Edema

What is lymphedema?

Lymphedema is an abnormal collection of lymphatic fluid in an area of the body.

Lymfoedeem kan meerdere oorzaken hebben:

• een te grote hoeveelheid lymfevocht;

• een verminderde functie van het lymfesysteem bijvoorbeeld als de lymfebanen beschadigd zijn of onvoldoende aanwezig zijn;

• een combinatie van beide, dus een te grote hoeveelheid lymfevocht met een verminderde functie van het lymfesysteem.

The causes of lymphedema

The causes of lymphedema are:

• Too much lymphatic fluid in the system;

• Reduced function of the lymphatic system for instance due to damaged or not enough lymph vessels; 

• A combination of both, too much lymphatic fluid and reduced function of the lymphatic system.

Compromised drainage of the lymphatic system can be idiopathic, known as primary lymphedema. When drainage is compromised for instance due to surgery, radiation treatment or an infection it is called secondary lymphedema.

Primary lymphedema

Idiopathic lymphedema can have various causes. The cause can be investigated and determined in the hospital.

Secondary lymphedema

Secondary lymphedema is caused by damage to the lymphatic vessels or lymph nodes, for instance due to surgery or an accident. Lymphedema can develop after removal of lymph nodes or radiation therapy of the affected body part. This is common when treating breast cancer, melanoma (type of skin cancer), head or neck tumors or removal of the lymph nodes of the abdomen and groin due to various cancers in the abdominal region. Lymphedema can also occur as a result of thrombosis or other venous insufficiency.  

The symptoms of lymphedema

Lymphedema can cause swelling, a feeling of pressure, fatigue or heaviness, tingling and restrictions in movement in daily life. It can also affect the skin resulting in skin conditions with an increased infection risk (erysipelas or St. Anthony’s fire). Edema itself does not cause pain. Pain can however be caused by fibrotic tissue (hardened tissue) or scarring.

The treatment of lymphedema

De behandeling van lymfoedeem bestaat uit 2 fases, namelijk de ‘behandelfase’ en de ‘onderhoudsfase’. In de behandelfase ligt de nadruk op het verminderen van het oedeem. De onderhoudsfase is gericht op zelfmanagement waarin u zelf het oedeem onder controle houdt. In deze fase is de invloed van de oedeemtherapeut meer op de achtergrond. De behandeling door een oedeemtherapeut kan uit verschillende aspecten bestaan.

Compression therapy

Bandaging is often used to quickly reduce swelling. This is usually a temporary measure. Once the excess fluid is drained, a medical compression stocking can be used to prevent the fluid from returning. This is not always needed.

Mobilizing scar tissue and myofascial techniques

The fascia is a layer of connective tissue that surrounds the structures of the body like a thin web. This connective tissue (fascia) weaves through and covers all of our muscles, joints, organs, blood vessels and nervous system. It connects everything and makes the body a connected and functional system. Local fibrosis (hardening of the connective tissue) can occur due to surgery or radiation treatment, leading to fluid retention and restrictions in circulation and drainage of lymphatic fluid. There can also be pressure on the nerves causing pain. The affected area becomes hardened, stiff and less flexible, potentially causing limitations in mobility.

Mild fascial techniques can be used to mobilize these adhesions in the connective tissue. This leads to improved circulation, increased lymphatic drainage, pain reduction and improved mobility. 

These techniques are often used in combination with lymphatic drainage to help drain the excess fluid.

Lymphatic taping

Lymphatic taping is a special taping method that uses a specific elastic tape. The tape is applied on the skin directly over the lymphatic vessels. The tape is applied with a slight stretch. This will increase local circulation and facilitate lymphatic drainage. It also has a beneficial effect on scar tissue and hardened connective tissue (fibrosis).

Exercise therapy

Lymphatic fluid will be mobilized and drained through increased muscle movement. Your edema therapist can design a custom  exercise program for you aimed at strengthening and stretching the muscles. Starting at the right intensity of exercise and gradual progress is important.

Lifestyle, advice and self management

Below you will find a number of factors that can prevent or decrease edema. For all factors it is important to listen to your body and report your findings to your edema therapist.

Movement and overuse:

• It is recommended to adhere to the WHO guidelines for health and wellbeing. Aim for 150-300 minutes of moderate aerobic exercise per week spread out over multiple days. Muscle movement will improve drainage of lymphatic fluid. Prevent overuse as this may result in extra local fluid production.  

• Strengthening exercises for the arms and shoulder are recommended to prevent edema. 

• Try to find a balance between exertion and rest that suits you. 

• Avoid heavy lifting and high intensity sports or exercises

• Avoid skin lesions and infections

• Wear gloves for activities with increased risk of skin lesions, for instance when gardening

• Use the opposite side when having blood taken

• Be careful with skin punctures, cuts or burns, use disinfectant to clean the wound

Avoid extreme heat

Extreme heat can cause fluid build up. For instance when bathing, in the sauna or when sunbathing.

A healthy body weight

Excess body weight is an important risk factor in causing or increasing edema. Being overweight can increase your fluid production and often restricts mobility.

Avoid cutting off or restricting circulation

Avoid tight clothing, jewelry and blood pressure cuffs on the affected body part.  

Flying

Consider a compression stocking when flying and try to move as much as possible while in the air.

Attention!
If your arm or leg turns red and feels warm, in combination with feeling feverish or unwell, this can be a sign of infection. Contact your GP or specialist immediately for an examination of suspected erysipelas (infection)

Synonyms:

edema, oedema, swelling, drainage, lymphedema, lymphdrainage, lymph nodes, lymphatic system

Advice

If you have any questions regarding the exercises, doubt if you are doing them correctly or aren’t sure they are suited for your condition, please contact your physiotherapist for support. 

Attention:

Yourbody.coach offers a range of exercises. Yourbody.coach can not be held responsible if you develop injuries. Always consult your physiotherapist or specialist.