From the Guidelines
The best way to manage lymphedema of the lower extremities is through a comprehensive approach that includes compression therapy with a minimum pressure of 20 to 30 mm Hg, manual lymphatic drainage, meticulous skin care, and targeted exercises to promote lymph drainage. This approach is supported by recent studies, such as the one published in the Journal of the American College of Radiology in 2023 1, which highlights the importance of compression therapy in reducing venous stasis and improving lymphatic drainage. The study recommends the use of compression bandages or garments with a pressure of 20 to 30 mm Hg for mild to moderate disease, and 30 to 40 mm Hg for more severe disease.
Key components of lymphedema management include:
- Compression therapy using multi-layer bandaging or compression garments
- Manual lymphatic drainage massage to stimulate lymph flow
- Meticulous skin care to prevent infections
- Targeted exercises to promote lymph drainage
- Elevation of the legs when possible to reduce swelling
- Maintenance of a healthy weight, as obesity can worsen lymphedema
Other studies, such as the one published in the Journal of Clinical Oncology in 2018 1, also support the use of manual lymphatic drainage, compression bandaging, and low-level laser therapy in improving lymphedema. Additionally, a systematic review published in Ca-A Cancer Journal for Clinicians in 2021 1 recommends referral to a lymphedema specialist for multimodality treatments, including manual lymphatic drainage, exercise, and compression therapy.
It is essential to note that while lymphedema cannot be cured, consistent management can significantly reduce swelling, prevent complications, and improve quality of life. Therefore, a comprehensive approach that incorporates compression therapy, manual lymphatic drainage, and other supportive measures is the most effective way to manage lymphedema of the lower extremities, as supported by the most recent and highest quality study available 1.
From the Research
Management of Lymphedema
The management of lymphedema of the lower extremities involves several components, including:
- Risk reduction
- Early detection
- Phase-I Complete Decongestive Therapy in a clinical setting
- Phase-II Self Management at home 2 Phase-I therapy includes:
- Manual lymphatic drainage (MLD)
- Short-stretch compression bandaging
- Decongestive exercise
- Skin care
- Sometimes intermittent pneumatic compression (IPC) 2
Treatment Components
Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual component has not been determined 3. CDT includes:
- Manual lymphatic drainage
- Compression bandaging
- Decongestive exercises
- Skin care The use of an advanced programmable IPC device for lymphedema treatment may support successful home management by addressing some of the home treatment barriers 2.
Comparison of Treatment Regimens
A study compared the reduction in edema volume achieved by compression bandaging and physical exercises vs. the same management augmented by an additional 30 minutes of MLD (Vodder II method) 4. The results showed that both groups had a significant decrease in limb volume and edema volume, and the improvement remained constant after six months of maintenance therapy. Another study assessed whether the treatment with intermittent pneumatic compression plus multilayer bandages is not inferior to classical trimodal therapy with manual lymphatic drainage in the decongestive lymphedema treatment 5. The results showed that all patients improved after treatment, and the global mean of percentage reduction in excess volume was 63.9%, without significant differences between the groups.
Physiotherapeutic Rehabilitation
Physiotherapeutic rehabilitation of lymphedema includes several approaches, such as:
- Manual lymphatic drainage
- Lymphedema rehabilitation exercises
- Compression therapy
- Skin care
- Pneumatic compression
- Elevation of the extremities
- Thermal therapy
- Complete decongestive physiotherapy (CDT)
- Taping
- Aqua lymphatic therapy 6 Treatment of lymphedema with CDT can achieve a 45-70% reduction in lymphedema volume 6. Prerequisites for successful physiotherapy are the availability of physicians, nurses, and therapists who are specifically trained, educated, and experienced in each method 6.