User Tools

Site Tools



manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt

MANUAL LYMPHATIC DRAINAGE (MLD) and COMPLEX DECONGESTIVE THERAPY

Related Terms: Manual Lymphatic Drainage, MLD, Comprehensive Decongestive Therapy, CDT, Complete Decongestive Therapy, Complex Decongestive Physiotherapy, CDP, Simple Lymph Drainage, lymphedema, arm lymphedema, leg lymphedema

TWO BASIC TYPES OF THERAPY FOR LYMPHEDEMA

Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.

This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.

First brought to North America in 1982, the school is located in Victoria, British Columbia, Canada. Before it was introduced the standard treatment course in North American was either a surgery called debulking or the use of compression machines wherein the limb was literally squeezed by pneumatic air pressure.

The sessions generally last about one hour and will continue for a duration of four to six weeks.

. . . . . . . . .

Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.

Also known as Complete Decongestive Physiotherapy (CDP), this treatment therapy was pioneered in the United States by Dr. Robert Lerner.


From a recent post I made on a lymphedema board 07/14/04

DECONGESTIVE THERAPY

I received an email request to describe what decongestive therapy is since I have mentioned it so many times. It is the treatment of choice presently used for lymphedema.

To understand how and why decongestive therapy works, first you need to undersand exactly how the lymph system is made up. We generally think of the lymph system as these “channels” the go throughout our body and are connected by lymph nodes. However, it is also comprised of an unblievable network of lymph capillaries that network under and through the skin layers our of body. This almost microscopic network collects fluids and channels it into the lymph veins to be filtered through the lymph nodes and eventually carried out of the body. In lymphedema, because of an impaired lymph system, fluid collects in the interstitial areas (tissues) between cells. This fluid is composed of proteins and electrolytes and even includes the liquid of blood plasma. You normally have about 15 quarts of this fluid in your system. With our condition, this liquid doesn't move as it should and eventually the affected areas swells from the excess fluid, the whole system becomes “clogged.”

Decongestive therapy is a massage technique that helps unclog the system. It gently moves this fluid, in the direction of normal body flow so that it can be eliminated. In unclogging the system, the tiny network of lymph capillaries are able to help move the fluid.

There are two basic types of decongestive therapy.

Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.

This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.

Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.

Also known as Complete Decongestive Physiotherapy (CDP) or Complex Decongestive Therapy (CDT).

After each session, your limb will be wrapped in compression bandages to prevent reswelling until the next session. Once the limb is down to the desired size, you will be measure for a custom made compression hosiery type garment and pressure sleeve.

WHAT HAPPENS WHEN LYMPHEDEMA IS NOT TREATED?

I sound like a broken record on urging everyone to get decongestive therapy, because for me, it came too late. By the time I had heard of this treatment my left leg (the worse one) was already beyond treatment. I have had three lymphedema therapists tell me that there was nothing that even this treatment could do.

Like most hereditary/primary lymhpedema patients (Milroy's Syndrome) my legs are not as large as lot I have seen. They are about twice the normal size. But, the left one is totally fibrotic, literally as hard as a rock. It is the hardest and most grotesque leg you would ever NOT want to have or see. As such, the infections, which have been plentiful and furious, especially during the past two years can only be controlled through months of IV antibiotics. Sometimes, I have even had to use a combination of Unasyn and Gentimycin.

It is also where the first of my two lymphomas appeared. I am now also loosing venous flow to my left foot because of the fibrosis. On my left ankle, I have an ominous and rapidly growing purplish nodular growth (soon to be biopsied). The change in this leg has been more dramatic and intense during the past year than all the other 50 years I have had lymphedema. What ever you do…get that lymphedema diagnosed early and get treatment immediately. I wish with all my heart that none of you have to experience the complications I now face.

The Dr. Vodder School - North America

Manual Lymph Drainage and Combined Decongestive Therapy

http://www.vodderschool.com/lymphedema

TREATMENT FOR LYMPHEDEMA

Complex Decongestive Physiotherapy, (CDP) or Complete Decongestive Therapy (CDT) Manual Lymphatic Drainage

This treatment is a gentle light touch massage. This prevents damage to the tissues. It promotes lymph flow through the collateral (superficial) lymph vessels to channel the lymph into the abdominal area ( the “watershed”) and into normal functioning lymphatic vessels and nodes. These collateral lymph vessels are usually working normally and the problem lies in the deeper vessels which were damaged and scarred.

Bandaging

The therapist places compression bandaging around the limb. Often foam chip pads are placed under the bandaging to increase pressure on fibrotic area to break down scar tissue. These bandages stay on 24 hours a day throughout the treatment period. They come off only to shower, do skin care, assess the swelling reduction and to do the MLD.

