The Author

Joachim Zuther, Lymphedema Specialist. Read more
Lohmann Rauscher
MediUSA

Tactile Medical

Review of Currently Available Treatment Modalities for Lymphedema

Early diagnosis and intervention of lymphedema are crucial for optimal treatment results. Whether lymphedema is caused by developmental abnormalities (primary lymphedema), or surgery/radiation to the lymphatic system (secondary lymphedema), the possible long-term physical and psychosocial burden resulting from untreated or mistreated lymphedema can be serious.

Proper treatment is available, and the classification of lymphedema into primary and secondary has little significance in determining the method and goal of therapy. The goal of any treatment is to reduce the swelling and to maintain the reduction – that is to bring the lymphedema back to a normal, or near-normal size so the patients can continue with the activities of daily living, and to limit the risk of infection.

Therapeutic approaches to lymphedema vary depending on the severity of the swelling, the degree of fibrotic tissue present and the affected body part. They range from surgery and medication to numerous conservative treatments.

For a comprehensive discussion of currently available treatment options for lymphedema, I would like to refer to an excellent article published December 2008 in the Clinical Journal of Oncology Nursing, labeled “Demystifying Lymphedema: Development of the Lymphedema Putting Evidence into Practice Card”.

The authors (E.Poage, M.Singer, J.Armer, M.Poundall, M.Shellaberger) provide a comprehensive and critical review of the currently available literature in order to identify effective evidence-based treatment modalities for the treatment of lymphedema. This discussion also includes modalities without established effectiveness, and those ineffective in the management of lymphedema.

 

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46 comments to Review of Currently Available Treatment Modalities for Lymphedema

  • cm taylor

    my problem has not only been lack of treatment, but the unwillingness of my primary care physicians to get information so that they are not dealing with side effects in the dark. the one physician in the chicago area is in evanston and a first-time consultation is almost $400. i just discovered that illinois has an insurance program for the disabled who are working. i’m looking into that. my compression garment should be changed every 3-6 months. my average is 3 years at almost $1000 a pop. so, progress is a rollercoaster. i have, however, through research, learned how to manage it over the last 44 years – thank the Lord.

  • DM Showers

    I have primary lymphedema. I’m blessed to have insurance that pays for a trained therapist to do weekly leg massage. The compression garments I wear, I wear 24/7 (2 pair- one for wear, one drying). The lymphaic pump I’m supposed to use daily (2 hrs) only gets a 3 times a week workout. Still, with all of this, from Oct 09 til 09/27/10 I had 20% reduction in size. I hear that there is now a new ‘wave’ pump that is supposed to be even more effective. I find out about it the week of Oct. 6th. Anybody else ever heard of this?

    • Barb Marsallo, RT

      I’m a respiratiory therapist who specializes in compression therapy and I agree with Ron also. And this is why: flat nor circular weave compression garments should be worn at night as they decrease arterial blood flow and that will put you at high risk for blood clots, wounds and cellulitis. Wearing this type of compression lying down can also increase blood pressure and occular pressure. But,a Reidsleeve Classic with its pantented convoluted foam would be a terrific solution for nightime compression as this product increses arterial recoil which incresaes oxygenation in the effected limb or limbs, while breaking up fibrotic tissue and decreasing risk of blood clots and cellulitis. Wounds,infection and clots have a much harder time developing in an oxygen enriched environment.

      • Joachim Zuther

        I agree with you, Barb. However, there are other products similar to the one you mentioned – for example products manufactured by CircAid. A very effective and less expensive way to apply night time compression are padded short-stretch bandages. Therapists who underwent specialized training for lymphedema management are able to teach patients this effective modality.

  • D Bourgeois

    I am a therapist who is looking for studies or funding that could support intensive treatment for a client. She has elephantiasis in both legs (significantly greater than that of the patient pictured in blog). She has been treated by five or more therapists, one in residential setting. Conical shape of legs meant that wraps fell off within minutes of her standing. Several workers were needed to support limbs in wrap process. Who out there could help such a person get enough reduction to then benefit from standard MLD/CDT? Funding her treatment would be an issue.

