Overview of Lymphedema Treatment

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Lymphedema is chronic swelling caused by a compromised lymphatic system. There is currently no complete cure for this condition. However, there are effective management techniques. Advances in surgical techniques and management options that allow you to treat your condition more fully and independently.  

This article will introduce you to the gold standard treatment for lymphedema as well as additional management techniques that show promise.

Overview of the Lymphatic System and Lymphedema

Part of your treatment for lymphedema will likely be education about the complex and amazing lymphatic system. But here are the basics:

The Lymphatic System

The lymphatic system helps your body fight disease and dispose of everyday waste created by your body’s cells. The most well-known components of the system are the spleen, thymus, and tonsils.

The component of the system that is most relevant to lymphedema is a series of tiny vessels and nodes that run parallel to the circulatory system forming a web throughout your body. These vessels collect fluid known as lymph. Lymph is fluid containing waste and large proteins that are excreted as blood cells deliver energy throughout the body.

The vessels carry lymph back to the neck, where the fluid is dumped back into the circulatory system at the subclavian veins. On the way to these veins, the lymph is filtered through lymph nodes, which produce antibodies when pathogens are detected.

 Lymph nodes are clustered in the armpit, groin, abdomen, and behind the ear.

Lymphedema occurs when this drainage system gets overloaded, ultimately resulting in visible swelling. If left untreated, the swelling can become painful, limit your ability to participate in daily life, and ultimately compromise the health of your entire body.

One of the major risks of lymphedema is that it can cause an infection to the body known as cellulitis. One of the primary goals of treatment is to reduce the risk of this type of infection.

The Causes of Lymphedema

Lymphedema occurs when lymph nodes or vessels are compromised, resulting in the blockage of lymph drainage. Lymphedema is grouped into two types, primary and secondary.

Primary lymphedema is caused by an abnormality ?in the lymphatic system, usually appearing at birth or puberty.

Far more common is secondary lymphedema, which is caused by damage to the lymphatic system. Injury, surgery, infection, diabetes, plastic surgery, Botox, obesity or radiation can all cause injury to the system. The most common cause of secondary lymphedema is cancer treatments.

The Stages of Lymphedema

One important distinguisher you will see between the stages is pitting edema. Pitting edema is observed when the skin is pressed with a finger and an impression or “pit” lingers for several seconds after the finger is removed.

It is an indicator of accumulated fluid and that the elasticity of your skin has been compromised.

Lymphedema appears in four stages. Below is a quick overview of each stage.

Stage 0 Lymphedema: Non-Visible Latency

  • No measurable swelling
  • No skin changes
  • Feeling of heaviness or fatigue in the affected area

Stage 1 Lymphedema: Spontaneously Reversible

  • Measurable swelling
  • Pitting edema
  • No skin changes
  • Elevation can reduce the edema

Stage 2 Lymphedema: Spontaneously Irreversible

  • Measurable swelling
  • Pitting edema is limited; rather, skin feels spongy or tough
  • Skin changes occurring

Stage 3 Lymphedema: Elephantitis

  • Significant Swelling
  • Skin becomes tough, dry, and scaly
  • Non-pitting edema
  • Increased risk of infection
  • Weight of limb can become debilitating

Your Lymphedema Treatment Team

Since lymphedema is typically caused by another condition, those with lymphedema tend to have specialists already invested in their care. Your treatment team may include your oncologist, cardiologist, primary care doctor, etc.  It will likely be one of these specialists that refer you to treatment.

The point person of your lymphedema care will likely be a certified lymphedema therapist (CLT).  A CLT is a health professional, such as an occupational therapist or physical therapist, who has gone on to receive extensive training in complete decongestive therapy.

It is important that everyone on your treatment team is aware of your lymphedema treatment as the lymphatic system interacts with all of the other body systems.

Management/Treatment Options for Lymphedema

As mentioned above, treatment techniques for lymphedema have evolved significantly over the past decades. There is currently a gold standard treatment with several other options that show promise, but need continued research.

Complete Decongestive Therapy (CDT)

Research shows strong support for a technique called Complete Decongestive Therapy. This therapy program has two stages, beginning with an intensive stage and then progressing to the maintenance stage.

CDT Stage 1(The Intensive Phase)

Manual Lymphatic Drainage

Manual Lymphatic Drainage is a specialized massage that certified lymphedema therapists have training in. It involves a light pressure, which increases the activity of the lymphatic system and helps propel accumulated lymph back to the neck.

