Lymph Oedema

Lymph oedema is a chronic condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. The cause can be insidious (primary) or after injury of lymph vessels (secondary).  Between 38 and 89% of breast cancer patients suffer from lymph oedema due to auxiliary lymph node dissection and/or radiation. Unilateral lymph oedema occurs in up to 41% of patients after gynaecologic cancer. Lymph can adversely affect quality of life and requires life-long management.

Lymph oedema can occur and be treated after

  • Lymph node dissection, surgery or radiology after cancer,
  • Complex regional pain syndrome
  • Chronic and sub acute inflammations, including sinusitis
  • Obesity,
  • In Palliative care, pain relief, relaxation

Manual lymphatic drainage (MLD) is a gentle massage technique which encourages the natural drainage of the lymphatic fluid. The lymph system depends on Angiomotorik of the lymph vessels and the pumping effect of the movement of skeletal muscles to propel lymph through the vessels to lymph nodes and to the lymph ducts which return lymph to the cardiovascular system. MLD uses a specific amount of pressure (less than 9 ounces per square inch) and rhythmic circular movements to stimulate lymph flow along the lymphatic ducts.

Combined Decongestive Therapy combines MLD technique with bandaging, exercises and skin care. It may also include breathing exercises and compressive garments. CDT has been shown to relieve the pain and discomfort that accompany oedema and fibrosis

Does it work? There is research to support the usage of MLD for lymph oedema. Williams et al (2002) found in a randomized controlled crossover study that MLD significantly reduces excess limb volume and reduced dermal thickness in the upper arm in woman with breast cancer- related lymph oedema. Quality of life, in terms of emotional function, dyspnoea and sleep disturbance and a number of altered sensations, such as pain and heaviness, were also significantly improved by MLD. (A.F. Williams et al 2002)

Frequency and duration of sessions depend on the extent of the oedema. In severe cases daily treatment over 2-3 weeks might be needed to reduce the oedema prior to fitting compressive garments. In other cases a few weekly sessions might be enough to educate the patient teach him or her to self manage/ massage.