Believe me, a lot of people have no idea what lymphedema is. I should know, I am a certified lymphedema therapist and I am excited to announce we are starting a lymphedema program at Fitness Forum Aquacare here in Annapolis. It is not uncommon for a new patient to arrive for their PT evaluation and say, “I am here for lymph-a . . . .?” “Lymphedema?” I happily supply and usually get a head nod in response.
Lymphedema is chronic swelling that is caused by a backup in the lymphatic system. Which begs the question, what is the lymphatic system? Again, this is a head scratcher for many of us, even my colleagues who have spent lots of time in the anatomy and physiology classroom. I think of the lymphatic system as one of the unsung heroes of the body. Nobody seems to know what it does, and yet you would not last long without it.
We are all pretty familiar with the blood circulation system, made up of arteries and veins that transport blood to every part of your body. However, a lot of people have no idea that running parallel to that circulatory system is a whole other network of lymphatic vessels that carry fluid and proteins throughout the body. Your body also has collectors for lymph fluid called lymph nodes. We are most familiar with these because they can get sore and swollen when they are irritated, like when our bodies are fighting off infections. That is because another function of the lymphatic system is to identify anything abnormal in the body’s fluid and to fight off intruders — from viruses to cancer cells.
Usually, this system works so seamlessly that we aren’t even aware that it’s there. The trouble comes when there is a backup of lymph fluid causing congestion. Here in Annapolis, we are pretty familiar with the Chesapeake Bay Bridge and the traffic congestion that can pile up, especially on a Friday afternoon in the summer. On an average Tuesday morning, the bridge does a fine job allowing all the traffic over to the Eastern Shore. However, on Friday afternoons in the summer, everyone and their cousin want to head to the beach and suddenly there is too much traffic for the road system. Similarly, a healthy lymphatic system has no trouble keeping up with the fluid volume in your body, however, if you have increased fluid-not from a sunny afternoon in this case but from your body responding to an infection, an injury, or increased heat in the environment- then you can get a backup, often into an arm or a leg. For that reason, you will often have swelling after a surgery like a knee replacement. Your lymphatic system hasn’t changed but a lot more fluid to process so it can get backed up.
Another reason you might get increased swelling is if the lymphatic system itself is disrupted. Take again the bay bridge on a Tuesday morning, even if there is not too much traffic volume you will surely have a backup if all the toll booths are closed. In the body, a similar thing can happen if one of the areas where there are collections of lymph nodes, like the armpits or the groin, is impaired. This can happen because of a congenital condition, the result of a trauma, or because of the effects of cancer and the surgeries and radiation that are used to treat it. The leading cause of lymphedema is when lymph nodes in the armpit are removed or damaged in the treatment of breast cancer. Those lymph nodes are then like the closed toll booths on the bridge, all the sudden instead of filtering traffic they are acting like road blocks and fluid backs up into the arm.
So what’s the big deal? Why do we care about lymphedema? Initially, it might not seem like too much of a big deal. Your affected limb might feel a little heavier, the skin might feel tight, and you may notice your rings or shoes feel small. Over time what started as a little swelling can turn into a lot of swelling and that’s where we have problems. When you have chronic swelling your skin itself can start to change becoming harder, dry, flaky, change colors, and, most worrisome of all, you become more susceptible to wounds and infections that could can to hospitalizations. Another problem people with lymphedema face is that their affected limb can become heavy, large and more difficult to move around, resulting in difficulty doing daily activities.
So what do we do about lymphedema? We redirect traffic. On the Bay Bridge, we can help move traffic along by opening a lane on the other span of the bridge and rerouting traffic. With lymphedema, we can do a similar thing with a specialized type of manual therapy (that’s PT for massage) called manual lymphatic drainage. We also use compression to help keep the fluid out once we’ve got it moving. In the early stages of treatment that compression might be a series of bandages, later on, the compression will likely be a special sleeve or stocking that is worn daily. Exercise is important for everyone but it is even more important for people with lymphedema. Maintaining a healthy weight has been shown to reduce risk and severity of swelling. Additionally, the pumping of muscle can help to push the lymph fluid through the system. The last crucial piece of lymphedema is care is immaculate skin care. In every stage of treatment keeping skin clean, dry and well moisturized reduces the risk of wounds and infection.
I hope this helps with your understanding of lymphedema. If you have any questions or have noticed persistent swelling anywhere in your body we at Fitness Forum Annapolis or at any of our Aquacare Physical Therapy locations are happy to talk you and develop a plan to address your needs.
Megan Griffin DPT
Lymphedema /Manual Lymphatic Drainage Certified Therapist