TREATING LYMPHEDEMA

Lymphedema can't be cured. Treatment focuses on minimizing the swelling and controlling the pain. Lymphedema is a chronic disease that tends to progress. Without adequate therapy, Stage I, which is characterized by swelling from accumulation of high protein edema fluid, will progress to Stage II with fibrosis and reproduction of fatty tissue, and possibly even to the elephantiasis of Stage III. Treatment for lymphedema varies depending on the severity of the edema and the degree of fibrosis of the affected limb. Most people with lymphedema follow a daily regimen of treatment as suggested by their physician or certified lymphedema therapist. The most common treatments for lymphedema are a combination of direct lymphatic massage, lymphatic exercise, daytime and nighttime compression garments or compression bandaging and the use of intermittent sequential gradient pumps. CDT or Complex decongestive physiotherapy is a guided system of lymphatic massage, skin care, and compressive garments. Although a combination treatment program may be ideal, any of the treatments can be done individually.

Compression Garments

Elastic compression garments are worn by a person with lymphedema on the affected limb following complete decongestive therapy to maintain edema reduction and to compress the arm or leg and encourage the flow of lymph fluid out of the affected limb. Depending on the therapist's discretion, a compression garment may be custom-fit or purchased in over-the-counter, standard sizes. Compression garments are meant to be worn twenty four hours a day, every day to maintain edema reduction and must be replaced on a regular basis. It is very important that the patient obtain a correct fit for their compression garments by getting professional help. Some people will require custom-made compression garments and it is important that these garments fit correctly. An inaccurate measurement or a poorly manufactured garment could cause severe pain and discomfort. Some people will require custom-made compression garments.

Circular Knit Compression Stockings (off the shelf)

Circular-knit compression stockings, like regular ladies' nylons, are knitted on a cylinder and have no seam. The same number of loops per row is used over the whole length of the stocking. Circular knitting is primarily suitable for manufacturing support stockings, stockings for prophylaxis, and Class 1-3 compression stockings. Seamless circular-knit stockings can be made finer/thinner and cosmetically more attractive than stockings produced by flat-knitting.

Flat Knit Compression Stockings (custom made)

Compression stockings produced by flat-knit machines are knit row by row, following a knitting pattern. Flat-knit stockings can be produced in almost unlimited shapes and sizes in accordance with the presented anatomical shape, and can also be made to fit extreme deformities. This flat-knit process is suitable for custom-made products, especially for higher compression classes (3 and 4). Because of their perfect fit, the stockings (when measured correctly) deliver a precise level of compression, as well as a pressure gradient, even for extreme body shapes. Flat-knit stockings are thicker and have a seam.

Compression Classes

   (1) = 18-21 mmHg
   (2) = 23-32 mmHg
   (3) = 34-46 mmHg
   (4) =>   49 mmHg

When Should a New Compression Stockings Be Ordered

Even the most perfect compression garment has only limited durability, even if treated with utmost care. After approximately 6 months it wears out and loses its compression effectiveness. If the stockings has been used consistently and the prescribed exercises and therapies have been performed on a regular basis, the swelling may be reduced to the point that a new stocking is required sooner – because the old one is too wide now.
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Compression Bandaging or Wrapping

Multi layered compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the affected areas. CDT (complete decongestive therapy) starts with the decongestive phase (Phase I). During this phase, compression is performed by compression bandages that are applied by a trained lymphedema therapist. The bandages must be worn until the next session. The patient must be treated every day. Phase I should be arranged for a four-week period. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas.
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Therapeutic exercise (Decongestive Exercises)

Light exercises that require your affected arm or leg may encourage movement of the lymph fluid out of your limb. In addition, specific therapeutic exercise while compression bandaging is worn is a valuable part of therapy, not only because it aids in the elimination of excess fluid, but also because some patients with chronic lymphedema or large, swollen areas will have poor strength or range of movement.. These patients benefit from exercise prescribed specifically for them by their physician to help improve their function and comfort.



Sequential Gradient Pump Therapy

Intermittent Pneumatic Gradient Sequential Pump Therapy has been utilized for over 30 years throughout the world. The most resent compression pump technology utilizes a multi-chambered pneumatic sleeve with overlapping cells, to gently move the lymph fluid. There are several manufacturers of these devices, including Lympha-Press and Bio Compression Systems. Until now, manual lymph drainage was the only option for patients with lymphedema in the torso, groin, buttocks, abdomen, trunk, chest, and back. Designed in accordance with the principals of Manual Lymph Drainage, Lympha Press Optimal is the most versatile, yet easy to use, home care lymphedema treatment system available today. The Lympha Press Optimal has a “Pretherapy” cycle that is based on the principles of manual lymph drainage. This mode clears the proximal lymphatics prior to the main treatment cycle. “Sequential” Lympha Press quality 12 zone calibrated pneumatic compression therapy, clinically proven effective. “Peristaltic” wave type calibrated gradient massage, for patients with focal discomfort. These compression devices are recognized treatments and approved by Medicare and most insurance plans in the USA. Many patients may benefit from a pump without ever going to MLD sessions, as they are very beneficial, but not a requirement. However, after completion of the appropriate number of MLD sessions, many patients will benefit from a home use of a sequential pump.
> View our catalog of Gradient Pumps

Skin care

Skin care is an important component of CDT. People with lymphedema or who have had lymph nodes removed are at a higher risk for infections of the affected areas, and so need to be taught a specific regimen of thorough but gentle cleansing followed by moisturizing in order to keep the skin in the best health possible. Teaching higher risk sufferers about the signs and symptoms of infections is also important, since awareness is the key to early identification and treatment. Untreated infections can further damage an already impaired lymphatic system and lead to more severe lymphedema and skin ulcers.

Kinesio Taping

A new adjunct treatment is being taught to therapists utilizing a special type of tape called Kinesio Taping used to help soften edemas.

Learn more about lymphedema:
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