*Lymphedema is the abnormal accumulation of a protein rich fluid in the body’s cells that causes chronic
inflammation and fibrosis of the affected regions.
Lymphedema is classified into two types:
Primary Lymphedema occurs as a result of lymphatic dysplasia. It is present at birth,
but most times it presents itself later in life lacking any obvious reasons.
Secondary Lymphedema can be a result of surgery, injury, or radiation for
cancer.
*Klose Training and
Consulting, LLC 2006What is Lymphedema Therapy and How Does It Occur?
Lymphedema therapy is also known as “Complete Decongestive Therapy” (CDT). It is a therapy method that has been
used in the United States since the late 1980’s. It originated and was developed in Europe since the 1930’s by a
massage therapist and a physician.
It consists of a massage technique known as “manual lymphatic drainage,” remedial exercises, education for skin
care, and the use of compression wrapping with bandages and/or compression garments.
Contraindications for Complete Decongestive Therapy (CDT)?
*MLD/CDT Contraindications: ABSOLUTE:
Acute infections of any kind
Decompensated CHF
Acute DVT
RELATIVE:
Malignant disease (OK for palliative care)
Cardiac arrhythmia (AV Block)
Hyperthyroidism
Hypersensitivity of the carotid sinus
Caution in patients greater than 60 years old (arteriosclerosis)
*Klose Training and Consulting, LLC
2006Considerations for CDT
Private insurance generally covers CDT
Medicare covers CDT
Garments are not covered by Medicare due to their soft good status, but are usually imperative in the
compliance and success of volume reduction
A patient must be able to assist in his/her program or have a family member that can assist
The Physiology Of Lymphedema
It centers on Starlings Equilibrium. Starlings Law is based on that there is nearly a balance between the venous
system and the arterial system at the cellular level. The “near” balance of the A-V system requires the accessory
lymphatic vessels pick up the remainder at the cellular level. The lymphatic system picks up the excess water,
proteins, and dead cells resulting from lymphocyte activities.
Physiologically, swelling occurs because of either a High Output Failure or a Low Output Failure. These two can
be combined to form a Combined Lymphatic Insufficiency.
A high output failure is also called a dynamic insufficiency.
The load on the lymphatic system is so great that even with it being intact it cannot compensate enough to prevent
swelling. This usually results in the swelling that we see resulting from surgery, injury, or CHF. This edema is a
low protein fluid.
Recap: The lymphatic system is intact, but overburdened. It will usually catch up, but it may take too long and
present additional risks for the patient including immobility, delayed wound healing or infection.
A low output failure is also called a mechanical insufficiency.
Because of malformation of the lymphatic system usually the lymph vessels, the lymphatic system has difficulty
transporting even a minimal amount of fluid. The result is lyphedema -a protein-rich fluid. Long term lymphedema
results in fibrosis of the skin, hardening of the protein intracellularly, high risk of cellulitis, and open
wounds.
CDT can assist patients with either type of insufficiency provided no other co-morbidities prevent the
implementation of CDT.
