bio-impedance

·         Stage I – Early onset lymphoedema, swelling resolves with elevation

·         Stage II – Elevation no longer helps reduce swelling and pitting is present, sometimes late in this stage, the swelling no longer pits as the fluid progresses to fat and later fibrosis

·         Stage III – More commonly known as elephantitis, the limb can be very large with significant skin changes

Classification of Severity

In cases where only one side of the body is affected, the severity of lymphoedema is assessed by comparing the affected limb to the unaffected one:

·         Mild: < 20% limb volume difference

·         Moderate: 20 – 40% limb volume difference

·         Severe: > 40% limb volume difference

Physiotherapy Treatment of Lymphoedema

A Physiotherapist specifically trained in treating Lymphoedema can offer a broad range of treatment options.

EDUCATION

COMPRESSION: BANDAGING, GARMENTS, WRAPS, INTERMITTENT PNEUMATIC COMPRESSION

MANUAL LYMPHATIC DRAINAIGE/ SELF LYMPHATIC DRAINAGE

SKIN CARE

EXERCISE

LOW LEVEL LASER

KINESIO TAPING

Seeking professional early help is of the upmost importance! At Core Elements Physiotherapy our Physiotherapist Emma is trained in the treatment and Management of Lymphoedema and can assist you in implementing the right strategies and support!