What Is Lymphedema?
Lymphedema is a chronic condition characterized by an elevated lymphatic fluid accumulation in the body, which results in swelling and may affect the skin and tissues. The lymphatic system can not handle the chronic, progressive buildup of protein-rich fluid in the fibro-adipose tissue and the interstitium, which is a continuous space filled with fluid that lies between a structural barrier, like a cell wall or the skin, and internal structures, like organs, including the muscles and the circulatory system. Lymphoedema can cause swelling in any body part, including the arms, legs, genitals, face, neck, chest wall, and oral cavity. A lymphedema diagnosis has numerous psychological, physical, and social effects.
There are two types of lymphedema: primary (genetic) and acquired secondary lymphedema.
Primary Lymphedema:
A congenital disorder in which the lymphatic vessels have not appropriately formed affects one in every 6,000 newborns. It usually affects both sides and is more frequently observed in the lower limbs. Some people have no symptoms, while others may experience swelling from an event such as cellulitis or a mosquito bite. There has been evidence of a hereditary component to primary lymphedema, and many patients mention a long family history of "chunky legs."
Secondary Lymphedema:
Secondary lymphedema develops due to lymphatic system damage caused by surgery, infection, cancer infiltration into the lymph nodes, blockage, or any of these factors. In addition to gynecological tumors and the subsequent (pelvic and inguinal) lymph node clearing, pelvic and lower limb lymphedema is frequently caused by the removal of axillary lymph nodes during breast cancer treatment, which is the most common cause.
Breast cancer surgeons can remove one or two lymph nodes and determine whether the cancer has spread to other organs by doing a sentinel lymph node biopsy. If the sentinel node has disease, a thorough clearing will be performed. However, if it is clear, the lymph nodes can be left alone. By using this technique, unnecessary removal of healthy lymph nodes is avoided.
A sentinel lymph node biopsy results in a 7 percent lymphedema incidence, but a full axillary node clearance results in a 22 percent incidence. According to research, radiotherapy to the axilla and some chemotherapy medications might harm the lymphatic system. As a result of treatment, 20 percent of patients with breast cancer will get secondary lymphedema.
Other factors that contribute to secondary lymphedema include cardiac illness, obesity, venous system damage, and dependency edema (such as after heart failure).
What Are the Physiotherapy Methods for Lymphedema?
Conservative lymphedema management strategies include the following:
Education:
This is undoubtedly the most crucial aspect of care and should begin with preventative education for high-risk lymphedema patients. Patients must be reminded that the illness is progressive and worse without treatment. Treatment might occur as either an intensive or maintenance phase, depending on the degree of edema. Patients with chronic edema may undergo flare-ups, but they should be equipped with various management strategies to control swelling on their own or with the aid of a physiotherapist.
Compression:
Compression techniques are frequently the most efficient way to reduce limb volume. There are various ways to achieve compression:
Bandaging:
A newer method uses coban, which is lighter and can be repeated every two days for best results. This method is useful instead of the daily and laborious multi-level lymphedema bandaging.
Garments:
Garments can be used to provide gradual compression. Due to the necessity of preventing fluid from being pushed away from the middle, the end of the limb should be under the most strain using garments. Garments can be created in flat knit, circular or round knit, or custom-designed for more uneven limbs. Wearing garments while exercising is necessary because the compression promotes the muscular pump. Clothes are often worn all day and taken off at night. Patients may have access to assistive equipment to help them put on and take off clothing.
Wraps:
Wraps come in handy at night or as an alternative for patients who find it difficult to put on or remove clothing due to mobility problems or arthritic fingers.
Intermittent Pneumatic Compression:
A compression pump can be particularly beneficial at home or in clinics. Pumps are not as efficient as physiotherapists' hands because of the typical compression cycle, but they are still helpful alternatives when needed.
Self or Manual Lymphatic Drainage:
This massage method aims to push edema back into the central nervous system for processing. Traditional manual lymphatic drainage (MLD) was extremely delicate, and a lot of time was used to prepare the body part directly above the edema. No proximal preparation is needed because fluoroscopy has modified the procedure to a firmer pressure. The modern method is called fluoroscopy guided MLD. Self-lymphatic drainage (SLD) is a technique that patients learn from a physiotherapist and can be utilized as part of their daily treatment practice.
Skin Care:
Skin must be clean and dry, with precautions to avoid infections, wounds, and scratches. Patients should moisturize regularly, with the ideal interval, right after taking a shower at night so that the moisturizer can get into the skin without interfering with the use of a compression garment. Fingers and toenails must be maintained short and tidy to avoid scratching.
Exercise:
Exercise is a critical component of lymphedema treatment that is often ignored. Muscles normally pump themselves to improve lymphatic return during exercise. An additional layer of pressure can be applied to help the pump by using a compression garment while exercising. Exercises should often be performed under the supervision of a physiotherapist to prevent recurrent overload on the injured limb because a heavy load might put undue stress on the system.
Patients with lymphedema must incorporate weight training into their routine to build lean muscle. The skin loses elasticity and resists swelling if it loses weight. Being overweight increases the likelihood of developing lymphedema. Thus, patients who have previously experienced swelling should try to maintain an appropriate weight to prevent adding to the stress on their already strained lymphatic system.
Conclusion
The most effective lymphedema treatment approaches are those the patient is willing to follow, giving them maximum freedom in their daily lives. Developing an effective workout regimen for lymphedema patients might be difficult. They occasionally have trouble moving around, start to worry about their bodies, and put on weight, which puts further stress on the lymphatic system. This is yet another reason why physiotherapy is so important.
