Physical Therapy for Lymphedema – The Nebraska Medical Center

Physical Therapy for Lymphedema – The Nebraska Medical Center


The great thing about what we do is that it
does work. You don’t have to be the right kind of person, the right ethnicity, the right
size or gender. It works on everyone, as long as you show up and are diligent with being
compliant with your care. Sometimes it’s a genetic link; patients
are born with fewer lymph nodes than the average person. And because of that, their lymphatic
system is not able to keep up with just the daily demand of fluid that flows through that
system. Sometimes it’s also obesity; people that are very heavy tend to put pressure on
the lymph nodes, usually in the groin. And because of that pressure on them, they’re
not able to work as well as they should, because if that fluid accumulates over time, then
people are left with swelling. On the flip side of that, there’s also secondary
Lymphedema and that’s secondary to a trauma that we know of, such as radiation or lymph-node
removal (some sort of disruption of a lymphatic system). In that case, patients generally
know why they have the Lymphedema, but they still don’t understand the process and the
treatment. In physical therapy, we kind of have two goals.
One is to reduce the size of the limb; the arm or the leg, or even the head and trunk.
The second part is to improve function; whether that’s range of motion or strength or mobility.
And they kind of go hand in hand. But once we’ve reduced the limb, then we work also
in stretching, range of motion, strengthening exercises, gate training, so that the person
can be as functional as possible. Our treatment for Lymphedema basically consists
of four parts. The first part is one of the most important; it’s manual lymphatic drainage.
People call this a massage, although it’s not technically a massage; it’s actually
re-routing the fluid from the damaged area to a healthy area that can handle the fluid
and eliminate it out of the body. That’s the biggest part of it and that part is very
relaxing, it consists for about 75 percent of our treatment time in the clinic. The second
component is wrapping; we wrap the extremity with a short stretch bandage. They kind of
look like an Ace wrap. However an Ace wrap has a really long stretch to it and what we
wrap with is a short stretch bandage. We wrap up the extremity with that and as the extremity
tries to swell, the short stretch bandage stops the swelling. The third component would
be skin care and education. That’s a big part of our treatment also, because Lymphedema
does not go away; we have no cure for it. We simply can manage it. So educating a person
or a patient on how to manage the condition for the rest of their life is a very important
part. The final component is exercise; we want a person to be active in their wraps
and therefore have a muscle pump going on along with the compression to help and reduction.
The other thing that I like is that there’s no drugs and no surgery; it’s a hands-on
manual technique. But it’s not as easy as it sounds either; you do have to be diligent
with your care and you have to come in for therapy consistently. If I just saw a patient
once a week or once every couple of weeks, the swelling would come back again. So it’s
something during the reduction phase, we really have to be consistent with treatment and patients
have to make a commitment to come in for their therapy appointments. Generally we see a patient three times a week,
and that can be anywhere from four weeks to 12 weeks to even more in severe cases. That’s the best part of my job; we get such
great patient reactions. The other great thing is that people usually start seeing a difference
within the first treatment or the first week and it really motivates them. My very first
Lymphedema patient came to me after about two weeks of treatment and said, “Deana,
for the first time in 10 years I can get my own leg into bed. I used to have to call my
son to help me get into bed and I can do it myself.” And that was really rewarding for
me as a therapist and for her too. It also motivated her to continue losing weight elsewhere
in her body too and just become more functional and more mobile. The other great thing is
lots of times this spurs a patient to lose weight. Just in general, they’re more mobile,
they’re able to do things better and it just kind of starts motivating them. And I
have two patients right now that have lost about 75 pounds since starting therapy in
a couple months, a couple two or three months. A lot of that’s fluid, but a lot of that
is just being more active and losing weight all around. So it’s great.

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