Manual Lymph Drainage

Manual Lymph Drainage (MLD)

Manual Lymph Drainage is necessary to manage fluid volume of the affected extremity to a normal or near normal size. MLD is a type of gentle massage which is intended to encourage the natural drainage of the lymph, which carries waste product away from the tissues back toward the heart. MLD uses a specific amount of low pressure and rhythmic circular movements to stimulate lymph flow and re-route it around blocked areas into more centrally located healthy lymphatic vessels, which will eventually drain into the venous system. Bandages are used in the phase 1 and compression garments in phase 2.

The Lymphatic System and Lymphedema

Your lymphatic system plays a large role in immune function and circulation.  It consists of lymph vessels meeting up with lymph nodes located in your neck, armpits and groin.  As the lymph vessels move fluids out of the tissues, waste products, bacteria, dead cells and large protein molecules are collected.  The waste products are carried to the lymph nodes to be broken down and eliminated, while the protein rich fluid is transported back to the heart to rejoin circulation.

When the lymph vessels are unable to transport lymph fluid back to into circulation it accumulates, resulting in chronic swelling.  This build- up of protein-rich lymph fluid is known as lymphedema.  Once this condition occurs, the swelling may increase if an effective treatment program is not initiated.

If left untreated it may result in hardening skin tissue, enlargement of the tissue channels that transport the lymph fluid, limit the oxygen in the transport system, interfere with wound healing , and provide a culture medium for bacteria that can result in lymphangitis (infection),.

How Does Lymphedema Develop?

There are two types of Lymphedema, Primary and Secondary, which both occur when normal drainage is impaired or disrupted. Lymphedema most often develops in one arm or leg, but may be present in both arms and both legs.  It may also occur in the hands or feet, even in the chest, back, neck, face, abdomen and genitals.

Primary Lymphedema

Primary Lymphedema is caused by malformations of the lymphatic system. These malformations are most common in women.  Symptoms may be present at birth or may develop later, often during puberty or pregnancy.  Primary lymphedema is most common in the legs, but may also occur in the arms and torso.

Secondary Lymphedema

Secondary Lymphedema is a result to damage to the lymphatic system.  Surgical procedures such as mastectomies, lumpectomies with radiation and /or removal of lymph nodes are the most common causes.  Secondary lymphedema occurs most commonly in the arms, but may also develop in the legs.  Other causes may include a traumatic injury, infection, or severe chronic venous insufficiency.

What Are The Symptoms?

Lymphedema may develop within in a few months after a procedure, years later, or not at all.  The first obvious sign of lymphedema is swelling characterized by “pitting”. This is recognizable when the skin is depressed for a few seconds and the indentation does not immediately disappear.  Other symptoms may include a tightness or heaviness in the affected area or changes in the texture of the skin.  You may notice that jewelry and clothing feel tighter.

What To Do If Symptoms Occur?

If your lymphatic system is compromised, this area of the body will have to work much harder to circulate fluid.  When it is unable to keep up, swelling and fluid build-up are likely to occur.  That is why lymphatic vessels in the compromised area need external support.

What Is The Treatment For Lymphedema?

Once the diagnosis of lymphedema is confirmed, certain treatment procedure are indicated.  Since there is no cure for lymphedema, the goal of the treatment is to reduce the swelling and to maintain the reduction.  For a majority of patients, this can be achieved by the skillful application of Complete Decongestive Therapy (CDT) which is safe, reliable, and non-invasive.  It is proven to provide positive long-term results for both primary and secondary lymphedema. CDT is performed by specially trained therapists.  The treatment consists of four components:

• Manual Lymph Drainage (MLD)
• Graduated Compression Garments or bandages
• Meticulous Skin Care
• Therapeutic Exercises

TREATMENT

Complete Decongestive Therapy works in two phases, the first being to move the lymph fluid out of the affected area region and reduce the swelling using MLD techniques and bandaging.  Ideally these treatments are performed daily, five days a week for 2-4 weeks, depending on the severity.  Once the swelling is reduced, the patient is fitted with a graduated compression garment.  This marks the second phase, in which the patient plays a large role in his or her ongoing self-care.  Wearing graduated compression garments, being meticulous about skin care, and performing self-manual lymph drainage and therapeutic exercises will assure continued success.

