Physical Therapy for Lymphedema

Lymphedema is a disease marked by swelling in the arms or legs. It’s caused by fluid retention and triggered by blockage of lymph vessels, which drain fluid from throughout the body. Lymphedema, also called lymphatic obstruction, compromises the lymphatic system, a crucial part of the immune and circulatory systems.

The removal or enlargement of the lymph nodes sometimes leads to lymphedema. It often develops after removal of the breast (mastectomy) and underarm lymph tissue due to breast cancer. This surgical treatment will lead to lymphedema of the arm in 10 to 15 percent of patients. Indeed, lymphedema is the most common complication after breast cancer treatment, sometimes developing years later.

Other causes include:

  • Injury
  • Radiation therapy
  • Skin infections
  • Tumors
  • Infections with parasites

Lymphedema may also cause severe fatigue, and a discoloration of the skin. Severity varies from very mild complications to a painful, disfiguring and disabling condition.

Physicians consider lymphedema a chronic disease requiring lifelong management, usually on a daily basis. Patients may control symptoms with special compression garments that fit tightly on the area affected. However, there is no cure. It occasionally improves with time, but swelling rarely disappears completely.

Lymphedema Treatment with Physical Therapy

A physical therapist treats lymphedema by first reviewing the patient’s medical history and performing a thorough physical examination including:

  • An analysis of the patient’s current and ideal weight
  • Measurements of the arms and legs
  • An assessment of the ability to do activities of daily living
  • Reviewing the patient’s history of swelling, previous radiation therapy and surgery

With this information, a physical therapist designs a treatment program.

In the early stages of lymphedema, when the swelling is mild, the disease can often be managed by compression garments, exercise, and elevation of the affected limb to encourage lymph flow. For more severe swelling, the physical therapist may use a treatment called "complete decongestive therapy." This treatment includes manual lymphatic drainage, which resembles a light form of massage and helps improve the flow of lymph fluid from the arm or leg. It is followed by compression bandaging to reduce the swelling. The therapist carefully monitors the size of the affected limb throughout the course of treatment.

Once the swelling has decreased, the therapist helps the patient take over his or her own care by:

  • Developing an exercise program that will increase physical fitness. The goal is to encourage movement of the lymph fluid without exhausting the affected limb.
  • Monitoring compression garments to ensure proper fit as swelling subsides.
  • Education about proper diet to decrease fluid buildup in tissues and about skin care to reduce the risk of infection.

Surgery is used in limited cases, and must be followed by physical therapy to reduce complications and to ensure a healthy and complete recovery.