Treatment for Lymphedema
The primary treatment for lymphedema is complex decongestive therapy (CDT), which consists of manual lymphatic drainage, compression therapy, exercise, and skin care, with immediate referral to a specialized lymphedema therapist being essential for optimal outcomes. 1, 2
Initial Management Algorithm
Immediate referral is critical when patients present with clinical symptoms or swelling suggestive of lymphedema. Refer to:
- Physical therapists with lymphedema certification 1, 2
- Occupational therapists with lymphedema training 1, 2
- Certified lymphedema specialists 1, 2
Delayed treatment leads to disease progression and increased complications, making early intervention paramount. 1
Two-Phase Treatment Approach
Phase 1: Intensive Reduction Phase (Initial 2 Weeks)
The goal is aggressive volume reduction through:
Compression bandaging is the most critical component—lymphedema cannot achieve sustained improvement without it. 3 Use multi-layer inelastic bandaging with:
Manual lymphatic drainage (MLD) is recommended as first-line therapy (Grade C evidence) to stimulate lymph flow. 1 However, recent high-quality evidence shows that compression bandaging alone may achieve equivalent results to CDT with MLD, making MLD optional rather than mandatory. 4 MLD is particularly beneficial for patients with sensitivity or allergies to compression bandaging. 1, 5
Exercise and skin care must be incorporated from the start. 1, 6
Phase 2: Maintenance Phase (Lifelong)
Following initial volume reduction, transition to:
- Elastic compression garments (stockings or sleeves) 3, 6
- Self-lymphatic drainage techniques 6
- Continued exercise program 1
- Meticulous skin care 1
Exercise Prescription
Supervised progressive resistance training is safe and potentially beneficial—contrary to historical advice about avoiding physical activity with the affected limb. 1, 2
- Target 150 minutes of moderate-intensity activity weekly 1
- Use compression garments during exercise if lymphedema is present 2
- Coordinate with lymphedema specialist 2
Adjunctive Therapies
Sequential pneumatic compression is reasonable for patients with moderate-to-severe lymphedema and significant edema. 5 The device increases arterial blood flow and enhances lymphatic drainage but requires several hours of daily use. 5
Low-level laser therapy can be considered for reducing arm volume and improving quality of life (Grade C evidence). 1
Weight Management
Weight loss is recommended for overweight or obese patients, as obesity is a significant risk factor for lymphedema development and exacerbates existing disease. 1, 2 Refer to a registered dietitian for counseling. 2
Infection Management
Prompt antibiotic treatment of infections is essential—erysipelas and lymphangitis are common complications that significantly worsen lymphedema. 1, 2, 3 Consider prophylactic antibiotics for recurrent infections. 7
Surgical Considerations
Microsurgical interventions should be considered when conservative treatment fails. 1, 2 Surgery is indicated earlier for:
Critical Pitfalls to Avoid
Do not use diuretics—they are physiologically unsound and generally ineffective for pure lymphedema management. 1, 7
Rule out arterial insufficiency before initiating compression therapy, as this is an absolute contraindication. 5
Do not delay treatment—lymphedema may be reversible or more effectively managed with early physiotherapy, but becomes progressively more difficult to treat over time. 2
Do not advise complete avoidance of physical activity—supervised resistance training is safe and beneficial. 1, 2