These sessions can typically range from 30 minutes to 90 minutes. Your therapist will take special care not to overwhelm your system by draining too much lymph at a time. These sessions are done over a course of weeks until the swelling has decreased.

There are certain conditions that make manual lymphatic drainage unsafe, such as congestive heart failure or acute renal failure. When this is the case, you may still benefit from the other components of CDT.

Compression Bandaging

For the time between sessions, your therapist will use short-stretch bandages, which are safe for 24-hour use and keep the area from refilling with lymph.

Patient Education: Skin and Nail Care and Self-care

Another crucial part of this therapy is education about caring for your skin and nails to reduce the chance of infection. Because the detoxification system to your limb has been compromised, it is important to reduce the risk of getting a cut, dry and cracked skin, or other injury that could quickly lead to infection.


Exercises also promote the drainage of lymph and increase the flow of blood to assist in flushing your body of excess lymph and toxins. These exercises will be customized to you, but here is an example of arm exercises for lymphedema.

Complete Decongestive Therapy- Stage 2 (The Maintenance Phase)

Compression Garments

Once the swelling in the area has decreased, the use of compression garments can assist in preventing the lymphatic fluid from accumulating again. These garments help fluid flow against gravity back toward the trunk. You may benefit from a compression sleeve, glove, bra or vest for the trunk area. These garments are specially fitted for each individual and may be covered by insurance.

Home Exercise Program and Self-Care

Toward the end of the intensive phase, your CLT will work with you to create a home exercise program that you can maintain the progress you have made. It will also be important to continue the skin and nail care that you learned in the intensive phase as well as take steps to prevent injury to the area.

Follow-up with a CLT As Needed

Another key component of the maintenance phase is contacting your doctor or CLT when you are unable to manage the swelling with the above techniques. The sooner the accumulation is addressed the easier it will be to reverse.

As lymphedema is a chronic condition, you may benefit from visits to your CLT every 3-6 months for manual lymphatic drainage massage. CLTs can also help you manage a wound to prevent infection or help you navigate a circumstance that has an infection risk, such as a surgery.


Kinesotape is a special kind of tape that can be applied to the skin to provide pressure, which theoretically should assist the limb in draining. Some practitioners use this to augment or replace the compression-bandaging phase. However, this technique does not yet have strong supporting evidence that it is effective. If your practitioner uses this technique, ask them about the clinical reasoning behind using it.

Compression Pumps

There is increasing amounts of evidence for the use of compression pumps (advanced pneumatic compression devices) to support complete decongestive therapy. These complex machines are utilized in the home setting and mimic components of manual lymphatic drainage massage. These have been shown to reduce the number of visits to therapy and incidents of cellulitis. They can even be covered by some insurance agencies.

Low-Level Laser Therapy

The Federal Food and Drug Administration cleared the use of low-level laser therapy for lymphedema. This treatment involves a small handheld device that emits a low-level laser that is thought to reduce swelling. Despite being an approved form of treatment, it does not yet have strong research supporting it.


Historically, surgical intervention for lymphedema has been unsuccessful, but two techniques have emerged that show promise making the condition more manageable.

Currently, you have to have had several failed attempts at conservative treatment (CDT) before qualifying for surgery. 

Lymphovenous Bypass involves redirecting some vessels back into the circulatory system and is a relatively noninvasive procedure.

Lymph Node Transfer is more invasive and involves collecting lymph nodes from healthy parts of the body and transferring them to affected areas. This technique had been ineffective in the past as it could result in lymphedema in the area where the nodes were harvested, but a new technique called lymphatic mapping has increased the success rate.

Advocating for the Best Care

Historically, lymphedema has often been under-diagnosed or misdiagnosed. The medical community’s knowledge about lymphedema and available treatments has grown dramatically, but there are still many health professionals who have not received training in identifying lymphedema.

As a patient, you should be aware that chronic swelling is not a normal condition. It puts strain on your body and increases your risk of infection. Chronic swelling is something you should speak to your doctor about or contact a lymphedema therapist directly if needed.

Here are two circumstances in particular where you should ask about lymphedema treatment  if the option is not presented to you.

1.) Before cancer treatment: It is now becoming a common practice to see a lymphedema therapist before undergoing any cancer treatments that will put you at risk for developing lymphedema, so that baseline measurements can be taken and education can be given.

2.) Swelling that becomes chronic following a surgery: Swelling that persists beyond 12 weeks following a surgery likely has a lymphatic component. Swelling may even appear years following the initial surgery and is often an indicator that the lymphatic system was compromised by the procedure. 


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