Section written by: Dr.Sminu Shah, OncoPhysiotherapist. Contact : firstname.lastname@example.org
Treatment options for Lymphedema
We have a Management and not a complete cure for LE. Depending on the stage and nature of the Lymphedema. the options are enumerated as follows and are described below in detail:
Manual Lymphatic Drainage
Self lymphatic Drainage
Intermittent Pneumatic Compression Machine
Multiple Layer Lymphatic Bandaging
Exercises need to be started from Day 1 postoperative and need to be continued regularly. Except for the patients that have undergone Plastic surgery they need to start exercises from day 5 or with Surgeon’s approval. Exercises includes initially free Range of motion exercises, Walking, Deep breathing exercises gradually start with Theraband exercise, Stretching, Strengthening exercise (Resistance training), Aerobic Training. Exercises are given tailor-made by therapist to the patient as per their symptoms/surgeries.
Manual Lymphatic Drainage (MLD)
MLD is gentle massage technique practiced by a skilled lymphedema practitioner in an Intensive Decongestive therapy. It works by encouraging the fluid away from the congested area by increasing the activity of normal lymphatic system and bypassing ineffective or obliterated lymph vessels. MLD as a single treatment is insufficient, it should be combined with MLLB to support and maintain its effects, if tolerated well.
Self Lymphatic Drainage (SLD)
- It is a simple drainage method taught by a specialized lymphedema practitioner to the patient to practice daily with Deep breathing exercises for approximately 15-20minutes.
Intermittent Pneumatic Compression Machine (IPC)
IPC machine is an electrical pump attached to an inflatable plastic garment that is fixed over the affected limb. The garment works in a rhythmic manner of inflation and deflation cyclically for a set period, time duration and pressure. It may be a single –to- multiple chambers that gets inflated sequentially to provide a peristaltic massaging effect directing from peripheries towards root.
The most essential factor is to combine/follow the IPC treatment with the compression sleeve or Multilayer lymphatic Bandaging to prevent rapid rebound swelling.
Careful surveillance is required to ensure that the correct technique and pressures are applied.
Multi Layer Lymphatic Bandaging (MLLB)
It is the key element of Intensive regimen therapy. MLLB works on the principle of High working pressure, low resting pressure by using inelastic bandages. By this they raise the peak pressure that produces massaging effect and stimulate lymph flow.
It is another key factor of the regimen. It is to be practiced in combination with IPC/ MLD/ MLLB. It acts as a catalyst in reducing edema from the limbs.
It falls into the management part post intensive therapy regimen of LE. Sometimes it can be used as a prophylaxis or as a part of initial treatment. The garment pressure may vary from 20-25 mm of hg pressure to 40-45 mm of hg pressure depending on the type and severity of swelling. Number of layers/ pressure to be given to the patient varies from person to person.
Do I need to main it lifetime?
Post CDT or Post Operatively patient needs to continue with the exercise lifelong. For IPC/MLD it is not necessary to be continued. But use of Compression Sleeve in Daytime and MLLB in night time is must, unless the therapist advices to discontinue