What Is The Physical Therapy For Lymphedema?
Lymphedema is a chronic entity whose treatment depends on its symptoms. Most experts recommend treating lymphedema when there is a symptom of heaviness, tightness or swelling of the affected limb.
Complex Physical Therapy
It consists of a series of measures that are characterized as coadjuvants and normally they should not be isolated: it consists of measures that must be carried out by one’s own patient (hygiene, lymphedema care, kinesiotherapy, postural treatment of lymphoedema and elastic containment garments) and therapies applied by specialized personnel: manual lymphatic drainage, low elasticity bandages, and intermittent sequential pneumatic pressure therapy.
Manual Lymphatic Drainage
The main thing that this lymphedema technique seeks is the initial decongestion of the healthy quadrants and then allowing the lymphatic edema to pass through residual lymphatic collectors and lymphatic channels from the affected limb to the neighboring quadrants.
Technique: it is a massage technique that is applied on the surface of the skin and follows the anatomical location of the lymphatic vessels. It is slow and painless, it has to exert scarce pressure (<40 mmHg) following a centrifugal order of maneuvers (from the root to the distal area), but centripetal in the application of each of them.
External Compression Methods
After the application of manual lymphatic drainage in lymphedema, volume reduction should be maintained compression in the limb or region to increase the total pressure, decrease the difference in hydrostatic pressure between tissues and blood capillaries and increase the gradient of pressure between tissues and initial lymphatics. This compression can be done with bandages elastic or with elastic compression garments or sleeves.
Two are the modalities of external compression: The low- elasticity bandages or multilayer and tailor-made garments.
Low Elasticity Bandages/Multilayer
The multilayer bandages are based on the placement of low elasticity bandages (70%) that allow a low and high resting pressure in movement. They should be used continuously between a manual lymphatic drainage session and the next. Its effect is based on the pressure it exerts against filtration from the blood capillaries, the increase of the effect of the muscles on the venous and lymphatic vessels, the avoidance of lymphatic reflux due to insufficient the valves of the lymphangions and the smoothing of the areas of fibrosis.
Technique: It is difficult since it requires skill on the part of the physiotherapist to achieve a uniform but the greater pressure in distal areas than in the proximal ones, and requires placement of padding or filling in some areas.
Tailored Elastic Containment Garments
Once the edema has stabilized in lymphedema, a daytime containment garment should be placed which can be replaced periodically depending on the loss of effectiveness. Its function is not to improve but keep the volume. These garments or sleeves must be made to measure in flat knitted fabric manufactured without tension in cotton, rubber, and nylon (the circular weave is made to tension, it is more difficult to place, it only acts when the muscle is inactivity and the adjustment is not as precise as the plane). The upper limb can wear shoulder extensions or silicone bands for subjection. The garments can be complete including the hand or, more advisable, composed of a hand piece independent of the rest of the member. For the lower limb, there are also socks and stockings with extension to hip or full panty with finger protection.
Intermittent Sequential Pneumatic Pressotherapy
They are devices that create a pressure gradient in the distal to proximal direction with an external action mechanism similar to compression measurements (bandages and sleeves). The apparatuses can be uni- or multi-compartmental, achieving the latter a compression in cycles and sequences along the extremity.
The need for studies of better quality to evaluate and compare the influence of each therapy is frequently emphasized. For the purposes of routine clinical practice, the application of one or another guideline obeys to international consensus, experience and the availability of centers in which it is applied.