Complex lymphoedema therapy

Spending time understanding how the lymphatic system works and how it drains the normal tissue fluids and what happens if it is damaged can help you be more involved in your own care. Your therapist is your coach and guide, so teamwork will create the best working relationship. Appreciate the time taken with your lymphoedema therapist to educate you about your condition, and the assessment and management needed.

Psychosocial implications of lymphoedema

Living with lymphoedema may impact your emotions and coping ability. Talking to your therapist and linking into a support group or network may assist you in understanding your condition and being able to manage it more effectively.

A variety of psychosocial issues may arise following a diagnosis of lymphoedema. These range from adjusting to a chronic illness, to dealing with the day-to-day demands of self-management. This may have an impact on body image and quality of life. Depression and anxiety may result when there is a lack of support.

Your skin is the body tissue involved in chronic oedema. Any damage can make swelling worse, but well-nourished skin can better protect itself. This means growing good skin from inside by eating well and staying hydrated.

Protecting the skin on the outside is also important by covering up if at risk of bites, burns or scrapes and daily moisturising with a quality thick emollient skin cream.

Exercise is important for those at risk of or living with lymphoedema as it is safe, helpful and protective. Regular, moderate intensity, aerobic and resistance exercise is highly recommended.

ICG lymphography imaging has shown that firmer, slower pressures in specific directions during MLD massage can move fluid within an area of lymphatic congestion. An ICG can guide your therapist to drain your limb the way it drains best. This means a personalised MLD plan can be devised based on how your lymphatic system is working and can be used in combination with other strategies.

The most effective strategy to keep the tissue fluid moving and keep the swelling well controlled is using compression therapy. This can be a bandaging program to reduce swelling in the initial treatment phase or compression sleeves, stockings or other garments in the long-term maintenance phase.

Another form of compression could be a Velcro strap wrap garment that allows adjustment and can be easier to put on or take off than standard compression garments. Textured garments can be used overnight or intermittently by day to soften oedema areas.

Compression garments provide graduated compression and are available in a variety of styles, sizes, colours and grades of compression (class 1-IV). Severe swelling usually requires stronger support than mild swelling.

Lymphoedema therapists are skilled at garment prescription and can advise on garment style and whether a pre-sized (ready to wear) garment or a custom made garment is required. Garment fabric may be constructed as a circular knit or a flat knit design. Most commonly garments are worn during the day and removed at night. Compression garments need to be replaced regularly in order to provide optimal support. Some people with mild lymphoedema may not require compression garments.

1. The Diagnosis and Treatment of Peripheral Lymphoedema: 2009 Consensus Document of the International Society of Lymphology. Lymphology 42 (2009) 51-60.

2. SRJ, Thiadens, PJ Stewart, NL Strout. (2010) 100 Questions and Answers about Lymphoedema. Jones and Bartlett Sudbury Massachusetts.

3. National Breast and Ovarian Cancer Centre. Review of research evidence on secondary lymphoedema: Incidence, prevention, risk factors and treatment, NBOCC, Surry Hills, NSW, 2008. Document can be downloaded from here.

4. Lymphoedema Framework: Best Practice for the Management of Lymphoedema. International Consensus. London: MEP Ltd, 2006.

5. International Lymphoedema Framework. Best practice for the management of lymphoedema 2nd edition: Surgical Intervention – A position document on surgery for lymphoedema. 2016. Document can be downloaded here.