Lymphatic Drainage Massage

• Interstitial fluids accumulate 
• Affected area becomes swollen and distended

1. Primary Lymphedema, or from birth. this is a congenital from the lymphedema cause by for a malformation  of the Lymph vessels or nodes It may present itself at birth, or later in life. Often it occurs in puberty or during pregnancy. Primary forms usually affect the lower extremities but may also be present in upper extremities. 
2. Lymphedema is cause secondary to lymph vessel destruction, or lymph node removal secondary to a disease process or a surgery. The common cause of lymphedema includes post-surgery, chemotherapy, radiation, after infection, blood clots, tumors, or chronic venous insufficiency ( Zuther, Lymphedema Management & Foldi, Foldi' Textbook of Lymphology) Lymphedema does not necessarily develop right after surgery.  It can develop decades later!

Primary and secondary lymphedema may affect the upper or lower extremity. In general, it can be said that the legs are more often involved in primary lymphedema whereas secondary forms are more commonly found in the upper extremities.

Lymph fluid rich in protein making the edematous area very thick and heavy feeling. (Zuther, p.3) Treatment is necessary to not only move the fluid and protein out of the area. If it not treated, over time, the lymphatic Vesselses will stretch out permanently and external compression and treatment will be necessary for a lifetime to maintain proper pressure in the valves to move fluid more normally. 

Lymphedema can cause keratin and fibroblasts to form an increased rate. This can lead to fibrosis a hardening of the dermis layer , hyper pigmentation and deposits of fatty tissue in effects areas. 

This is condition of chronic nature, and therefore patients are at risk for infections such as cellulites due to the oedema exerting pressure on the tissues and causing cracks, allowing bacteria in, or compromising skin when bumped or scraped. 

Subjective differences: Many people report the first signs and symptoms of lymphedema as a feeling of tightness, or heavy decreased flexibility in the joints, and clothing or jewelry fitting tightly. Some patients only report strange sensations such as tingling or a crawling feeling on the skin. 

Objective differences: Measurable change. 

Why do we need treat oedemas? 

Forms of Treatments for Lymphedema

1. Manual Lymphatic Drainage (MLD) : this gentle manual treatment technique increases the active of lymph vessels and lymph node and manual moves interstitial fluid. Applied correctly, a series of MLD treatments decreases the volume of the affected extremity to a normal or near normal size is applied daily in the first phase of the therapy. 
2. Compression Therapy: the elastic fibers in the skin are damaged in lymphedema. In order to prevent deaccumulations of fluid it is necessary to apply sufficient compression to the affected extremity. Compression therapy also improves the function of the muscle pumps, helps to reduce fibrotic tissue, and promotes venous and lymphatic return. Compression garments with follow up/ new garments every 6-12 months 
3. Exercises: a customised exercise program is designed by the therapists for each patient. These decongestive exercises aid the effects of the joint and muscle pumps and should be performed by the patient wearing the compression bandage or garment. Vigorous movements or exercise causing pain must be avoided. Exercises should be performed slowly and non affected extremity. 
4. Skin care: the skin in lymphedema is very susceptible to infections and usually dry. A low-pH lotion, free of alcohol and Frances, should be used to maintain the moisture of the skin and to avoid infections. You should consult your physician if there are any fungal infections present in your affected extremity.