Written by Sue Hansard, Lymphoedema Nurse Specialist, Mary Ann Evans Hospice and First Lymph Care & Dr Jens Reinhold, Physiomed Elektromedizin AG

1. Understanding Lymphoedema and Managing
it
Written by Sue Hansard, Lymphoedema Nurse Specialist, Mary Ann Evans Hospice and First Lymph Care & Dr
Jens Reinhold, Physiomed Elektromedizin AG
What is Lymphoedema?
Put simply, LYMPHOEDEMA means swelling (oedema) due to an accumulation of fluid (lymph).
Lymph fluid is transported around the body via a network of lymphatic channels (vessels) and lymph nodes. The lymphatic
system is part of our immune system. Lymph fluid carries nutrients to cells and removes large particles of waste such as
bacteria. Lymph nodes, of which there are between 501 and 700 in the body, filter lymph fluid, which passes through. This
is why cancer cells, which are too big to pass through and ‘get stuck’ are sometimes found in lymph nodes and why they
may be removed as part of cancer treatment.
WHEN DOES LYMPHOEDEMA OCCUR?
Lymphoedema occurs if the lymphatic system is faulty or damaged because lymph fluid cannot move around the body
properly. It becomes `back logged’ in the tissues nearest the damage, causing tissues to swell and skin to stretch. This
causes heavy, aching discomfort and increases the risk of cellulitis infection, which the impaired immune system struggles
to combat.
Posted on 06/03/2018 in Lymphoedema Service
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2. If lymph vessels are blocked or damages they are unable to carry lymph fluid away from the tissues and localised
swelling (lymphoedema) is the result
What are the causes of Lymphoedema?
There are many causes of lymphoedema as the diagram above shows. It can affect children and adults and can arise at
any time in life. It can affect any body part and it cannot be cured. Treatments are aimed at controlling swelling as much as
possible and preventing skin infection, to which people with lymphoedema are especially prone.
As swelling increases, function in the affected area may be reduced, such as mobility, or ability to grip or carry items. It can
affect body image also. Living with the condition can affect people physically, psychologically, socially, emotionally and
financially.
Lymphoedema is a life­long, life­changing, (though not life limiting) condition, which can impact significantly on quality of
life. It affects 1­3/1000 people. Prevalence increases with age and it is estimated that between 76,000 and 227,000 men,
women and children in England live with this condition. (LSN, 2013).
ACCESS TO TREATMENT PROVISION
Access to appropriate specialist treatment is variable around the UK. Some services are within NHS services; others are
based in Hospices or are in the Independent sector. NHS and Charity based services are free at the point of care. The
scope of services varies; some services only treat patients with a cancer diagnosis, few services treat children, though
there is now a list on the Lymphoedema Support Network (LSN), which can be accessed here www.lymphoedema.org
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3. In the main however, there is great inequality in service provision in the UK. Services offered is also dependent on the level
of Lymphoedema specialist training clinicians have.
BRITISH LYMPHOLOGY SOCIETY www.thebls.com
The BLS has a directory of service provision in the UK and is the main professional body promoting standards of care and
research advances within the specialism.
MLD UK www.mlduk.org.uk/therapists/
MLDuk is an association of Manual Lymphatic Drainage Practitioners from different professional backgrounds, which exists
to promote the development of Manual Lymphatic Drainage (MLD).
PhysioPod® UK Ltd www.physiopod.co.uk
PhysioPod hold a register of Lymphoedema services in the NHS and independently using DEEP OSCILLATION®, where
appropriate, for the Lymphoedema patients in their care.
We have a number of therapists (including PhysioPod and this article's author, Sue Hansard) listed in our
directory
What are the treaments used to manage Lymphoedema?
This is a medical condition and it is therefore important that therapists have the correct skills, training and knowledge to
treat people with lymphoedema.
