Lymphedema is an abnormal collection of fluid beneath the skin, often in one or both arms or legs. The protein-rich substance, lymph, fails to properly drain and re-enter the circulatory system as a result of damaged lymphatic vessels or missing lymph nodes. Damaged lymphatic vessels may occur as a result of an acute injury such as an ankle sprain. Missing lymph nodes are often due to intentional removal in the treatment of cancer. Complete Decongestive Therapy (CDT) is the gold standard in managing lymphedema and is carried out by physical therapists specialized in working with this condition.
CDT has four different components, each of which require the skilled intervention of a specialist. 1) Manual Lymphatic Drainage (MLD) is a very light, slow massage that begins and ends with deep breathing. Areas closer to the trunk and on the unaffected side are stimulated first to open up the lymphatic vessels. This makes it possible for fluid to move out of the affected area using gentle, rhythmic strokes directed up towards the trunk. 2) Compression therapy consists of wrapping special bandages around the affected limb in a specific manner to direct fluid out and keep it out of the area. Once stable, custom compression garments are used to maintain the decreased level of edema. 3) The muscle-pumping action achieved through exercise, prescribed in a very particular order, helps to move fluid out of the affected limb. And 4) skin care is essential to prevent infection, which is a big concern for patients with lymphedema.