Lymphedema Therapy and Bandaging

For those of you that suffer with lymphedema you have no doubt figured out a very simple thing. This is nothing to play with.

When lymphedema is left untreated, the outcome is often disabling painful and progressively worse. With Lymphatic drainage impaired interstitial and lymphatic fluid and protein gradually collect on the soft tissue eventually causing the production of fibrotic tissue and providing a natural medium for infection. Much like a snake eating its own tail, chronic edema, lymphedema and fibrosis of the tissue exacerbate the effects of the other.

These are examples of lymphedema. One arm is at least twice the size of the other. MLD or Manual Lymphatic Drainage assists the body in its processing of this fluid. Moving that fluid out of a stagnant situation is critical to the health of the tissue.

The picture on the right shows a somewhat harder state of lymphedema to immediately  recognize. You really have to look at the limb before you realize it is quite swollen.

Size does not dictate need!

Bandaging and compression Garments produce great effect in maintaining the results garnered by MLD

Bandaging works by balancing pressures. Excess fluidic pressure forces the skin to accommodate it.
Bandaging increases the external or atmospheric pressure so the fluid instead of spreading the skin moves between the two pressures up the pressure gradient and into the "normal pathways" for the body to process.

Whether primary or secondary, lymphedema develops in stages, from mild to severe. Methods of staging are numerous and inconsistent. They ranged from three to as many as eight stages.

The most common method of staging was defined by the Fifth WHO (World Health Organization) Expert Committee on Filariasis:

  • Stage 0 (latent): The lymphatic vessels are overloaded and damage to the vessels are not yet apparent. Transport capacity is still sufficient for the amount of lymph being removed. Lymphedema is not present.

LDT I,II,III, or MLD is very helpful at this point to assist in the flow of lymphatic fluid and is also helpful in the normal venous reabsorption of fluid.

  • Stage 1 (spontaneously reversible): Tissue is still at the "pitting" stage: when pressed by the fingertips, the affected area indents and holds the indentation. Usually upon waking in the morning, the limb or affected area is normal or almost normal in size.

LDT  I,II,III, or MLD is very helpful at this point to assist in the flow of lymphatic fluid and is also helpful in the normal venous reabsorption of fluid. Though the therapist needs to take care here of cardiac conditions, and other potential problems.


 

  • Stage 2 (spontaneously irreversible): The tissue now has a spongy consistency and is "non-pitting:" when pressed by the fingertips, the tissue bounces back without any indentation. Fibrosis found in Stage 2 Lymphedema marks the beginning of the hardening of the limbs and increasing size.
  • Stage 3 (lymphostatica elephantiasis): At this stage, the swelling is irreversible and usually the limb (s) or affected area is very large. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery called "debulking". This remains controversial, however, since the risks may outweigh the benefits, and the further damage done to the lymphatic system may in fact make the lymphedema worse.
  • These level requires LLCC Certification. Bandaging and/or taping as well as the skills to recognize rerouting pathways and their direction. "Personally I a not a fan of the reconstructive surgery "debulking as i feel it tends to exacerbate the condition by further damaging the lymphatics of the area"