Lymphedema and Physical Therapy
- Posted on: Jun 18 2020
Lymphedema is characterized by an abnormally high accumulation of lymph fluid in the tissues of the body either due to a birth defect or damage to the lymphatic system through surgery or trauma. Lymphedema occurs when lymphatic load (amount of lymphatic fluid) outweighs transport capacity (amount of fluid lymphatic system can transport) resulting in lymphedema (excess in lymph fluid). When a major lymph node is affected by trauma or surgery, the transport capacity decreases resulting in an increased risk of developing lymphedema. Some of the major lymph nodes are located in the jaw, neck, underarms, groin area and behind the knees.
Due to the progressive nature of lymphedema, it can be categorized into four different stages. Stage 0 is the latency stage where there is no clinical edema (swelling). Stage 1 is termed the reversible stage and is characterized with soft and pitting edema. Pitting refers to the presence of an indentation in the skin that lasts for a few seconds when fingertips are pressed onto the skin tissue. In stage 1, the edema increases with standing and other activity, but decreases when elevating the limb. In most cases, patients are in this stage of lymphedema when they have intermittent swelling in a body part. For example, a patient that notes swelling in an ankle after sitting all day that resolves with elevation of the ankle, can be classified as having stage 1 lymphedema. Stage 2 is identified as present edema that progresses to non-pitting edema where the skin does not indent with fingertip pressure. Lastly, stage 3 is characterized by severe, non-pitting edema with noted fibrotic (hardening) changes of the skin.
Physical therapists can help to manage lymphedema using stroking techniques, teaching diaphragmatic breathing exercises, and sequencing exercises to best decongest the edematous limb or body part. All techniques can help to draw the fluid through the lymphatic system in an orderly fashion and allow the body to get rid of the extra fluid to return the limb to typical proportion. With the decreased amount of fluid, patients can have increased range of motion and greater stability leading to increased strength and functional performance.
Posted in: Physical Therapy