The Complete Decongestive Physical Therapy program at The Farnum Rehabilitation Center is an intensive, comprehensive program designed to evaluate and treat lymphedema while educating patients, families and physicians how to manage this condition long term.
Since lymphedema is a chronic, generally incurable condition, careful management is essential to minimize potential health risks, i.e.: infections and a worsening of the edema and trophic changes to the skin.
What is Lymphedema?
How Does Lymphedema Occur?
Complex Decongestive Therapy
Factors That Contribute to Lymphedema
Avoiding or Minimizing Lymphedema
Warning Signs for Those At Risk
For More Information
Lymphedema is a swelling of a body part from an accumulation of fluids and proteins just under the skin. This occurs whenever lymphatic vessels are absent, under-developed or obstructed and cannot handle their function of absorption and transport of excess fluid and cellular by-products.
The condition can be embarrassing, cause difficulty with dressing, decrease mobility, cause discomfort and repeated episodes of infection that can worsen the lymphedema and sometimes require hospitalization.
Some individuals are born with an inadequate lymph vascular system. Edema may present as early as birth, and as late as midlife. This is a known as primary lymphedema.
Secondary lymphedema may occur after a severe trauma and most commonly after treatment of cancer. When the normal flow of tissue fluid and proteins is blocked by scar tissue, damaged or removed vessels and nodes, and if alternate pathways are not available or found, lymphedema develops. Lymphedema may also occur as a result of chronic venous diseases, which always involve the large lymphatic vessels running beside the veins.
Decongestive Therapy Participants must have a physician’s referral to Physical Therapy. Patients will be evaluated by a licensed Physical Therapist and treated by a certified Lymphedema Therapist. The first phase of therapy is aimed at decreasing the edema. Treatments (15 – 20) include:
- Manual Lymph Drainage – a method of massage which opens lymphatics to remove fluid and proteins from congested tissues.
- Compression Therapy – Precise bandaging prevents refilling of tissues and enhances the muscle pump action to continue drainage. Later, elastic stockings/sleeves are worn during the day.
- Exercises and DEEP breathing – Muscle “pumping” moves lymphatic fluid, and improves venous return.
- Skin Care/Education – Careful hygiene and care can prevent infections which can worsen lymphedema.
The second phase, or maintenance phase, is done by patients at home. Exercises, breathing, sleeves/stockings, bandaging, and skin care are continued. Checkups and/or tune-ups may be needed to monitor and maintain progress.
- Combined surgery and radiation
- Trauma: (burns including sunburns, cuts, pet scratches, bruises, strains, insect or animal bites)
- Sedentary lifestyle
- Constrictive clothing or jewelry
- Extreme temperature exposures
- Heavy breast prosthesis
- Blood pressure cuffs
- Airplane or long car rides
- Recurrent tumor
- Avoid temperature extremes: (hot tubs, saunas, steam rooms, traveling in very hot or cold climates, burns including sun burns)
- Avoid infections caused by insect bites, hang nails, cuts, punctures, pet scratches, or gardening wounds – wear gloves and shoes.
- Avoid injury that can be caused from lifting heavy objects, participating in jarring sports, use of blood pressure cuffs, or wearing tight jewelry and clothing,
- Maintain balanced nutrition
- Maintain optimal weight.
- Exercise (walk, swim, light weight training).
- Treat cuts with antibiotic cream.
- Treat infections vigorously.
- Sleep with affected limb elevated.
- An infection in the ‘at risk’ area
- Pitting edema – press a finger against the swollen tissue. If this pressure causes and indentation that gradually goes away, pitting edema is present.
- An unexplained sensation of ‘pins and needles’. A feeling of heaviness in the ‘at risk’ area may occur before you notice swelling.
- A sensation of tightness of the skin as it is stretched by the swelling
- Changes such as a ring or bracelet that is too tight or a shoe that is suddenly too small.
- Aching in the adjacent shoulder or hip due to the increased weight of the affected limb
- Decreased mobility of a joint as increased size of a limb may decrease the ability of the joint to move properly
Lymphedema is a chronic, incurable condition that requires an ongoing effort to control. While the response to therapy may vary, Complete Decongestive Therapy (CDT) works best when started early. It requires determination, motivation and commitment to all phases of treatment to obtain the best results. Long term reduction of lymphedema improves an individual’s medical, physical and economic quality of life and improves comfort, appearance and function.
The Farnum Rehabilitation Center
The Cheshire Medical Center/Dartmouth-Hitchcock
580 Court Street
Keene, NH 03431