Lymphoedema Management: The Role of Early Diagnosis and Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on November 19, 2024
Lymphoedema, a condition that results from an impaired lymphatic system, causes swelling and fluid retention, primarily in the limbs. Recent advances have improved our understanding of lymphoedema’s underlying causes and how best to manage it through both traditional and innovative treatment methods. This comprehensive guide explores lymphoedema’s causes, symptoms, and treatment options, with an emphasis on how physiotherapy can contribute to effective management and overall quality of life.
What is lymphoedema?
Lymphoedema is a chronic condition characterized by the buildup of lymphatic fluid in tissues, typically in the arms or legs. The lymphatic system, part of the immune system, plays a critical role in transporting waste products, proteins, and immune cells. Lymphoedema disrupts normal lymphatic flow, resulting in swelling and a range of associated symptoms.
New advances highlight that lymphoedema may not only be due to blockages in lymph flow but also stem from systemic inflammation and immune response dysregulation (Rockson, 2018). Ongoing research suggests that these inflammatory responses play a significant role in the progression of the disease, which has led to a shift in treatment strategies aimed at managing inflammation and supporting lymphatic health.
Types of lymphoedema
Lymphoedema is classified into two main types, with recent research revealing more about the genetic and acquired aspects of the disease:
Primary lymphoedema
This form is congenital and linked to genetic mutations that impact lymphatic system development. Subtypes include:
Congenital Lymphoedema: Present from birth and often due to specific gene mutations.
Lymphoedema Praecox: Typically manifests around puberty.
Lymphoedema Tarda: Appears after age 35, though its onset mechanisms are still under investigation.
Secondary lymphoedema
Caused by external factors, secondary lymphoedema results from trauma, infection, or medical treatments. Research continues to explore how cancer therapies, especially lymph node dissection and radiation, lead to lymphatic scarring and dysfunction (Mortimer, 2014). There is also evidence that chronic infections and inflammatory diseases can elevate lymphoedema risk by triggering immune responses that interfere with lymph flow.
Causes of lymphoedema
Genetic factors: Advances in genomics have identified several genetic mutations responsible for primary lymphoedema, such as mutations in the FOXC2 and VEGFR3 genes, which disrupt normal lymphatic development (Brouillard et al, 2014).
Cancer treatments: Cancer-related lymph node removal and radiation remain significant contributors to lymphoedema. The damage caused by radiation can lead to fibrosis, which impedes lymphatic drainage.
Injury or trauma: Physical damage to lymph nodes or vessels can block or delay lymph flow, leading to swelling. Inflammation resulting from injuries can exacerbate lymphoedema in susceptible individuals (Schook & Fish, 2018).
Infections: Chronic infections, particularly parasitic infections like filariasis, cause significant lymphatic damage. Repeated bouts of cellulitis can also compromise the lymphatic system over time (Rockson, 2018).
Signs and symptoms of lymphoedema
Symptoms of lymphoedema may develop slowly and include swelling in the affected area, often accompanied by feelings of heaviness, tightness, or discomfort. Key symptoms include:
Gradual swelling: Unlike other forms of edema, lymphoedema progresses gradually, with early symptoms sometimes misinterpreted as other conditions.
Skin changes: Thickening and hardening of the skin (fibrosis) can occur as the condition progresses. These changes may be due to prolonged fluid accumulation and an ongoing inflammatory response.
Restricted motion and pain: Swelling and skin tightening can limit joint movement and lead to discomfort.
New insights into the inflammatory aspects of lymphoedema have shown that managing inflammation through anti-inflammatory treatments may alleviate some of these symptoms (Greene & Slavin, 2016).
Prevention of lymphoedema
Maintaining a healthy weight: Weight control has shown to reduce the risk of lymphoedema, especially in those who have undergone cancer treatments (Shih et al., 2009).
Exercise: Regular physical activity improves lymphatic flow, and specific types of exercises—like resistance and flexibility training—have been shown to be especially beneficial for lymphatic health.
Skin care and hygiene: Proper moisturization and avoiding cuts, burns, and insect bites prevent infections that may trigger lymphoedema.
Injury prevention: Taking precautions to avoid trauma and minimizing repetitive strain on affected limbs are essential.
Diagnosis of lymphoedema
Diagnosis includes physical exams and imaging techniques. Recent diagnostic advancements provide earlier and more accurate detection:
Bioimpedance Spectroscopy: This technique, which measures fluid levels in limbs, is proving effective in detecting early-stage lymphoedema before visible swelling occurs (Ward et al., 2009).