  • paula

    I am not sure what your current pump is.
    If you are referring to flexi touch- by tactile systems, it does a very good job. Medicare will cover therefore many other insurances will too. Worth a look.

    • Joachim Zuther

      Dear Paula:

      I would like to add that pneumatic compression pumps should never be used without Complete Decongestive Therapy in phase I of the treatment for lymphedema. The use of these devices to decongest lymphedema without the application of Manual Lymph Drainage has shown to cause serious side effects.

  • Ron Carson, MHS, OT

    Garment manufacturers that I use recommend not wearing garments at night while sleeping.

  • Joachim Zuther

    Dear DM Showers:

    I agree with Ron’s comment in reference to wearing compression garments at night. I would also like to refer you to page 10 of the article I linked to in this post on more information about the use of pneumatic compression pumps. These devices should not be used as a stand-alone therapy in case of lymphedema.

  • I am greatful for my training in lymphatic massage! I have found it very helpful to my patients as well as family members.

  • To D Bourgeois re: your client… Sounds like she is not being bandaged correctly. Narrower parts of the limb need to be bulked out w/ foam. If her ankles and lower legs are narrower than the upper leg, the lower leg needs to be padded out so you have as even a cylinder as possible. It is difficult to keep bandages up on a very large leg – lots of tape &/or wearing biking shorts or other lycra garments over the bandages can help.

    It can be done. I’ve worked on people w/ huge legs, not easy, but possible.

    I’m in the Metro DC area.

    – Jill BS, CLT

  • walter floyd

    i caint find enough people in shreveport,la. who know anything about this condition my problem is only in my upper right thigh area

  • Lisa W

    I have lymphedema and struggle top keep it under control. Has anyone read or heard anything about Lymph node transplants?

  • Lesley E.

    For Walter Floyd- I too, had a hard time finding a proper therapist for lymphadema treatment. I found that asking the therapist or your primary care physician, if they know the “Vodder Technique”, If not, find a therapist that does, it’s a massage that is specifically for lymphadema, primary or secondary. The therapist should teach you also how to do it yourself, like mine did. I manage on my own now.

    To CM Taylor- I too, have to change/order new compression garments every 6 mos., I buy them about once a year though. But, there is a company out of Chicago, that I order them from and they charge $200 each, for a leg garment. The company is called Luna Medical Inc, you do need a prescription from your doctor/therapist and measurements taken, and sent in. I hope this helps.

  • I’ve send this page to my fb friends. Keep this good work 🙂

  • last few days our class held a similar talk on this subject and you point out something we haven’t covered yet, thanks.

    – Laura

  • kathy

    Does anyone have any idea on what to do with swollen feet, the legs are not affected, just the dorsom of the feet?

  • kathy

    She has done the obvious and has endured many vascular tests to find no answer. She has responded well to wraps but the question is how much compression is appropriate when it is only her feet that are swollen.

    • Joachim Zuther

      Hi Kathy:
      The level of compression depends on many factors, such as possible comorbidities, age, mobility, etc. However, the basic parameters for compression remain the same, even if only the dorsum of the foot is affected by the swelling

    • Jacqueline Wiley, DPT, MSPT, CLT

      I recently had a patient with stubborn lymphedema on the dorsal surface of his bilateral feet. I added toe compression wraps to the compression bandages I was using on his feet and legs. It worked like a miracle to reduce the dorsal foot lymphedema.

  • CARRIE

    Can anyone tell me where to purchase a 50mm gel-filled squeeze ball for decongestive exercises? Thank you

  • kathy

    This 50y/o has no comorbidities, weighs about 120 lbs.,5ft5in. My concern is the 30-40mmHg will be too tight on her very thin ankles. I was possibly thinking about the Farrow toe caps with a lighter compression for the leg, perhaps 20-30mmHg. Has anyone tried the toe wraps?I guess the question is, can stockings do more damage if the proper compression is not recommended? She also enjoys walking every day after work and is frustrated she cannot enjoy fitting into regular shoes.