Skin Care

Use a soap with a low pH., unscented and not antibacterial soaps. A good liquid soap is Cetaphil. The skin must be moisturized after bathing. Use a lotion like Eucerin or Nivea. If there are any irritations use an antibacterial cream. Always dry the area very well, and gently, after washing.

Exercises

An individualized exercise program will be given by the therapist to each patient. They will improve muscular contractions and joint mobility. There will also be strengthening exercises for the limb that will reduce muscle atrophy. Muscular contractions along with the low-stretch bandages provide constant counter pressure to keep the lymph fluid moving.

MANUAL LYMPHATIC DRAINAGE

Dr Vodder's Manual Lymphatic Drainage (MLD) is an advanced therapy in which the practitioner uses a range of specialized and gentle rhythmic pumping techniques to move the skin in the direction of lymph flow.

This stimulates the lymphatic vessels which carry substances vital to the defense of the body and removes waste products.

The first visit will include a consultation and the therapist will outline the number and frequency of sessions. Each session will last approximately one hour.

Where appropriate the therapist will work in conjunction with your medical practitioner.

THE HISTORY OF MANUAL LYMPHATIC DRAINAGE (MLD)

During the early 1930's Dr Emil Vodder created a unique range of movements which brought relief from chronic conditions such as sinus congestion and catarrh.

Since Vodder's pioneering work, Manual Lymphatic Drainage has spread world-wide and has become a popular treatment in many European hospitals and clinics.

MLD is now beginning to gain acceptance in the U.K. as a component in the treatment and control of lymphoedema.

The Benefits Of Manual Lymphatic Drainage

Manual Lymphatic Drainage:

is both preventative and remedial and can enhance your well-being is deeply relaxing

promotes the healing of fractures, torn ligaments, sprains and lessens the pain

can improve many chronic conditions: sinusitis, rheumatoid arthritis,scleroderma, acne and other skin conditions. may strengthen the immune system

relieves fluid congestion: swollen ankles, tired puffy eyes and swollen legs due to pregnancy

is an effective component of the treatment and control of lymphoedema and assists in conditions arising from venous insufficiency

promotes healing of wounds and burns and improves the appearance of old scars minimizes or reduces stretch marks

HOW TO DO SELF LYMPHEDEMA MASSAGE (Simple Lymph Drainage) ON A LEG

All the Lymphatic Drainage strokes are based on one principle motion.

Research has found that the initial lymphatics open up and the lymph angions are stimulated by a straight stretch, but even more so with a little lateral motion. After these 2 motions, we need to release completely to allow the initial lymphatics to close and the lymph to be sucked down the channels. In this zero pressure phase don’t completely disconnect from the skin, just return your pressure to nothing. Also don’t pull the skin back with you as you return, let it spring back by itself.

This basic motion may resemble a circle, and is called stationary circles. All motions are based on this principle.

In orienting this motion, we always want to push the lymph towards the correct nodes, so the last, lateral stretch motion should be going towards the nodes.

Think about moving water. Visualize those initial lymphatics just in the skin, stretch, opening them up, then release and wait for the lymph angions to pump the lymph down the vessel. Remember how superficial this is. If you are feeling muscle, or other tissue under the skin, you are pushing too hard.

Here are four points remember when performing Lymphatic Massage-

1. Correct pressure is deep enough so that you do not slide over the skin, but light enough so that you don’t feel anything below the skin. This is about 1-4 ounces. It is very common for massage therapists trained in Swedish or deep tissue to apply too much pressure with lymphatic drainage massage. Sometimes it is hard to believe that something so light could be effective. Always remember- you are working on skin. How much pressure does it take to deform the skin? Almost nothing. Remember- if you push too hard you collapse the initial lymphatic.

2. Direction of your stroke is of great importance, because we always want to push the lymph towards the correct nodes. If you push the lymph the wrong way, your work will not be effective.

3. Rhythm is very important because with the correct rhythm and speed, the initial lymphatics are opened, and then allowed to shut and then there is a little time that is given for that lymph to get sucked down along the vessel. An appropriate rhythm will also stimulate the parasympathetic nervous system, causing the client to relax.

4. Sequence means the order of the strokes. When we want to drain an area, we always start near the node that we are draining to. Always push the lymph toward the node. Then as we work, we move further and further away from the node, but always pushing the fluid back in the direction of the node. In this way we clear a path for the lymph to move, as well as create a suctioning effect that draws the lymph to the node.

Link no longer valid

Self MLD for the Lower Extremity

v Rules for MLD:

o The strokes should be made with arcing motions or half circle motions.

o Do not slide over your skin, but rather, keep your fingers in contact with your skin and stretch it gently over the underlying tissues.

o You should have NO PAIN.

o Each stroke should be done 10-15 times SLOWLY, taking about 2 seconds for each stroke.

o If redness occurs, you are pressing too hard.

o For lymphedema of BOTH legs, perform all moves on both sides.

o The best position to be in for this is seated reclined, or lying down and propped up slightly.

o Make sure you can make skin-to-skin contact for all of these strokes. They won't work when done over clothing.