Treatment procedures such as diuretics or surgery are not appropriate for lymphedema. Initially, a diuretic will decrease the water content and reduce swelling, but the protein molecules remain in the tissues and swelling will reoccur as soon as the drug loses its effectiveness.  Surgical methods for lymphedema have not proven successful.

Wearing A Compression Garment

Wearing a compression garment provides external pressure to assist lymph drainage and hopefully prevent additional swelling.  Although swelling is sometimes reversible, in most cases it is not and could lead to chronic lymphedema.

When you are about to engage in repetitive motions, such as exercise, cleaning, yard work, golf or tennis it is a good idea to wear a compression garment. It is also important to wear compression garment when you are flying.  The decrease in cabin pressure in the airplane puts stress on the lymphatic and circulatory systems and this can increase swelling.

Graduated Compression Garments: Graduated compression garments are necessary to maintain the reduced limb and are designed to replace the bandages that were used earlier in the treatment. They are worn during the day while you are active.  At night when you sleep, bandages or night garments are usually worn.  The compression garments help to keep the swelling down, improve circulation, and prevent the re-accumulation of lymph fluid in the area. The garments must be worn every day, for life.

Pneumatic Compression Pumps: Some treatment may include use of a pneumatic compression pump. This mechanical device works as a sleeve with chambers that are intermittently inflated with air. This device is sometimes used in combination with CDT.

Skin Care: With lymphedema, the skin is usually dry and may crack easily, making it very susceptible to infections. A low-pH lotion, free of alcohol and fragrances should be used to maintain the moisture of the skin and to protect it.  If an infection develops, consult your physician immediately!

Exercise: A skilled therapist may recommend an exercise program that is suited for your particular need and ability. An effective decongestive exercise program aids the muscular system to move lymph fluid out of the affected area.  Any exercise that causes pain or muscle soreness should be discussed with a therapist. Moderate exercise such as swimming, walking, biking, light weight training and yoga are recommended. Overly aggressive sports that may cause injury should be avoided. Consult your physician before beginning any program.

LIFESTYLE – TIPS FOR MANAGING AND LIVING WITH LYMPHEDEMA

If you are at risk for developing lymphedema or already have it, these guidelines will help you prevent and manage the condition. Although you may not need to follow each suggestion, it is good to be aware of them.

If you have lymphedema, it is important that you avoid injury and overexertion in the affected area. You should wear the prescribed compression garments and/or bandages as instructed by your physician or therapist. Be sure all of your medical charts are updated and consider wearing a lymphedema alert bracelet available through the National Lymphedema Network.

Clothing & Jewelry

Avoid tight or restrictive clothing that may impair circulation or cause irritation and swelling. Shirt sleeves, bra straps, belts, socks and shoelaces should fit comfortably. Shoes with low heels are recommended. Jewelry, including watches, bracelets, and rings should not feel tight. Avoid carrying heavy purses, luggage and should bags on the side that is affected.

Skin Care

Keep skin protected using a moisturizing lotion and wash with a mild pH balanced soap. When bathing, water should be warm, not hot. Avoid irritating or allergy-causing cosmetics, detergents, deodorants, and perfumes. Inspect your feet, hands, and limbs regularly for skin changes since open skin invites bacteria and infection. Avoid cuts, pricks, scratches, burns, and insect bites that could increase swelling or promote infection. Use sunscreen and insect repellent regularly. Gloves are also a good protective measure for the hands when washing dishes, cooking, cleaning or working outdoors.

TRAUMA CAN ALSO INCREASE SWELLING & FURTHER DAMAGE THE LYMPHATIC SYSTEM

Avoid blood pressure checks, IV’s, blood draws, and shots in the affected limb. Do not cut into cuticles when trimming fingernails or toenails. Use an electric razor when shaving.

Proper Nutrition

Increased weight complicates lymphedema. Maintain a balanced diet of fruit, vegetables, whole grains, and protein. Avoid excessive consumption of fatty foods, sweets, salt and alcohol. Drink plenty of water and unsweetened liquids.

Exercise

Moderate exercise such as swimming, walking, biking, light strength training and yoga are recommended. Overly aggressive sports that may cause injury should be avoided. Consult your physician before beginning a program.

Weather & Traveling

Always wear compression garments when flying or driving, as recommended by your physician or therapist. When traveling by car, be sure the seat belt is comfortable and make frequent stops since prolonged sitting may increase swelling. Avoid extreme changes in temperature (over 90 degrees or below zero), sunbathing, tanning beds, saunas, steam rooms, and hot tubs.