Lymphedema poses many challenges to providers and patients alike. Often times, specialists like vascular surgeons receive referrals for patients diagnosed with lymphedema, and there is little they can do surgically to reverse lymphedema.
For patients, a diagnosis of lymphedema may cause feelings of despair and worry, since it can lead to swollen limbs and, if it continues to progress, deformities. It can also be challenging for healthcare providers to determine the most effective treatment approach, since little available evidence currently exists on the subject.
The physical complications of lymphedema can include DVT (deep vein thrombosis), cellulitis, amputation, and functional impairments. The psychosocial impairments can be lasting and debilitating as well [1]. Luckily, conservative therapeutic techniques backed by current evidence offer hope to many individuals facing this diagnosis.
Answers from the Research
Well, since we’re talking about evidence-backed treatment options, let’s explore what the research has to say on the topic of lymphedema and treating it. According to recently published studies, physical/occupational therapy can be an effective treatment option to address the symptoms that come as a result of lymphedema.
Take this quote from a 2018 article: “Complete Decongestive Physiotherapy is the mosteffective treatment as it reduces the symptoms of lymphedema and improves patients’ functionality, mobility, and quality of life.” [3] So it seems that research would support having your doctor send over a referral to PT/OT, if you’ve been diagnosed with lymphedema. Let’s look at a couple common questions about what treatment may look like and how it can help.
What does conservative management of lymphedema involve?
Conservative management includes manual lymph drainage, exercise, compression bandaging, skin care, pneumatic compression, extremity elevation, taping, aquatic lymphatic therapy, and thermal therapy. That’s a lot of techniques that could be appropriate, depending on a specific situation. According to research a combination of these conservative treatment options can cause a 45-70% reduction in lymph volume [3]. That’s a wide range, but it also shows the potential effects of treatment.
Complete Decongestive Therapy (DCT) involves manual lymphatic drainage and compression performed by an experienced Occupational or Physical therapist. A pilot study measured fluid shifts before, after, and during CDT with results showing increased fluid mobilization and decreased limb volume after just 1 week of CDT [1]. Basically, this type of treatment involves manual therapy and then compression, either via bandages or compression garments. In fact, after talking to a colleague of mine from NBCOT, who is a certified lymphedema specialist, compression tends to be one of the most beneficial treatment options to manage the day-to-day edema.
How can Physical Therapy and Occupational Therapy help?
While it might seem counterintuitive, participating in a supervised therapeutic exercise program provides multiple benefits for patients experiencing lymphedema, In fact, research shows that exercise enhances physical and emotional well-being and improves health-related quality of life (QoL) outcomes for patients with lymphedema [2]. As we’ve mentioned about here, there’s always more to managing any diagnosis than just the physical or biological symptoms. Humans are complex creatures, and we need to address not only the physical, but also the other aspects of health and well-being.
Additionally, a crucial portion of lymphedema treatment involves educating patients on self-care and home management to prevent further complications. As we say in our manifesto, our goal is to be a healthcare guide, not a crutch. That means giving patients the tools to manage their symptoms and diagnosis on their own. It turns out that the research supports this approach. Research shows that Physical and Occupational therapy services improve the Quality of Life (QoL) and overall well being of patients with lymphedema by reducing symptoms and improving function, mobility, and quality of life [3].
Summary
Lymphedema can cause pain, swelling, and deformity of the affected limbs. This often leads to complications, both physically as well as emotionally/socially. It also poses challenges to the clinicians trying to help their patients who have been diagnosed with this disease. There is, however, research that supports physical and occupational therapy treatment to both improve the symptoms of lymphedema as well as providing the tools and strategies for patients to self-mange the disease on their own.
References
1] Brix, B., Apich, G., Rössler, A., Walbrodt, S., & Goswami, N. (2021). Effects of physical therapy on hyaluronan clearance and volume regulating hormones in lower limb lymphedema patients: A pilot study. Science progress, 104(1), 36850421998485. https://doi.org/10.1177/0036850421998485
[2] Do, J. H., Kim, W., Cho, Y. K., Lee, J., Song, E. J., Chun, Y. M., & Jeon, J. Y. (2015). EFFECTS OF RESISTANCE EXERCISES AND COMPLEX DECONGESTIVE THERAPY ON ARM FUNCTION AND MUSCULAR STRENGTH IN BREAST CANCER RELATED LYMPHEDEMA. Lymphology, 48(4), 184–196.
[3] Tzani, I., Tsichlaki, M., Zerva, E., Papathanasiou, G., & Dimakakos, E. (2018). Physiotherapeutic rehabilitation of lymphedema: state-of-the-art. Lymphology, 51(1), 1–12.