1. Neck: Place the flats of your fingers on your opposite shoulder, in the triangular part just above the collarbone and next to your neck. Move your hand in an arcing motion stretching the skin forward and down towards your chest. Repeat this on the other side.

2. Armpit: Raise your arm (on the same side as the leg in which you have lymphedema), bend you elbow, and place the hand behind your head. Place the flat of your opposite hand in your armpit. Stretch the skin in an arcing motion up towards the neck.

3. Above the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) below the breast, but above the waist. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

4. Below the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) on or just below the waist, but above your hip. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

5. Deep (diaphragmatic) breathing: Place both open palms on top of each other below the belly button. Take a slow breath in and feel your belly rise up into your hands as it expands to take in the air. Then breath out and feel your belly sink in as the breath leaves you. As you get better at this you can use your hands to resist your stomach slightly as you breath in, and press in slightly with your hands as you breath out. Don’t get dizzy. Start with only 2 or 3 breaths and work up to 10 as you get stronger.

6. Groin: Place the flat of your hand on the front of your groin, right where your underwear falls. Make a scooping motion in the groin, rolling your hand from the thumb to the little finger. Imagine that your hands are the bottom of a water wheel.

7. Back of knee: Place the flat fingers of both hands behind your knee. Perform a scooping motion up towards the body.

8. Repeat steps 3, 4 and 6 (waist and groin areas)

A very special Thanks to Katy from

LymphedemaTherapists · Lymphedema Therapists

FINDING A QUALIFIED LYMPHEDEMA THERAPIST

To find a qualified and trained CDT/MLD lymphedema therapist in your area, in addition to information on training programs, and some helpful links, visit: The American Society of Lymphology Resources (aka Lymphedema Therapist International)

When looking for a therapist, you should ask the following questions:

1. Where did you get your training?

2. What approach do you use? Vodder, Foeldi, Casley-Smith etc.

3. How many hours of training have you had? (120 to 160 hrs. or more is good)

4. Are you an OT., PT., MT. ? Where did you get your degree?

5. How long have you been doing CDT/MLD ?

6. What certification do you have?

7. How many times a week will I have treatment and for what length of time?

8. How long will my consultation be?

9. Will there be a therapist on call at all times?

10. Is there a doctor, APRN, or nurse connected with the facility? How often will I be seen by them?

For more information on choosing a lymphedema therapist, go to the

National Lymphedema Network's Resource Guide

Choosing a Lymphedema Therapist

http://www.lymphnet.org/choosing.html

Support the National Lymphedema Network

http://www.lymphnet.org/

Clinical Studies and Articles

Comprehensive decongestive therapy in postmastectomy lymphedema: An Indian perspective. Oct 2011

Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R.

Source

Department of Surgery, JIPMER, Puducherry, India.

Abstract

Background: Lymphedema following breast cancer treatment is one of the most morbid conditions affecting breast cancer survivors. Currently, no therapy completely cures this condition. Comprehensive Decongestive Therapy (CDT), a novel physiotherapeutic method offers promising results in managing this condition. This therapy is being widely used in the West. Till date, there are no studies evaluating the effectiveness and feasibility of this therapy in the east.

Materials and Methods: The therapeutic responses of 25 patients with postmastectomy lymphedema were analyzed prospectively in this study. Each patient received an intensive phase of therapy for eight days from trained physiotherapists, which included manual lymphatic drainage, multi layered compression bandaging, exercises, and skin care. Instruction in self management techniques were given to the patients on completion of intensive therapy. The patients were followed up for three months. Changes in the volume of the edematous limb were assessed with a geometric approximation derived from serial circumference measurements of the limb and by water displacement volumetry. Changes in skin and sub cutis thickness were assessed using high frequency ultrasound.

Results: The reduction in limb volume observed after therapy was 32.3% and 42% of the excess, by measurement and volumetry, respectively. The maximum reduction was obtained after the intensive phase. The reduction in skin and subcutis thickness of the edematous limb followed the same pattern as volume reduction. Patients could maintain the reduction obtained by strictly following the protocols of the maintenance phase.

Conclusions: CDT combined with long-term self management is effective in treating post mastectomy lymphedema. The tropical climate is a major factor limiting the regular use of bandages by the patients.

PubMed

Effects of complex decongestive physiotherapy on the oedema and the quality of life of lower unilateral lymphoedema following treatment for gynecological cancer.

Sept 2008

Kim SJ, Park YD.

