What Is Lymphedema?
Primary lymphedema is thought to result from a congenital malformation of the lymphatic system such as hypoplasia (decreased number or size of vessels) or hyperplasia (too many vessels which do not function properly). Secondary lymphedema is the result of damaged or blocked lymphatic vessels caused by surgery, radiation therapy, trauma, limb paralysis, infection, or an inflammatory condition. Surgery combined with radiation therapy for breast cancer is a common cause of upper arm secondary lymphedema for women in the United States.
Chronic Vascular Insufficiencies (CVI) is the failure of the valves in the veins to fully shut causing the legs to chronically swell leading to thickening and hard tissue fibrosis.
Acute Orthopedic, Sports Injuries and Post Surgery. The lymphatic system can be overloaded in some injuries leading to edema problems.

How Does Lymphedema Occur?
The lymphatic system is designed to filter bacteria, proteins and cellular debris from the tissue fluid. It this system is damaged by surgery or radiation; blocked; or abnormally developed, the lymphatic system can no longer transport fluid. Protein-rich fluid accumulates in the tissues, resulting in chronic swelling, decreased oxygenation to the tissues providing a medium for bacteria growth, which can make recurrent infection a significant problem. There is also a proliferation in fat cells which stimulates thick, hard fibrosis if left untreated in the early stages. These infections place an increased load on the lymphatic system, which only worsens the condition.

Compression Therapy
Utilization of a short stretch (not ACE wraps) compression bandaging system increases the tissue pressure and is applied between treatments to prevent re-accumulation of lymph fluid .This system is always applied to lymphedema patients and may also be used in chronic venous insufficiency patients and some orthopedic injuries. After the lymphedema has become stabilized, patients will be fitted with compression garments and instructed in self bandaging techniques.

Manual Lymphatic Mobilization & Manual Lymphatic Drainage
Lymphatic Mobilization is a gentle, effective and conservative therapy used to treat localized swelling. It utilizes a gentle skin stretching technique which improves the activity of the
lymphatic system. It opens up pathways to move congested fluid either through an intact system in an orthopedic injury or re routing the lymph flow around blocked areas in cancer patients into more centrally located lymph vessels that drain into the venous system. All patients are instructed in self MLD techniques to manage their condition independently.

Exercises
The lymphatic system drains through the right lymphatic duct and left thoracic duct. Cardiovascular exercises and deep diaphragmatic breathing techniques are crucial to increasing lymphatic flow. Decongestive exercises are performed while patients are in their bandages and aid lymphokinetic efforts of the joint and muscle pumps. An individual’s general physical status is assessed to take into consideration post surgical status, radiation therapies and any other medical considerations. Post mastectomy patients are instructed in shoulder stretching and Range Of Motion exercises.

What Role Does Skin Care Play In The Treatment Of Lymphedema? 
Assessment and maintenance of skin integrity is a central issue in the care of patients with lymphedema. Because lymphedema increases susceptibility of the skin to problems such as fungal infections and dryness, proper skin care is an important element in the treatment of lymphedema. Proper skin care includes:
Keeping the affected area(s) clean and moisture-free.
Using lotion after bathing, to protect against dryness.
Avoiding any injury to the skin of the affected limb. For example, protect skin from: bruising, cuts, sunburn, sports injuries, insect bites, and cat scratches.

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Linne Stringer PT 911 Hildebrand LN NE #101 Bainbridge Island (206) 842-6288	Claudette Wheeler, PT, OCS 19319 7th Avenue, #108 Poulsbo (360) 779-3777	Breane Martinez , PT 26001 Barber Cut Off Rd #C-1 Kingston (360) 297-7050