There are many strands to helping people cope with their lymphoedema. Historically the specialism focused on the FOUR
CORNERSTONES of decongestive lymphatic therapy (DLT):
1 MANUAL LYMPHATIC DRAINAGE (MLD)
This is a gentle form of massage, which specifically influences the superficial lymphatic system and helps to re­direct lymph
away from congested/swollen areas towards lymph nodes and vessels which are working well. Patients are usually taught
a simplified version for daily self­massage. Manual lymphatic drainage massage is based on in­ depth knowledge of the
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4. lymphatic system and specialist advanced training is required in order to treat lymphoedema.
2 COMPRESSION THERAPY comprising:
Multi­layer compression bandaging ­ Specialised multi­layer compression bandaging treatments may be used to improve
skin condition and improve limb shape/reduce swelling.
Elastic Garments ­ Stockings, socks, sleeves, gloves which are specially made with a graduated compression. Worn daily
they help to support the limb and improve lymph drainage and circulation
Velcro wrap garments ­ These are special neoprene supports for daily wear, which work like compression garments.
Garments can be worn during the day and or at night.
3 SKIN CARE
To maintain healthy skin integrity and prevent infection, by using moisturising creams/lotions, and meticulous cleansing and
treating any skin damage immediately.
4 EXERCISE
Movement and activity promotes lymph flow around the body and helps the circulation as well as improving psycho
emotional well­being. Swimming, cycling, Nordic walking, yoga, healthy steps are just some effective forms of exercise.
Other treatment approaches include:
DEEP OSCILLATION® Therapy (also known as HIVAMAT® therapy or DOT)
Alongside MLD, some therapists are now combining deep oscillation therapy with MLD to enhance lymph drainage, relieve
symptoms of pain/discomfort, soften swollen/fibrotic tissues and reduce swelling)
Lypmphoedema of the arm being treated by Deep Oscillation therapy
The DEEP OSCILLATION Personal
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5. Deep Oscillation ­ Frequently Asked Questions
Scientific explanation of Deep Oscillation Therapy by Dr. Jens Reinhold
Intermittent Pneumatic Compression (IPC) Pumps
There are different types of these medical devices which use self­inflating sleeves /boots to gently massage the limb prior
to bandaging or as a regular part of maintenance treatment plans. Some people buy the home device for personal use.
Infrared Low­level Laser Therapy (LLLT)
This can be used as part of treatments to help soften fibrosis (firm tissue) and to promote cell activity and repair.
Kinesiology Tape
This is a special medical tape, which, when applied in a specific way can help to redirect lymph flow in superficial
pathways, away from the swelling. Patients can be taught how to self apply for occasional use.
As we learn more about the condition and its causes and as research provides greater evidence and knowledge, more
treatment modalities are being used by Lymphoedema services and surgery, as outlined below, is offered in some areas of
the UK.
Liposuction
This involves using suction to remove the build­up of fluid and excess fat tissue in the limbs through small cuts in the skin.
In lymphoedema, this form of micro liposuction is performed by specialist lymphatic surgeons and is different from cosmetic
liposuction procedures.
Supermicrosurgery techniques are emerging with some effective results being reported via:
Lymph node transfer
This involves transferring spare lymph nodes with their blood supply from the groin or axillary area to the damaged
area and this has shown to improve symptoms of upper and lower limb lymphoedema.
Lymphaticovenous Anastomosis (LVA)
This is a method of directly connecting the lymphatic vessels in the affected area of the body to the tiny veins nearby.
This allows the excess lymphatic fluid to drain directly into the vein and be returned to the body’s natural circulation.
Deep Oscillation Treatment works! ­ The proof
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6. To demonstrate the benefits of Deep Oscillation Treatment, here is a Case Study that examines a patient who was living
with Lymphoedema following treatment for Breast Cancer and the difference it made to her.
Management of Breast Lymphoedema PDF
This additional video testimonial is worth watching if you're interested in managing your Lymphoedema yourself!
For further information about how to manage Lymphoedema, get in touch with Physiopod UK.
DEEP OSCILLATION
Lymphoedema Deep Oscillation Mld Hivamat Manual Lymphatic Drainage Kinesio Taping
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