Lymphoedema is a chronic condition characterised by localised fluid retention and tissue swelling caused by a compromised lymphatic system. When the lymphatic system is compromised, due to a blockage or damage, including lymph node dissection surgery, lymph fluid cannot be effectively removed from a region or limb and therefore accumulates and can subsequently cause long‑term swelling.
How Does Lymphoedema Occur?
Inherited (genetic)
Lymph node dissection
Other surgery
Radiation therapy
Accidents or diseases that inhibit the lymphatic system from functioning
Symptoms
Swelling
Feeling of heaviness
Soreness in affected area
Skin changes
Clothing or jewellery may feel tighter
Grading
Grade 1: Mostly pitting oedema; spontaneously reversible with elevation
Grade 2: Mostly non-pitting oedema; non-spontaneously reversible with elevation
Grade 3: Gross increase in volume of Grade 2 lymphoedema; eight stages of severity
Staging
Stage 0: Lymphatic vessels have sustained some damage that is not yet apparent; transport capacity is sufficient; lymphoedema not present
Stage 1: Swelling increases during the day and disappears overnight with limb elevation; tissue still at the pitting stage; treatment not yet required
Stage 2: Swelling is not reversible overnight and only reduces with proper management; spongy tissue consistency; oedema considered non-pitting; fibrosis at this stage marks the beginning of hardening of the limbs and increasing size
Stage 3: Swelling is irreversible; tissue is fibrotic and unresponsive
Stage 4: Size and circumference of limbs become increasingly large; knobs (bumps, lumps and protrusions) begin to appear
Stage 5: The affected limb becomes grossly large; one or more deep skin folds present
Stage 6: Knobs cluster together; mobility of the patient becomes increasingly difficult
Stage 7: Patient is unable to independently mobilise and perform activities of daily living
Physiotherapy Management
Unfortunately, lymphoedema cannot be prevented or cured. Symptom management via Physiotherapy can help to reduce the uncomfortable effects.
Goals of Lymphoedema Physiotherapy
Increased range of motion/flexibility
Decreased swelling
Decreased pain
Increased strength
Restore function and improve the quality of life
Techniques Used by Physiotherapists to Manage Lymphoedema
Complete decongestive therapy: Manual manipulation of lymphatic ducts + short-stretch compression bandaging + therapeutic bandaging + skin care
Compression garments: Measured to fit; inelastic to contain and reduce oedema
Compressive bandaging: During movement, enhance pumping action of the lymph vessels; encourage lymphatic flow
Intermittent pneumatic compression therapy: Multi-chambered pneumatic sleeve promotes movement of lymph fluid
Low-level laser therapy: Theories suggest that laser therapy can potentially decrease fibrosis; stimulate macrophages and the immune system; and a possible role in encouraging lymphangiogenesis
Exercise: Resistance and other types of exercise, usually in conjunction with wearing compression garments; appropriate assessment is required prior to commencing an exercise program
Other Treatment Techniques
Skin care: Due to the compromised lymphatic system, there is an increased risk of infection and delayed healing. Taking care with risky tasks such as gardening, cooking and shaving is important. Should cuts and grazes occur, cleanse the area and apply clean dressings until the wound has healed
Various surgical techniques
If you have been diagnosed with, or are at risk of developing lymphoedema, book an appointment with one of our Physiotherapists for an assessment and appropriate management.