    • Best thing would be for her to get **custom made** stockings. She should see someone who is a properly trained fitter to take her measurements. The company, such as Juzo, will make garments to her specific measurements. This should prevent too much compression where it is not needed.

      Farrow wraps are a good night time alternative.

      Good luck.

  • Julie

    For all you out there who are interested, I thought I’d share my history of primary. I was in my mid-twenties when the swelling first appeared in my left foot. At first it was only the foot and a little in the ankle but it quickly progressed to my toes. Over the next 20 years, it got worse on that foot so that my calf became involved. Until I was measured by a PT trained in Lymphedema treatment, I was unaware that my left thigh was also slightly effected. In the last few years it has begun to show up on my right foot as well. I presume it will progress as it has on my left foot. The bandaging briefly helped but is impossible to live with if one wants to live a normal life. I would like to find a MLD practitioner for weekly sessions but have yet to find one in the Boston Area. Please do let me know if anyone can recommend someone. As far as I know, insurance covers my stockings and did cover the PT but I have my doubts about getting the MLD covered if it were on a regular basis. If you know otherwise, please do tell.

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  • Colleen Aspik

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  • Bert Lotice

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  • […] balance in the body. Lymphedema, the most common form of non-pitting edema, requires a different treatment approach. The treatment of choice is known as complete decongestive therapy, which consists of manual […]

  • Annie Ridgley

    My Mom is having difficulty breathing. I am very concerned as the doctors have not attributed any of her problems to her lymphedema. Please help. We are in the Washington, D.C. metropolitan area and I need a doctor who is proactive and extremely knowledgeable about lower extremity lymphedema. I would greatly appreciate recommendations. Thank you!

  • Karen

    Hi Joachim,
    What’s your opinion on flexi-touch pumps in place of daily MLD for people who want to be active? When I do MLD on my arm, nothing happens. I was thinking that a flexi-touch might be more effective. What’s your take on this?
    Thanks!

  • Thank you so much for this. We have significantly changed procedures and prices since this post. We are definitely here to help the entire nation. We are contracted with Cigna, Humana, UHC, Tricare and BCBS FEDERAL.

  • Anita

    What does it take for a lymphedema specialist to also be trained for kinesiotaping and vice versa? What courses, certifications, etc. are necessary and where would they be found? I can find physical therapists certified for one or the other, but not both.

  • Gayle

    Are there any treatments and compression for lymphedema of the hip, buttock and thigh (unilateral)? I had pelvic surgery and a single gland removed February of 2015. I noticed some swelling along the panty line and then my hip, thigh and calf and buttock. Mild – not very noticeable, but very hard to get compression for since I’m a RN, I work, am frequently in boardroom meetings and need something that is inconspicuous as well as comfortable. It is unfortunately, slowly getting worse which is immensely stressful.
    We tried Jobst custom compression which was an unmitigated disaster – one of the most uncomfortable garments I have ever worn. Took 3 months to make and the garment design was incorrect. I could barely stand it for more than a few minutes. MLD seems not work on the buttock very effectively and the area is impossible to bandage.I’m currently using Bioflect biker shorts (a size smaller than I would normally get), and Futuro over the counter 20-30 mmhg pantyhose over.
    Any and all suggestions regarding treatment and compression would be so helpful.

  • Jane

    What information do you have regarding “It Works” wraps to reduce swelling and toxins from your body. Several people have suggested I try them for my Lymphedema in my arm due to breast cancer. What is your advise?

  • Joachim Zuther

    Jane: We do not recommend these wrapping systems for the treatment of lymphedema. In the decongestive phase we recommend short-stretch bandages. Here is a link to an article that may be of interest to you: http://www.lymphedemablog.com/2012/01/12/the-role-of-short-stretch-bandages-in-the-management-of-lymphedema/

  • Jane

    I use short-stretch compression sleeves and night garment 24/7 in between MLD treatments along with hydrotherapy at least 4 times a week. Not much progress from my first visit for MLD therapy a year ago. Was hoping these wraps that you leave on for 15 minutes would help or is there anything else I can do. Haven’t seen my elbow bone in over a year. Frustrated. Thank you for your knowledge in this condition.