Source

Department of Physical Therapy, Youngdong University, Chungbuk, Republic of Korea. lymphkim@naver.com

Abstract

Keywords: cancer;lymphoedema;quality of life;complex decongestive physiotherapy

There is increasing interest in the health-related quality of life (QOL) of patients with chronic lymphoedema. The purpose of the present study was to ascertain whether or not complex decongestive physiotherapy (CDP) for 57 gynecological cancer patients with unilateral lymphedema results in a measurable change in the oedema and QOL, and % excess volume correlated with change in QOL. % excess volume was significantly (P<0.05) decreased after CDP. The QOL scores were significantly (P<0.05) higher than the scores at baseline, indicating an improvement in the QOL. The change in % excess volume was associated with a change in physical functioning, social functioning, role-physical, bodily pain and general health at baseline and 1 month (P<0.05). This study suggests that significant improvements are made in the QOL of gynecological cancer patients with unilateral lymphoedema after CDP, which is necessarily correlated with limb reduction.

PubMed

Intensive decongestive treatment restores ability to work in patients with advanced forms of primary and secondary lower extremity lymphoedema.

Dec 2011

Stanisic MG, Gabriel M, Pawlaczyk K.

Source

Department of General and Vascular Surgery, Poznan University of Medical Sciences, ul Długa 1/2, 61-848 Poznań, Poland.

Abstract

OBJECTIVE: To show that adequate therapy for lymphoedema is able to restore ability to work.

MATERIALS AND METHODS: The population of patients with primary lymphoedema registered in the university clinical centre diagnosed with primary or secondary lymphoedema and presumed by the national social institution as completely unable to work was selected for the retrospective analysis and divided into two groups. Group 1 consisted of 25 patients treated with a complex decongestive therapy programme daily for 3-6 weeks. The study population comprised 19 women and six men from 14 to 61 years of age (mean 31.5). In all 25 patients, complete inability to work was certified by the social institution before the treatment started. Group 2 consisted of 47 patients, 14 men and 33 women, aged from 26 to 71 years (mean 39 years) treated by so-called standard methods, who resigned from the proposed intensive treatment. In all 47 patients, complete inability to work was declared by the social institution before the treatment. Ability to work and oedema reduction were assessed by the treating physician.

RESULTS: The intensive phase of treatment succeeded in 3870-15,330 mL oedema reduction in Group 1. After the end of therapy, 21 patients were able to work or study without any limitation and patients returned to their regular professional activity. Among four others, two were on welfare for at least 10 years, for another one welfare was their only income and one person was receiving a social pension. In none of the patients from group 2 was any significant oedema reduction observed. Every patient from group 2 maintained the social pension due to ineffective treatment.

CONCLUSIONS: Complex decongestive therapy is a very efficient form of treatment in advanced primary and secondary lymphoedema. It allows returning to work after a short period of temporary disability without the necessity of a social pension.

PubMed

Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Nov 2011

Cohen MD.

Source

mercohphysicaltherapy@gmail.com

Abstract

BACKGROUND AND PURPOSE: This case report describes a patient who developed lower-extremity lymphedema secondary to orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP), with 8 treatment sessions over 3 months.

CASE DESCRIPTION: The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion, and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited activities such as ambulating long distances and climbing stairs. This limited activity restricted him from participating in his normal lifestyle activities such as walking his dog in the community and performing all necessary work duties.

OUTCOMES: Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at discharge. He was independent with his home program in order to maintain the results of therapy.

DISCUSSION: Physical therapist management of secondary lymphedema due to orthopedic trauma and surgery of the lower extremity was effective in decreasing circumferential girth measurements and decreasing limb volume, thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported improvement in his ability to perform all work activities, and he returned to his prior level of participation in the community.

Journal of American Physical Therapy Assoc

Retrospective trial of complete decongestive physical therapy for lower extremity secondary lymphedema in melanoma patients. Jan 2011

SpringerLink

The standard of care for lymphedema: current concepts and physiological considerations.

2009

Lymphatic Research and Biology

MaryAnnLiebert Publications

Complete decongestive physiotherapy with and without pneumatic compression for treatment of lipedema: a pilot study. Mar 2008

PubMed

Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema.

Szuba A, Cooke JP, Yousuf S, Rockson SG.

Stanford Lymphedema Center, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.

PURPOSE: A prospective evaluation was undertaken to assess the efficacy of intensive, short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema.

METHODS: The therapeutic responses of 79 patients with lymphedema were analyzed prospectively. Each patient received intensive, short-term decongestive lymphatic therapy, with quantification of the extent and durability of the clinical response. Decongestive lymphatic therapy was performed by therapists trained in these techniques. The mean (+/-SD) duration of therapy was 8+/-3 days. Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient's treatment. The mean period of follow-up was 38+/-52 days. Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb. RESULTS: The mean short-term reduction in limb volume was 44%+/-62% of the excess volume in the upper extremities and 42%+/-40% in the lower extremities. At follow-up, these results were adequately sustained: mean long-term excess volume reductions of 38%+/-56% (upper extremities) and 41%+/-27% (lower extremities) were observed. CONCLUSION: Decongestive lymphatic therapy, combined with long-term self-management, is efficacious in treating patients with lymphedema of the extremity.

