Treatment & Therapy for Lymphedema

Patient being bandagedDecongestive Lymphatic therapy (DLT)

Decongestive lymphatic therapy (DLT) combines skin care, compression (using bandages or garments), manual lymph drainage (MLD), and remedial exercises. DLT is currently considered the most effective treatment available. DLT therapists are specially trained and certified. Consult the LAQ Resource Guide for a therapist in your area.

 

 

Skin care

  • Careful attention to your skin is essential to reduce the risk of infection.  Cleanse gently with mild soap.  Dry thoroughly and apply a non-allergenic moisturizer to prevent chapping and chafing
  • Be vigilant about cuts, scratches, splinters and pinpricks. Use electric razors to avoid nicks and skin irritation.
  •  If a cut or scratch does occur, clean the wound with soap, apply disinfectant, and, if indicated, an antibiotic ointment. Watch for signs of infection. If they appear, consult a doctor immediately.
  • Protect your skin with high protection sunscreen to avoid sunburn, and insect repellent to avoid bites.

For arm lymphedema

  • Protect your hands and nails.  Do not cut cuticles.
  • Inform your manicurist that you are at risk for lymphedema and that equipment must be properly sanitized.
  • Consider wearing medical gloves to prepare food, rubber gloves for household chores, gardening gloves for outdoor tasks.

For leg lymphedema

  • Protect your feet and nails.  Do not cut cuticles.
  • Inform your pedicurist that you are at risk for lymphedema and that equipment must be properly sanitized.
  • Avoid walking barefoot, and wear closed, well-fitting shoes and comfortable hosiery.

Lymphedema compression bandaging (LCB)

Multi-layer compression bandaging is the application of multiple layers that include protective covering, soft padding, and compression bandages.    Various compression bandaging systems are available.  LCB aids muscles in stimulating lymph flow and prevents re-accumulation of swelling. LCB can be worn 24 hours a day.  LCB is applied by trained therapists, and those with lymphedema should be taught how to bandage themselves.

Manual lymph drainage (MLD)

Manual lymph drainage (MLD) is a specific, gentle massage that stimulates lymph flow and redirects the lymph fluid to areas of the body where the lymphatic system is functioning. Special techniques help to break down hardened tissue. Those with lymphedema can be taught self lymphatic drainage (SLD) techniques by a trained therapist.

Exercises / movement / deep breathing

If starting a new or returning to a former exercise program, follow the exercise guidelines set up in the pamphlet. Exercise, deep breathing and movement stimulate lymphatic flow.  Mobility and activity are encouraged to maintain normal functioning during decongestive therapy and after.  General exercise helps build strength, maintain joint mobility, promote healthy body weight, increase fitness and prevent injury.  In general be as active as you can.

Other Treatments

Pneumatic pumps

Pneumatic pumps are sometimes used to treat lymphedema; however, they have the potential complication of pushing fluid upwards and causing swelling and hardened tissue above the treated area.

Pumps are best used in conjunction with DLT and under the guidance of your therapist.

Diuretics

Diuretics are generally not recommended for the treatment of lymphedema because they remove water and increase the buildup of protein which can harden tissues and increase inflammation.  However, you should remain on this medication if it is given for another health condition. Please discuss any questions with your doctor.

Maintenance and self-management

Once lymphedema is stabilized through DLT (usually 2 or more weeks) your therapist will help your transition to self-management which includes ongoing skin care and the following components.

Compression garments

Compression garments stabilize swelling and are an essential part of long-term treatment. Garments must be prescribed by a doctor and fitted by a trained measurer. They can be off the shelf or custom-made, but they must fit properly. Compression garments are worn during the day, especially during times of high activity, and removed at night. A variety of other non-elastic compression products are available for night use.  When waiting for a new compression garment to be delivered, it is recommended that you keep your lymphedema stable with self-bandaging.

Body Weight

Maintain a normal body weight as being overweight is associated with increased severity of lymphedema symptoms.  To date, there are no special dietary recommendations for lymphedema.  Try to eat a balanced diet.

Self-bandaging

In some cases, to maintain treatment results, the therapist will advise and teach self-bandaging.

Self-massage

Consult your therapist for instructions on self-massage techniques.

Self-measuring

Self-measuring is a quick and easy way to monitor a lymphedematous limb.  Measure once a month if your lymphedema is stable, and more frequently if it is variable.  Keep a record of your measures.  If you limb becomes more swollen and self-bandaging does not control the increase, consult your therapist.

Exercise guideline

  • Begin or return to any exercise program with the approval of your physician and/or therapist.
  • While studies have shown the benefits of exercise, everyone is different.  Listen to your body and rest when necessary.
  • Measure your limb once a month or before starting any new exercise activity.
  • According to research it is advisable to wear compression garments while exercising.
  • Whether starting a new physical activity or returning to a previous exercise program, progress slowly, at your own pace and monitor carefully for changes in swelling.
  • Swimming, water exercises, walking, gentle cycling, dance and light aerobics are all beneficial activities for general health.  Such activities are also encouraged during and after cancer treatments.
  • Resistance exercises can begin once your therapist has defined your lymphedema as stable.  Progress gradually with low weights and low repetitions; if possible, seek guidance from a trained professional.

Air travel recommendations

There is little research to determine whether lymphedema can be caused or aggravated by air travel.  Nonetheless, experts advise wearing well-fitted compression garments and moving the affected limb as much as possible on flights.

 Other recommendations

  • If possible, avoid needle sticks, injections, blood tests and vaccinations on the affected arm.
  • When possible, infusion lines and Port-a-caths should be on the non-affected side.
  • For arm lymphedema, wear a well-fitted bra with wide, soft shoulder straps and evenly-distributed support, avoiding underwire.  Avoid wearing tight jewelry or watches.
  • For leg lymphedema, wear comfortable socks, stockings and undergarments without tight elastic bands.
  • Avoid prolonged exposure to high heat such as hot tubs and saunas.
  • If possible, avoid staying in one position for too long.