From the Guidelines
Lower limb (LL) lymphedema treatment options include manual lymphatic drainage, compression bandaging, and low-level laser therapy, with the choice of therapy depending on patient sensitivity and preferences, as evidenced by recent studies 1. When considering treatment for LL lymphedema, it's essential to evaluate the patient's overall condition and medical history to determine the most suitable approach.
- Diagnostic evaluations, such as lymphoscintigraphy, duplex ultrasound, MRI or CT lymphangiography, and indocyanine green (ICG) lymphography, can help assess the severity of lymphedema and guide treatment decisions.
- The International Society of Lymphology (ISL) classification system is used to stage lymphedema, ranging from Stage 0 (subclinical) to Stage III (elephantiasis), which aids in determining the appropriate treatment plan.
- Treatment options, including compression therapy, manual lymphatic drainage, exercise programs, and surgical interventions, should be tailored to the individual patient's needs and preferences, taking into account potential allergies or discomfort with certain therapies, as noted in studies 1.
- Manual lymphatic drainage and compression bandaging are considered equivalent therapies for lymphedema, with the choice between them depending on patient sensitivity to bandaging 1.
- Low-level laser therapy is also a viable option for improving lymphedema, particularly for patients who cannot tolerate compression bandaging due to allergies or discomfort, as suggested by research 1.
From the Research
Lymphedema Treatment Components
- The standard of care for lymphedema encompasses risk reduction, early detection, Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home 2
- Phase-I therapy includes manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC) 2
- Home management includes many of the same elements, with adaptations for home treatment, and the use of an advanced programmable IPC device may support successful home management 2
Management of Lymphedema
- The basic principle of the management of lymphedema is complex decongestive physical therapy, divided into two phases: edema reduction phase and maintenance phase 3
- The first phase consists of manual lymph drainage, pneumatic pump drainage, low-stretch bandaging, exercises, and skin care, while the long-term maintenance phase consists of self-lymph drainage, low-stretch bandaging, or compressive garments, and sometimes pneumatic pump drainage, exercises, and skin care 3
Collaborative Lymphoedema Management
- Conservative treatment of lymphoedema in palliative care involves complete/complex decongestive therapy (CDT) using manual lymphatic drainage (MLD), compression therapy, skincare, and remedial exercises, adapted to the needs of the patient 4
- A collaborative clinical protocol can improve access to lymphoedema management for patients, and develop an effective partnership approach to lymphoedema management between local district nursing services and the specialist lymphoedema physiotherapist 4
Complete Decongestive Therapy
- Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual CDT component has not been determined 5
- CDT can achieve a 45-70% reduction in lymphedema volume, and is the most effective treatment as it reduces the symptoms of lymphedema and improves patients' functionality, mobility, and quality of life 6
Physiotherapeutic Rehabilitation of Lymphedema
- Approaches for conservative management of lymphedema include manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care, pneumatic compression, elevation of the extremities, thermal therapy, complete decongestive physiotherapy (CDT), taping, and aqua lymphatic therapy 6
- Prerequisites for successful physiotherapy are the availability of physicians, nurses and therapists who are specifically trained, educated, and experienced in each method 6