Linda Koehler, PT, CLT-LANAUniversity of Minnesota

Artery VeinLymphatics

Blood Capillary

Arterial malformation •Venous malformation•Venous insufficiency•DVT

•Lymphatic malformation•Infection•Trauma•Phlebolymphedema

Venous swelling

Lymphatic swelling

The Lymphatic System

Main functions: Helps balance the

body’s fluidProtects the body from

infection

Wikipedia-Lymphatic system, July 2008

What is Lymphedema?Swelling caused by an abnormal

accumulation of protein rich fluidIt can be located anywhere in the body -arms,

legs, trunk, chest, genitalia, or head/neckIt is chronic and progressive if left untreatedLeads to increase swelling, loss of function,

chronic infections, skin changes, and interferes with wound healing

Signs and Symptoms• Swelling of a body part• Heaviness, tightness, or fullness• Tingling sensation• Tight clothing or jewelry• Decreased flexibility of a limb• Feeling of achiness or the limb may tire more

easily• Pain, burning, throbbing• Skin and tissue changes, discoloration

Lymphedema Treatment: Complete Decongestive TherapyFour treatment

components:Manual Lymph

DrainageCompression TherapyRemedial exercisesSkin and nail careWound Care

Intensive Phase: Attending PT appts 4-5x/wk for 3-6 weeks. Appts lasting 1-2 hours.

Home management phase: Instruction in a home lymphedema program

Complete Decongestive Therapy

Manual Lymph Drainage-Manual movement of lymphatic fluid to areas that are functioning normal

Complete Decongestive TherapyCompression Therapy

Compression bandaging - low stretch bandages are applied to promote movement of the lymph fluid, soften hardened tissue, and prevent re-accumulation of fluid (Low stretch bandages vs. high stretch)

Compression garments-Comes in various styles, material, compression, and options.

PROPER FIT IS IMPORTANT!Juzo

BSN Jobst

Complete Decongestive TherapyLymphatic Exercises

Remedial exercises-helps improve lymphatic flow in an area (muscle pump action)

Aerobic exercise-biking, walking, etc. Pool therapy/Aquatics-compression and

movement of the water promotes lymph movement

Complete Decongestive TherapyProper skin and nail care /Lymphedema

precautionsAvoid infectionsAvoid extreme hot and cold temperaturesAvoid constriction Take good care of your skinLive a healthy lifestyle

Complete Decongestive TherapyWound Care

Pulsatile lavage with suctionDebridementVACCMIST therapyDressing changes and drainage management Wound prevention and protection.

Physical Therapy InterventionsPain Management

TENS-Transcutaneous electrical nerve stimulator

Modalities such as ultrasound, e-stim, hot and cold packs (if not contraindicated)

Pain relief exercises and activity (ie. Yoga, relaxation excercises)

Compression garments

**Each individual is different and may respond differently to therapy. People have different types of bodies, different patterns of movement, different alignments, different habits, and different conditions. Physical therapists can assess each individual and attempt to correct improper habits, alignments , movement patterns, and the physical condition of an individual.

How to find a CERTIFIED LYMPHEDEMA THERAPIST:

Academy of Lymphatic Studies- www.acols.comKlose Training- www.klosetraining.comNorton School- www.nortonschool.comVodder School- www.vodderschool.comNational Lymphedema Network-

www.lymphnet.orgLymphology Association of North America-

www.clt-lana.orgCasley-Smith Training- cltcourses@cs.com

Inpatient Lymphedema Program: Providence St. Peter Hospital -Olympia,

Washington-1-888-492-9480 x 37646

Genital compression

Scrotal swell spotLabia swell spot