Physical Therapy for Lymphedema - The Nebraska Medical Center

Uploaded by NebraskaMedCenter on 17.09.2010

The great thing about what we do is that it does work. You don’t have to be the right
kind of person, the right ethnicity, the right size or gender. It works on everyone, as long
as you show up and are diligent with being compliant with your care.
Sometimes it’s a genetic link; patients are born with fewer lymph nodes than the average
person. And because of that, their lymphatic system is not able to keep up with just the
daily demand of fluid that flows through that system. Sometimes it’s also obesity; people
that are very heavy tend to put pressure on the lymph nodes, usually in the groin. And
because of that pressure on them, they’re not able to work as well as they should, because
if that fluid accumulates over time, then people are left with swelling.
On the flip side of that, there’s also secondary Lymphedema and that’s secondary to a trauma
that we know of, such as radiation or lymph-node removal (some sort of disruption of a lymphatic
system). In that case, patients generally know why they have the Lymphedema, but they
still don’t understand the process and the treatment.
In physical therapy, we kind of have two goals. One is to reduce the size of the limb; the
arm or the leg, or even the head and trunk. The second part is to improve function; whether
that’s range of motion or strength or mobility. And they kind of go hand in hand. But once
we’ve reduced the limb, then we work also in stretching, range of motion, strengthening
exercises, gate training, so that the person can be as functional as possible.
Our treatment for Lymphedema basically consists of four parts. The first part is one of the
most important; it’s manual lymphatic drainage. People call this a massage, although it’s
not technically a massage; it’s actually re-routing the fluid from the damaged area
to a healthy area that can handle the fluid and eliminate it out of the body. That’s
the biggest part of it and that part is very relaxing, it consists for about 75 percent
of our treatment time in the clinic. The second component is wrapping; we wrap the extremity
with a short stretch bandage. They kind of look like an Ace wrap. However an Ace wrap
has a really long stretch to it and what we wrap with is a short stretch bandage. We wrap
up the extremity with that and as the extremity tries to swell, the short stretch bandage
stops the swelling. The third component would be skin care and education. That’s a big
part of our treatment also, because Lymphedema does not go away; we have no cure for it.
We simply can manage it. So educating a person or a patient on how to manage the condition
for the rest of their life is a very important part. The final component is exercise; we
want a person to be active in their wraps and therefore have a muscle pump going on
along with the compression to help and reduction. The other thing that I like is that there’s
no drugs and no surgery; it’s a hands-on manual technique. But it’s not as easy as
it sounds either; you do have to be diligent with your care and you have to come in for
therapy consistently. If I just saw a patient once a week or once every couple of weeks,
the swelling would come back again. So it’s something during the reduction phase, we really
have to be consistent with treatment and patients have to make a commitment to come in for their
therapy appointments.
Generally we see a patient three times a week, and that can be anywhere from four weeks to
12 weeks to even more in severe cases.
That’s the best part of my job; we get such great patient reactions. The other great thing
is that people usually start seeing a difference within the first treatment or the first week
and it really motivates them. My very first Lymphedema patient came to me after about
two weeks of treatment and said, “Deana, for the first time in 10 years I can get my
own leg into bed. I used to have to call my son to help me get into bed and I can do it
myself.” And that was really rewarding for me as a therapist and for her too. It also
motivated her to continue losing weight elsewhere in her body too and just become more functional
and more mobile. The other great thing is lots of times this spurs a patient to lose
weight. Just in general, they’re more mobile, they’re able to do things better and it
just kind of starts motivating them. And I have two patients right now that have lost
about 75 pounds since starting therapy in a couple months, a couple two or three months.
A lot of that’s fluid, but a lot of that is just being more active and losing weight
all around. So it’s great.