PubMed - National Library of Medicine

NIH

Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema.

Liao SF, Huang MS, Li SH, Chen IR, Wei TS, Kuo SJ, Chen ST, Hsu JC.

Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan.

BACKGROUND AND PURPOSE: Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema.

METHODS: Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume.

RESULTS: The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients. CONCLUSIONS: Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese

PubMed - National Library of Medicine

NIH

ffect of complex decongestive therapy on edema and the quality of life in breast cancer patients with unilateral leymphedema.

Sept 2007

Lymphology. 2007 Sep

Kim SJ, Yi CH, Kwon OY. Department of Physical Therapy, Yongdong University, Chungbuk, Republic of Korea.

There is increasing interest in the health-related quality of life (QOL) of patients with chronic lymphedema. The aim of this study was to ascertain whether complex decongestive therapy (CDT) for upper limb lymphedema results in long-term changes in lymphedema and QOL, and to determine whether the treatment-induced change in the percentage excess volume (PCEV) is correlated with any changes in QOL. Fifty-three patients who had lymphedema were treated with CDT. PCEV and QOL were recorded before and 1 month after CDT, and at a 6-month follow-up visit. PCEV was significantly (p<0.05) decreased at 1 month, but significantly (p<0.05) increased at 6 months compared to 1 month [but still significantly reduced (p<0.05) from baseline]. The QOL scores at 1 and 6 months were significantly higher than the score at baseline, indicating an improvement in the QOL. Significant changes were evident in the single domains of physical functioning, role-physical, mental health, and general health. The change in PCEV was associated with a change in physical functioning, vitality, bodily pain, and general health at 1 and 6 months (p<0.05). This study suggests that QOL significantly improved with upper limb lymphedema during the maintenance phase, which was necessarily correlated with the reduction in limb volume.

Pub Med

The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema.

Comment in: Lymphology. 2002 Jun;35(2):44-5. Weiss JM, Spray BJ.

Cox Regional Center for Sports Medicine and Rehabilitation, Springfield, Missouri 65807, USA. Weissfour@aol.com

Lymphedema is a chronic disorder which can adversely affect quality of life (QOL). The purpose of this study was 1) to evaluate whether QOL was improved in patients with lymphedema following Complete Decongestive Therapy (CDT), and 2) whether limb volume change as a result of treatment correlated with change in QOL. Thirty-six patients with peripheral lymphedema from varying causes were enrolled in the study. The QOL of each participant, with regard to physical, functional, and psychosocial concerns, was measured by pre- and post-treatment questionnaires. Percent edema volume reduction was calculated for each patient with only one affected limb. QOL pre- and post-treatment scores were assessed by multivariate repeated measures analysis. QOL scores differed significantly (p<0.05) between pre- and posttreatment in all areas of inquiry. Patients with lower extremity lymphedema had significantly greater mean improvement in QOL scores compared with patients with upper extremity lymphedema (p=0.02). There was no correlation between percent edema volume reduction and post-treatment QOL improvement. This study suggests that significant improvements are made in the QOL of patients exhibiting peripheral lymphedema following CDT, which is not necessarily correlated with limb volume reduction.

PMID: 12081052 [PubMed - indexed for MEDLINE]

NIH

Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema.

Johansson K, Albertsson M, Ingvar C, Ekdahl C.

Department of Physical Therapy, Lund University Hospital, Sweden. Comment in:

Lymphology. 2000 Jun;33(2):69-70.

We examined the effects of low stretch compression bandaging (CB) alone or in combination with manual lymph drainage (MLD) in 38 female patients with arm lymphedema after treatment for breast cancer. After CB therapy for 2 weeks (Part I), the patients were allocated to either CB or CB + MLD for 1 week (Part II). Arm volume and subjective assessments of pain, heaviness and tension were measured. The mean lymphedema volume reduction for the total group during Part I was 188 ml (p < 0.001), a mean reduction of 26% (p < 0.001). During Part II the volume reduction in the CB + MLD group was 47 ml (p < 0.001) and in CB group 20 ml. These differences were not significant (p = 0.07). A percentage reduction of 11% (p < 0.001) in the CB + MLD group and 4% in the CB group was significantly different (p = 0.04). In both the CB and the CB + MLD group, a decrease of feeling of heaviness (p < 0.006 and p < 0.001, respectively) and tension (p < 0.001 for both) in the arm was found, but only the CB + MLD group showed decreased pain (p < 0.03). Low stretch compression bandaging is an effective treatment giving volume reduction of slight or moderate arm lymphedema in women treated for breast cancer. Manual lymph drainage adds a positive effect.

Publication Types:

Clinical Trial - Controlled Clinical Trial

NIH

Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy.

