by Dr. Sara S. Morrison

Lymphedema is a condition affecting 1 in 1,000 Americans. It occurs when fluid backs up in the arm, leg, or trunk, causing one area of the body to be much larger and out of proportion from the rest. Sometimes people are born not having enough lymph vessels or lymph nodes. By far, most cases of lymphedema are developed because of injury to the lymph or vein systems. This is common after cancer treatments. It is important to understand that many times the cancer itself does not cause the lymphedema, but rather the treatment for it does. 

Signs of Lymphedema

  • Swelling occurs in the arm/leg on the side of the cancer or injury
  • Dull achy pain 
  • Swelling initially improves with elevation, but as it progresses, elevation no longer helps
  • Difficult to fit into clothes
  • Skin changes (e.g., discoloration, skin folds, peeling, breaks/cracks)

Possible Causes of Lymphedema

Surgery: Many times cancer will be treated with surgery. During surgery, the doctor will remove anything that is affected by the cancer, including lymph nodes. When the lymph nodes are gone, they cannot drain the lymph from this area. 

Radiation: Radiation kills cancer, but it also kills everything else as well. During radiation treatment, the lymph nodes in the immediate area often undergo radiation and are unable to drain the lymph from that area.

Vein Insufficiency: Normally, valves in your deeper leg veins keep blood moving forward toward the heart. With long-term (chronic) venous insufficiency, vein walls are weakened and valves are damaged. It can also occur after blood clots in the legs. The veins stay filled with blood, causing swelling in the legs and feet. The skin may look brown and flakey.

Areas with the most lymph nodes:

  • Abdomen (belly)
  • Neck
  • Armpits and groin

When a person has cancer, surgery and/or radiation is often required to fully remove the cancer. Lymph nodes in the armpit, groin, or belly may be removed during surgery or damaged after radiation, causing fluid build up in these areas.

This process of fluid build-up may be fast or slow, depending on how many lymph nodes were affected. Some people notice excess fluid in a matter of weeks. For others, it’s years. Some never develop lymphedema. The important thing is to know the signs of lymphedema and get treatment IMMEDIATELY!

Lymph fluid is made of water as well as other “gunk” leaving your body. Since it is made of more than water, lymphedema is different than other edema. It is much thicker and more dense than regular swelling. We call this “fibrous” or “high protein” fluid. 

Successful PT treatment of Lymphedema includes 4 phases:

Skin Care
The skin over your affected area is very sensitive. It is very important to take good care of it! Keep the area moist, clean and protect it in the sunlight.

Manual Lymph Drainage
A specialized, very light massage is used to target the lymph system and stimulate the lymph vessels to remove more fluid.

The fluid can be “rerouted” around missing/broken lymph nodes. I think of this like a traffic detour. If you are on your way from Point A to Point B, the best route, as they say, is a straight line. But when you head out to work on Monday morning, you find there is a traffic detour. (ugh!) In order to get from Point A to Point B, you have to detour in a big circle. You will eventually get to work, but it is not the fastest route.

Your lymph system is much like this. Lymph vessels are special because the direction of their flow can be changed. When we move excess lymphedema out of your fingers and up your arm, we find that there are missing lymph nodes in your armpit. No worries! We can just reroute the flow to lymph nodes that ARE present and working! This way, all of the fluid gets removed from your body. The fluid may take the long route, but it will leave. 

Bandaging
Compression bandages make sure the fluid continues to drain properly during MLD and for a long time afterwards. This is important to keep improving and not let that fluid creep back into your system.

Low-level Exercise
Light range of motion exercises will help stimulate the lymphatic flow. These will also restore your movement. Resisted exercise using weight is not advised.

Following these steps will be the best way to manage your lymphedema. Lymphedema is a life-long issue. It cannot be cured, only managed. Following these steps and being treated at first sight of these symptoms will allow you to live a healthy, normal life. 

No doctor referral is needed for Physical Therapy, and treatment is often covered under your health insurance. Lymphedema is a specialized kind of Physical Therapy. For best results, make sure you are treated by a Certified Complete Decongestive Therapist.

Dr. Sara S. Morrison
Owner Total Body Therapy & Wellness / PT, DPT, CDT, FCE, CFT, Cert DN, Cert FMT