Lymphoscintigraphy and MRI/CT scans: These imaging methods help visualize lymphatic flow and structure, aiding in identifying blockages or abnormalities.
Physical examination: Clinicians assess symptoms and use circumferential or volumetric measurements to track changes in limb size.
Early diagnosis and intervention are crucial, as they can slow or prevent the disease's progression.
Treatment options for lymphoedema
Complete Decongestive Therapy (CDT)
A cornerstone of lymphoedema management, CDT includes manual lymphatic drainage, compression therapy, exercise, and skin care. Studies show CDT effectively reduces swelling and prevents symptom progression (Piller, 2013).
Compression Garments
These are essential for maintaining reduced limb size and preventing fluid accumulation. Recent advancements in garment design have improved comfort and efficacy.
Manual Lymphatic Drainage (MLD)
MLD involves gentle massage techniques that stimulate lymph flow. While beneficial, MLD’s effects are best sustained with ongoing compression therapy.
Surgical Interventions
For advanced lymphoedema, surgical options, such as lymphaticovenous anastomosis or lymph node transfer, offer potential for relief, although long-term outcomes vary.
Physiotherapy’s role in treating lymphoedema
Physiotherapists provide tailored lymphoedema care, including manual lymphatic drainage, compression application, and exercise prescription. Advances in physiotherapy for lymphoedema focus on:
Lymphatic Drainage Techniques: Specialized techniques stimulate fluid movement and reduce swelling.
Guided Exercise: Resistance and flexibility exercises improve mobility and muscle strength, aiding lymphatic flow (Stout et al., 2012).
Compression Therapy: Physiotherapists provide training on the proper use of compression garments, a critical component in controlling swelling.
Studies have shown that a personalized physiotherapy plan can significantly improve lymphoedema symptoms, quality of life, and mobility (Warren et al, 2007).
Living with lymphoedema
Self-management practices, such as regular skin care, compression use, and daily exercise, are essential. A balanced diet with anti-inflammatory foods may reduce swelling, while mental health support can help individuals cope with the emotional aspects of lymphoedema.
Conclusion
Lymphoedema can be managed effectively with early diagnosis, comprehensive care, and professional support. Physiotherapy is integral to managing symptoms, improving function, and enhancing quality of life. Consult a certified physiotherapist for a tailored treatment plan to manage lymphoedema effectively.
References:
Brouillard, P., Boon, L., & Vikkula, M. (2014). Genetics of lymphatic anomalies. The Journal of Clinical Investigation, 124(3), 898–904. https://doi.org/10.1172/JCI71614
Greene, A. K., & Slavin, S. A. (2016). Lymphedema: Presentation, diagnosis, and treatment. Circulation, 133(3), 150–162.
Mortimer, P. S., & Rockson, S. G. (2014). New developments in clinical aspects of lymphatic disease. The Journal of Clinical Investigation, 124(3), 915–921. https://doi.org/10.1172/JCI71608
Piller, N. (2013). Lymphoedema: Causes, prevention, and management in older people. Reviews in Clinical Gerontology, 23(2), 142–154. https://doi.org/10.1017/S0959259812000238
Rockson, S. G. (2018). Lymphedema after cancer treatment. New England Journal of Medicine, 379(20), 1937–1945.
Shih, Y. C., Xu, Y., Cormier, J. N., Giordano, S., Ridner, S. H., Buchholz, T. A., Perkins, G. H., & Elting, L. S. (2009). Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: A 2-year follow-up study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 27(12), 2007–2014. https://doi.org/10.1200/JCO.2008.18.3517
Stout, N. L., Binkley, J. M., Schmitz, K. H., Andrews, K., Hayes, S. C., Campbell, K. L., & McNeely, M. L. (2012). A prospective surveillance model for rehabilitation for women with breast cancer. Cancer, 118(8), 2191–2200.
Ward, L. C., Czerniec, S., & Kilbreath, S. L. (2009). Operational equivalence of bioimpedance indices and perometry for the assessment of unilateral arm lymphedema. Lymphatic Research and Biology, 7(2), 81–85. https://doi.org/10.1089/lrb.2008.1027
Warren, A. G., Brorson, H., Borud, L. J., & Slavin, S. A. (2007). Lymphedema: A comprehensive review. Annals of Plastic Surgery, 59(4), 464–472. https://doi.org/10.1097/01.sap.0000257149.42922.7e
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.