Mondry TE, Riffenburgh RH, Johnstone PA.

Breast Health Center, Naval Medical Center, San Diego, California 92134-1005, USA.

PURPOSE: Lymphedema is a well-described complication of therapy for breast cancer. Patients who present with lymphedema may experience pain and body image issues and are at increased risk for developing cellulitis. Complete decongestive therapy (CDT) is a four-component therapy for lymphedema. Data regarding CDT as an intervention in the immediate after the diagnosis period and prolonged follow-up are limited; we prospectively analyzed results of CDT in this cohort of patients.

MATERIALS AND METHODS: Twenty patients were enrolled in CDT immediately after their diagnosis of lymphedema. The Functional Assessment of Cancer Therapy quality of life (QoL) measure and a visual analogue scale for pain were completed before, on the 10th day of, and on the last day of treatment. Each patient underwent a daily 60- to 90-minute treatment session, 5 days per week for 2-4 weeks. Treatment consisted of skin and nail care, manual lymphatic drainage, a multilayer compression bandage, and therapeutic exercise. Edema of the affected limb was reassessed weekly. On reaching a measurement plateau, the patient was discharged from active treatment and began a maintenance phase. The patient was reassessed for girth, volume, and body weight at 3 months. These measurements plus the QoL and pain measures were also reassessed at 6 months and 1 year after treatment.

RESULTS: Patients completed 2-4 weeks of treatment (median, 2 weeks). Those classed as severe decreased from 7 to 1. Median girth reduced 1.5 cm and median volume reduced 138 mL. Decreasing girth correlated significantly with decreasing visual analogue scale scores for pain, but not with increasing QoL. Increasing grade correlated significantly with girth reduction and volume reduction. Compliance with the treatment regimen at home decreased with time on the program. During follow-up, girth and volume reverted slightly but stabilized at about 1 cm and 100 mL below baseline, respectively. Although the increase in QoL was not significant, it was noted that during the entire treatment and follow-up period, QoL consistently increased, ending about 5% above baseline, and pain scores gradually decreased, ending with 54% (and median) of patients at 0 pain.

CONCLUSIONS: CDT is effective in treating lymphedema. Success in girth reduction contributes to less pain. Grade is a useful indicator of severity; class is not. Increased number of treatment sessions provides marked improvements in girth, volume, and weight but result in poorer compliance. Longer latency more successfully reduces girth, volume, and pain and increases QoL. QoL and pain are improved by treatment and continue to improve after treatment has ended.

Publication Types: Evaluation Studies PMID: 15000494 [PubMed - indexed for MEDLINE]

PubMed

Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer.

Int J Radiat Oncol Biol Phys. 2007 Mar

Koul R, Dufan T, Russell C, Guenther W, Nugent Z, Sun X, Cooke AL. Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. rashmi.koul@cancercare.mb.ca

OBJECTIVE: To evaluate the results of combined decongestive therapy and manual lymphatic drainage in patients with breast cancer-related lymphedema.

METHODS AND MATERIALS: The data from 250 patients were reviewed. The pre- and posttreatment volumetric measurements were compared, and the correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. The Spearman correlation coefficients and Wilcoxon two-sample test were used for statistical analysis.

RESULTS: Of the 250 patients, 138 were included in the final analysis. The mean age at presentation was 54.3 years. Patients were stratified on the basis of the treatment modality used for breast cancer management. Lymphedema was managed with combined decongestive therapy in 55%, manual lymphatic drainage alone in 32%, and the home program in 13%. The mean pretreatment volume of the affected and normal arms was 2929 and 2531 mL. At the end of 1 year, the posttreatment volume of the affected arm was 2741 mL. The absolute volume of the affected arm was reduced by a mean of 188 mL (p < 0.0001). The type of surgery (p = 0.0142), age (p = 0.0354), and body mass index (p < 0.0001) were related to the severity of lymphedema.

CONCLUSION: Combined decongestive therapy and manual lymphatic drainage with exercises were associated with a significant reduction in the lymphedema volume.

Keywords: Lymphedema, Breast cancer, Combined decongestive therapy, Manual lymphatic drainage

REDJournal

Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy.

Breast Cancer Res Treat. 2007 Mar

Vignes S, Porcher R, Arrault M, Dupuy A. Department of Lymphology, Hôpital Cognacq-Jay, Site Broussais, 102 rue Didot, 75014, Paris, France, stephane.vignes@hopital-cognacq-jay.fr.

Keywords: Breast cancer - Lymphedema - Physiotherapy - Compliance - Elastic garment - Low stretch bandage

BACKGROUND: Treatment of lymphedema is based on intensive decongestive physiotherapy followed by a long-term maintenance treatment. We analyzed the factors influencing lymphedema volume during maintenance treatment.

