Balanced Physical Therapy

An article distributed to physicians on March 16, 2007

Lymphedma is a painful, emotionally taxing condition suffered by more than half a million Americans.¹Â  Irreversible  lymphedema occurs when the lymphatic system is damaged to the extent that interstitial fluid production exceeds the lymphatic system’s capacity to filter and transport.  In most cases of secondary lymphedema, surgery and/or radiation often did not cause all the damage necessary to create irreversible lymphedema.  In many cases, these procedures only started the process.  The subsequent swelling triggers an inflammation-like response that, when inadequately addressed, can permanently degrade the lymphatic system.  When prescribed prophylacticly, as few as two timely sessions of manual lymphatic drainage at Balanced Physical Therapy can help your patient manage harmful swelling after surgery or radiation.  After lymphedema is established, maximal decongestion can often be achieved in 10 visits for upper extremities or 20 visits for lower extremities.  

In the United States, lymphedema usually develops following disruption or obstruction of lymphatic pathways due to surgery, radiotherapy, or disease process.²Â  The most common scenario is lymphedema following surgery for breast cancer.

 

Pathophysiology:  After an initial insult to the lymphatic drainage system, protein-rich fluid accumulates in the tissues (usually upper or lower extremities).  Protein rich swelling or edema causes the accumulation of lipoperoxides that attract defense cells.  The defense response results in fibroblasts producing more connective tissue and lipid-storing adipocytes.  This can result in the fibrosclerosis typical of lymphedema and proliferation of fatty tissue.³Â Â Â Â Â 

Publicity for manual lymphatic drainage techniques often focuses on the dramatic effects achieved with moderate to severe lymphedema.  However, by managing post-surgical swelling before the defense response causes further damage, manual lymphatic drainage works to prevent swelling from progressing to irreversible lymphedema.  Research involving lymphoscintigraphies has demonstrated that manual lymphatic drainage stimulates accessory routes useful for resporption of lymph.⁴  Numerous studies have demonstrated the safe efficacy of complete decongestive therapy^5-8 and of manual lymphatic drainage alone^4,9-13 (without compression garments). Prescribe a short course of manual lymphatic drainage soon after surgery to prevent progressive damage to the lymphatic system and to enhance what capacity remains in the system.   

Please let your patients know that Balanced PT works to prevent lymphedema and helps manage existing cases of lymphedema.

 References  

1. Sunga A, Oeffinger K, Hudson M, et al. “Care of Cancer Survivors.” Am Fam Physician 2005; 71: 699-706, 713-4.
2. O’Brien J, Chennubhotla R. “Treatment of Edema.” Am Fam Physician 2005; 71: 2111-7, 2118.
3. Foldi E, Foldi M, Jamal S, et al. “Lymphedema – Management Today.” Beiersdorg AG Hamburg, JOBST GmbH Emmerich, 1999; p 11.
4. Ferrandez J, Laroche J, Serin D, et al. “Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.” J Mal Vasc. 1996; 21 (5): 283-9.
5. Cheville A, McGarvey C, Petrek J. et al. “Lymphedema management.” Semin Radiat Oncol. 2003; 12 (3): 290-301.
6. Fiaschi E, Francesconi G, Fiumicelli S. “Manual lymphatic drainage for chronic post-mastectomy lymphodema treatment.” Panminerva Med. 1998; 40 (1): 48-50.
7. Liao S, Huang M, Chou Y. “Successful complex decongestive physiotherapy for lymphedema and lymphocutaneous reflux of the female external genitalia after radiation therapy.” J Formos Med Assoc. 2003; 102(6): 404-6.
8. Leduc O, Leduc A, Bourgeois P. “ The physical treatment of upper limb edema.” Cancer. 1998; 83 (12 Suppl American): 2835-9.
9. Kafejian-Haddad A, Perez J, Castiglioni M, et al. “Lymphscintigraphic evaluation of manual lymphatic drainage for lower extremity lymphedema.” Lymphology. 2006; 39 (1): 41-8.
10. Williams A, Vadgama A, Franks P. “A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema.” Eur J Cancer Care (Engl). 2002; 11 (4): 254-61.
11. Kligman L, Wong R, Johnston M, et al. “The treatment of lymphedema related to breast cancer: a systematic review and evidence summary.” Support Care Cancer. 2004; 12 (6): 421-31.
12. de Godoy J, Batigalia F, Godoy F. “Preliminary evaluation of a new, more simplified physiotherapy technique for lymphatic drainage.” Lymphology. 2002; 35(2): 91-3.
13. Herpertz U. “Outcome of various inpatient lymph drainage procedures.” Z Lymphol. 1996; 20 (1): 27-30.

©BMA 2008