what can a physical therapist do for lymphedema?
Lymphedema is swelling in any part of the body that occurs due to a build-up of protein-rich fluid. It is stereotypically thought of in the legs, feet, toes, arms, hands, and fingers. But it can also occur in the head, neck, and breasts/chest.
There are two different types of lymphedema, primary and secondary. Primary lymphedema is when a person is born with an issue with their lymphatic system that goes on to cause swelling in their body, typically starting in childhood. Secondary lymphedema is swelling that usually develops later in life and is a result of an injury to the lymphatic system.
Secondary lymphedema is the more common form of lymphedema that occurs within the population and can, less commonly, be caused by a parasitic infection called filariasis (a mosquito-borne infection). The more common causes of secondary lymphedema are from damage to the lymphatic system due to cancer treatment including radiation and lymph node removal and dissection. Other medical conditions, like lipolymphedema, chronic venous insufficiency, congestive heart failure, and kidney disease and failure can also cause swelling in the extremities of the body (typically the legs).
Lymphedema is unfortunately something that once you have, you have for life. It is considered a chronic condition and is progressive in nature if it goes untreated. Usually the beginning phases of lymphedema (Stage 0) is where you don’t have any apparent changes in your skin, but you may have short-lasting indentation at the skin when you press on it and you may feel that the affected area feels heavy or tight. Lymphedema can remain at Stage 0 for months and even years before it goes on to progress further.
Stage I lymphedema is a mild form of swelling and a progression of Stage 0 lymphedema. At this point in the progression of lymphedema you are able to actually visualize your swelling that fluctuates throughout the day and tends to improve when your legs are elevated or at night while sleeping. You will begin to notice pitting edema which is where when you press on the affected area with your fingers an indentation will remain on the skin. There are no changes in the skin tissue at this point in the progression.
Stage II lymphedema is a progression from Stage I and is when skin changes (like fibrosis or hardening of the skin) begin to occur and elevation of the impacted area no longer improves your swelling. Pitting edema continues during this stage.
Stage III lymphedema is a progression of Stage II lymphedema and is the most severe form of lymphedema. This is where you no longer have pitting edema present because the fibrosis of the skin is so severe. It is common to see skin changes like increased skin folds, hyperkeratosis (changes in skin color), fat deposits, and wart-like growths. This stage of lymphedema increases your risk of cellulitis (skin infection) and wounds.
Mmmkay so lymphedema might sound really scary. But guess what? There are things that a skilled clinician, like a Certified Lymphedema Therapist (CLT), can do to help!
As a Certified Lymphedema Physical Therapist we offer complete decongestive therapy (CDT) that is broken into two phases of treatment, a more intensive phase of treatment where we do compression wrapping, review appropriate skin care techniques, and manual lymphatic drainage (MLD). The intense phase of treatment is followed by the maintenance phase where we are trying to get you into more permanent compression garments and obtaining assistive devices or aids to help you get your garments on and take them off, as well as educating you on how to continue with your own MLD techniques (or even assisting you in obtaining and pneumatic compression pump).
The nice thing about lymphedema is if we are able to catch it early we can help to prevent things from progressing so that you can manage things on your own and continue to do all of the things you love.
Thinking that you may benefit from lymphedema physical therapy treatment? Or know someone else that you think may need care for their swelling? Reach out to schedule a lymphedema physical therapy appointment with me today. At Flora Physical Therapy I am passionate about providing 1:1 accessible treatment options including in-home, in-clinic, and virtual appointment options to help meet you where you are.
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