METHOD: Prospective cohort of 537 patients with secondary arm lymphedema were recruited in a single lymphology unit and followed for 12 months. Lymphedema volume was recorded prior to and at the end of intensive treatment, and at month 6 and month 12 follow-up visits. Multivariate models were fitted to analyze the respective role of the three components of complete decongestive therapy, i.e. manual lymph drainage, low stretch bandage, and elastic sleeve, on lymphedema volume during the 1-year maintenance phase therapy.

RESULTS: Mean volume of lymphedema was 1,054 +/- 633 ml prior and 647 +/- 351 ml after intensive decongestive physiotherapy. During the 1-year maintenance phase therapy, the mean lymphedema volume slightly increased (84 ml-95% confidence interval [CI]: 56-113).

Fifty-two percent of patients had their lymphedema volume increased above 10% from their value at the end of the intensive decongestive physiotherapy treatment phase. Non-compliance to low stretch bandage and elastic sleeve were risk factors for an increased lymphedema after 1-year of maintenance treatment (RR: 1.55 [95% CI: 1.3-1.76]; P < 0.0001 and RR: 1.61 (95% CI: 1.25-1.82); P = 0.002, respectively). Non-compliance to MLD was not a risk factor (RR: 0.99 [95% CI: 0.77-1.2]; P = 0.91).

CONCLUSION: During maintenance phase after intensive decongestive physiotherapy, compliance to the use of elastic sleeve and low stretch bandage should be required to stabilize lymphedema volume.

SpringerLink

Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment: a cohort study.

Breast Cancer Res Treat. 2006

Vignes S, Porcher R, Champagne A, Dupuy A. Department of Lymphology, Hôpital Cognacq-Jay, Université Paris, France. stephane.vignes@hopital-cognacq-jay.fr

Key words: breast cancer - lymphedema - physiotherapy - predictive factors

BACKGROUND: Lymphedema is a frequent complication after breast cancer treatment. Reduction of lymphedema volume is obtained during an intensive phase with daily physiotherapy. Response to treatment remains unknown prior treatment. We purposed to analyze predictors of response of lymphedema treatment throughout the first course of physiotherapy.

DESIGN: Patients with secondary arm lymphedema were recruited in a single lymphology unit between 2001 and 2004. For each patient, the following data were recorded: characteristics of breast cancer treatment, patient characteristics, body mass index and lymphedema volume prior and at the end of treatment.

RESULTS: Three hundred and fifty-seven women (mean age: 53+/-11 years) were included. Initial excess volume of lymphedema was correlated to body mass index and duration of lymphedema. Mean duration of intensive decongestive therapy was 11.8+/-3.3 days. Mean excess volume of lymphedema was 1067+/-622 ml prior treatment and 663+/-366 ml after treatment (p<0.001), percentage of excess volume of lymphedema was 59+/-34% and 36+/-19%, respectively. Absolute volume reduction was 404+/-33 ml (p<0.001). Body mass index and duration of lymphedema before treatment were the two predictors of absolute reduction of lymphedema volume. Higher was the body mass index or the duration of lymphedema, more important was the absolute reduction of lymphedema volume. Mean relative percentage of volume reduction was 36+/-14% whatever mass index or the duration of lymphedema was.

CONCLUSION: Duration of lymphedema from cancer treatment and body mass index were the only two predictors of absolute reduction of lymphedema volume after intensive decongestive physiotherapy. For all patients this latter treatment is highly effective in management of secondary upper limb lymphedema after breast cancer.

Springerlink

Breast cancer-related lymphedema–what are the significant predictors and how they affect the severity of lymphedema?

Breast J. 2006 Nov-Dec

Soran A, D'Angelo G, Begovic M, Ardic F, Harlak A, Samuel Wieand H, Vogel VG, Johnson RR. Magee-Womens Hospital, Pittsburgh, Pennsylvania 15213, USA. asoran@magee.edu

According to the American Cancer Society, there are currently 2 million breast cancer (BC) survivors in the USA and 20% of them cope with lymphedema (LE). The primary aim of this study was to determine the predictive factors of BC-related LE. The secondary aim was to investigate the impact of predictors on the severity of LE.

The study design was intended to be a 1:2 matched case-control study. Instead, we stratified on age (+/-10 years), radiation therapy (y/n), and type of operation (SM/MRM/MRM with tram). Patients who underwent BC surgery between 1990 and 2000 at UPMC Magee-Womens Hospital were reviewed for LE. Data were collected on 52 women with LE and 104 female controls. Logistic regression was utilized to assess the relationship between risk factors and LE. Ordinal logistic regression was performed to determine the association between risk factors and severity of LE.

Severity was defined according to the volume difference between affected and unaffected limbs. Risk factors considered were occupation/hobby (hand use), TNM stage, number of dissected nodes, number of positive nodes, tumor size, infection, allergy, diabetes mellitus, hypertension, hypothyroidism, chronic obstructive pulmonary disease, and body mass index (BMI). LE was mild in 43 patients and was moderate/severe in nine patients.

