Lymphedema Management

If you have recently been diagnosed with lymphedema, you are not alone. An estimated 3-5 million Americans are estimated to have lymphedema, many are undiagnosed or under-treated. Through education, rehabilitation, and emotional support, the Certified Lymphedema Therapists at Kitsap Physical Therapy and Sports Clinics strive to identify lymphedema or swelling disorders early.

Our goal is simple: to empower our patients to improve their quality of life for the months and years after a lymphedema diagnosis.

What is Lymphedema?

Lymphedema is chronic swelling of a body part which can be caused by a build-up of fluid that occurs when the lymphatic system is damaged or faulty. Lymphedema can be divided into two main categories: primary and secondary. Ten percent of all cases are primary lymphedema which is related to rare congenital diseases. The remaining 90 percent of lymphedema cases are secondary – acquired via non-cancer or cancer-related causes.

Common Causes of Lymphatic Dysfunction

  • Lymph node removal for cancer treatment
  • Injury to lymphatic vessels due to trauma, delayed wound healing, or infection
  • Venous insufficiency causing overload of lymphatic vessels
  • Congenital malformation of lymphatic system
  • Lymphatic overload related to increased blood volume during pregnancy

Want to learn more about different types of swelling? Please visit one of the links below

  • Cancer-related lymphedema
    • The most common cancer-related lymphedema is related to breast cancer treatment, most often due to removal and/or radiation of lymph nodes. Breast cancer is the most predominant cancer, but other forms of cancer and cancer treatments can also lead to lymphedema. Any cancer that can invade the lymph nodes or requires removal of lymph nodes can result in cancer-related lymphedema. Cancers that commonly disrupt the lymphatic system include cervical, uterine, ovarian, breast, melanoma, sarcoma, and lymphoma.
  • Primary lymphedema
    • Lymphedema that is caused by an abnormal or damaged lymphatic system that often exists from birth, but symptoms can manifest later in life. Hereditary lymphedema is passed down from one family member to another and usually has a family history of symptoms. Sporadic lymphedema occurs without previous family history and is much more common than hereditary lymphedema. It typically manifests in the lower extremities, often affecting the feet and ankles.
  • Venous-related lymphedema
    • Swelling as a result of venous insufficiency is caused by damaged venous valves which causes blood to reflux back into legs, ankles and feet due to gravity (as compared to returning to heart in normally functioning valves). Individuals will often have hemosiderin staining as a result of red blood cell debris in surrounding tissue. This rarely improves with treatment. Venous ulcers are very common and occur most often in the medial aspect of distal lower extremities. Swelling is often improved with elevation but returns when in standing or sitting positions due to gravity.
  • Obesity-related lymphedema
    • Obesity can cause increased stress on the lymphatic system which can then lead to lymphedema as the body cannot keep up with that stress. In addition, obesity can lead to a sedentary lifestyle which in turn can cause impaired lymphatic drainage and lead to increased fat adipose tissue in extremities.
  • Lipedema
    • Swelling caused by increased adipose tissue most typically from hips to the ankles without feet involvement. Often present with disproportionate, bilateral, symmetric deposition of fatty tissue which presents as fatty enlargement of hips, buttocks, thighs and sometimes legs but has an abrupt cutoff at ankles. Individuals with lipedema tend to bruise very easily and are tender to palpation in affected areas. Stemmer’s sign is negative and patients are not prone to cellulitis (unlike individuals with lymphedema).

Treatments We Provide – Complete Decongestive Therapy (CDT)

  • Skin care and education
    • Counseling on skin care practices, nutritional, and lifestyle factors to support lymphatic function to decrease the risk of infection or future complications
  • Manual Lymphatic Drainage
    • Therapist or caregiver-administered and self-lymphatic drainage techniques
    • Taping support for lymphatic drainage
    • Lymphedema pumps
  • Supervised strengthening, conditioning, and stretching
    • Promote drainage of lymphatic fluid through movement and exercise
  • Multi-layer Lymphedema Bandaging (MLLB)
    • Therapist or caregiver-administered and instruction in self-directed bandaging to reduce limb or body region volume and improve skin condition before fitting for compression garments
  • Compression garment fitting, training, and recommendations for assistive devices
    • Develop a long-term plan for compression garment care, prescription renewal and replacement every 6 to 12 months
  • Supplement medical management of wound healing through CDT principles, education, exercise, and emotional support

Additional Benefits of a CDT program with KPT

Medicare and many private insurance programs DO NOT cover compression garments, wraps, or bandages. KPT recognizes this gap in healthcare coverage and so we offer:

  • MLLB supplies on loan with a signed contract and retainer fee which is reimbursed at the end of care (contingent on materials being returned in original condition)
  • Coordination of referrals for compression garments, assistive devices, and lymphedema pumps
  • Access to aerobic equipment between appointment times while an active patient

At Kitsap Physical Therapy, we have therapists who are trained in evidence-based protocols for lymphedema rehabilitation management, offering location preference and convenience for patients. Ask your medical provider and get a referral to start your lymphedema program today.

Related links:

National Lymphedema Network (NLN)

Lymphedema Treatment Act (LTA)

Lymphatic Education and Research Network

Klose Training Lymphedema Certification

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