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Bruce R. Wilk, P.T., O.C.S. Director
8720 N. Kendall Dr. Ste. 206
Miami, FL 33176
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Lymphedema Management is Much More than a Massage
By: Cynthia Gonzalez, D.P.T., O.C.S. and Bruce R. Wilk, P.T., O.C.S.

Cancer is prevalent in today’s society. The NIH (National Institute of Health) lists breast, prostate, colorectal and lung cancers as the most frequent in number of new cancer cases and highest in mortality rates among Americans. However, cancer survivorship has risen dramatically with improvements in early diagnosis and treatment options. The 5 year survival rate for all cancers is 66 percent. That is almost 10.5 million Americans living with a history of cancer, according to the ACS (American Cancer Society). Some of these cancer survivors have developed lifelong physical impairments secondary to the effects of their cancer or the treatment of it. One such common impairment is secondary lymphedema.

Lymphedema is the abnormal accumulation of fluid in the skin and fatty tissues. This occurs in the body when the flow of lymph does not match the production of lymph. Lymph flow is facilitated normally in the body by breathing, contraction of the skeletal muscles, exercise and external compression of the body. Some causes of decreased lymph flow are lymph node and vessel removal, scarring following surgery, radiation therapy, spread of cancer to lymph tissues, infection and trauma. Many of these causes can be managed effectively by physical therapy. Better recovery is likely when lymphedema is discovered early. Some post cancer treatment signs of a developing lymphedema are: feelings of tightness, heaviness, and aching in the arm or leg.
Lymphedema can develop any time after the treatment of cancer begins, and is a chronic condition. This means that it can only be managed, not cured. Prolonged fluid accumulation can keep nutrients from reaching cells, slow healing after injury, restrict movement at nearby joints and lead to decreased strength and balance in the affected part. Sensory changes such as limb heaviness and numbness may occur due to nerve compression. Lymphedema can affect the ability to function at work and home, and may contribute to a decreased quality of life. Seeking and getting physical therapy early on should lead to a shorter course of treatment and get your lymphedema under control.
There are many different physical therapy interventions used to manage lymphedema. These may include patient education, skin care, positioning, injury prevention, compression bandaging, garments and pumps, scar management, exercises and manual lymphatic drainage. Manual lymphatic drainage is a manual therapy technique that physical therapists are trained to use. This technique It has been shown to help decrease the congestion of lymph fluid and facilitate the flow of lymph, and different massage techniques are required to address the various aspects of lymphedema. Facilitating lymphatic flow requires gentle strokes, while stronger massage strokes assist lymph to flow into the deeper vessels. More specialized massage strokes help to decrease hard and fibrotic tissues as well as scarring. But manual lymphatic drainage should not be the only technique used to treat lymphedema. Compression bandaging and compression garments use is essential and used in conjunction with the soft tissue work. This compression helps to maintain the decrease in edema achieved with physical therapy. Exercise is also essential in maintaining the reduction in edema as well as improving strength and mental wellness.
At Orthopedic Rehabilitation Specialists we are different. Our mission at Orthopedic Rehabilitation Specialists is to manage the treatment of lymphedema comprehensively. Each physical therapy session is individualized and includes massage and soft tissue manipulation, patient education, neuromuscular reeducation, therapeutic activity and instruction in proper exercise techniques along with applicable manual techniques.
As with any other health condition, a thorough medical history is necessary. You should be properly evaluated by your physical therapist and an individualized program developed to help you manage your problem. Depending on the severity of your condition, your therapist will be able to suggest how best to progress your individual situation. Other causes of edema and concurrent conditions where therapy may be contraindicated, such as infections, must be ruled out. Barring these complications, the best management for lymphedema is an individualized evaluation & treatment by a licensed physical therapist.

1. http://www.cancer.org/downloads/stt/CFF2008Age-AdjustedCDR_Female.pdf
2. http://www.cancer.org/docroot/home/index.asp