The level of hand use in the control group was categorized as low in 56 (54%), medium in 15 (14%), and high in 33 (32%) patients. The corresponding frequencies were 14 (33%), 6 (14%) and 23 (53%) for patients with mild LE and 3 (33%), 1 (11%), 5 (56%) for patients with moderate/severe LE (p < 0.05). Infection of the operated side arm was reported by two (2%) patients in the control group, 14 (33%) patients with mild LE and five (56%) patients with moderate/severe LE (p < 0.05). The mean BMI was 26.1 kg/m(2) (SD 4.9) for the control group, 29.0 kg/m(2) (SD 5.9) for the mild LE group and 30.9 kg/m(2) (SD 7.5) for patients with moderate/severe LE (p < 0.05).

The results of this stratified case-control study demonstrated that the risk and severity of LE was statistically related to infection, BMI, and level of hand use.

Blackwell=synergy

Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema.

J Formos Med Assoc. 2004 May

Liao SF, Huang MS, Li SH, Chen IR, Wei TS, Kuo SJ, Chen ST, Hsu JC. Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan.

BACKGROUND AND PURPOSE: Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema.

METHODS: Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume.

RESULTS: The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients.

CONCLUSIONS: Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese.

PMID: 15216399 [PubMed - indexed for MEDLINE]

HIP

Links - Manual Lymphatic Drainage

MLD UK

Manual Lymphatic Drainage - United Kingdom

http://www.mlduk.org.uk/


Dr Vodder's Manual Lymphatic Drainage

http://www.summertownclinic.co.uk/therapies/mld.htm


Manual Lymphatic Drainage: The Benefits

http://www.summertownclinic.co.uk/therapies/mldben.htm


Manual Lymphatic Drainage

http://www.cosmicjeweler.com/heal/mld.html


Traditional Massage Therapy in the Treatment and Management of Lymphedema

http://www.massagetoday.com/archives/2002/06/03.html


Intensive decongestive treatment restores ability to work in patients with advanced forms of primary and secondary lower extremity lymphoedema. Dec 2011

http://www.ncbi.nlm.nih.gov/pubmed/22156385

INFORMATION LINKS FOR COMPREHENSIVE or COMPLEX DECONGESTIVE THERAPY

CERTIFIED LYMPHEDEMA SCHOOLS OF THERAPY AND TREATMENT

LYMPHEDEMA TREATMENT INFORMATION PAGES

How To Find a Lymphedema Therapist

Short Stretch Bandages for Lymphedema

Compression Bandages for Lymphedema

Compression Garments Stockings for Lymphedema

Tissue Tonometry

Oscillation Therapy

Skin Care

Lymphedema Clinics Hospital Affiliated

Complications of Lymphedema Debulking Surgery

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=200

Choosing a Rehabilitation Provider or Physical Therapist

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=1120

Lymphobiology

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=72

Low Level Laser

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=114

Laser Workshops Information

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=781

Naturopathy: A Critical Appraisal

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=202

Self Massage Therapy – Self MLD

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=227

Elastin Ampules

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=240

Flexitouch Device for Arm Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=273

Intensive Decongestive Physiotherapy Upper Limb Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=283

Lymphomyosot

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=306

Why Compression Pumps cause Complications with Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=327

Patient self-massage for breast cancer-related lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=332

Daflon 500 and Secondary Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=322

Ball Massage technique

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=377

Infrared Therapy for Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=429

Craniosacral Therapy

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=432

Essential Oils

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=435

Selenium, Lymphedema and Cancer – Update

http://www.lymhpedemapeople.com/phpBB3/viewtopic.php?t=482

The Lymphoedema Project: Consensus on Lymphoedema Bandaging

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=560

The Flexitouch Device - Initial Observations

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=155

Hyperbaric Oxygen Treatment Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=279

Lymphocyte injection therapy

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=632

Coumarin powder/ointment

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=768

Complete decongestive therapy lymphedema in breast cancer

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=792

Daflon vs Pycnogenol

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=825

Homeopathy for childhood and adolescence ailments

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=900

Complete Decongestive Therapy Management of Arm Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=907 Diaphragmatic Breathing

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=113

Microsurgery for treatment of peripheral lymphedema update

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=985

Should primary lymphedema be treated differnently?

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=893

Lymphatic venous anastomoses

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=1099

Lymph node transplants

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=788

Lymph Vessel Transplantation

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=1100

Surgical Management of Scrotal Lymphedema Using Local Flaps

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=1107

How to be Safe with Complementary and Alternative Medicine

http://www.lymphedemapeople.com/phpBB3/viewtopic.php?t=66

Lymphedema People Resources

manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt.txt · Last modified: 2013/01/05 07:25 by Pat O'Connor