Wednesday, December 23, 2009

Understanding the Essentials of the Lymphatic System

Lymphedema is a type of swelling that can occur anywhere in the body, but most commonly occurs in the limbs. It is often discussed in the course of care for women who have been treated for breast cancer, but it is not unique to this population. In fact, the condition is an issue for individuals with many types of cancer and also for people who have never had cancer at all. Anyone with insufficient lymph transport abilities, either because we were born that way or because we have been through medical procedures that compromised them, may develop lymphedema. The reason people who have had cancer are at increased risk is that surgeries and radiation are likely to damage nodes and lymphatic pathways.

The vessels of the lymphatic system run parallel to the blood vessels. Their job is to transport the body’s cellular waste. Lymph nodes along the way screen out the large particles. This is an important part of our body’s ability to heal localized injuries and clear infections. Lymphedema is the result of impaired transportation within this system.

Looking at traffic flow provides an excellent analogy to the problem of lymphedema. When our local highways get overloaded with cars, traffic slows, gets backed up, and then cars on the highway may exit and spill over into adjacent streets. In the case of lymphedema, the fluid traveling up through lymphatic vessels gets trapped because of insufficient pathways. Just like the traffic jam scenario, the fluid transit gets stopped and then seeps out into the nearby tissues, causing swelling.

Many people do not have full-blown cases of lymphedema, but have a tendency to have some sluggishness in their lymphatic system that is manifest as ankle swelling or other mild impaired fluid transport. There are some simple strategies we all can use to help support and enhance our lymphatic flow. Gentle exercise helps, as does one of life’s great joys: laughter!

When lymphedema occurs it is usually recognizable by chronic swelling. Sometimes people feel heaviness or a dull aching in their limb. This is not an emergency unless it is also accompanied by redness, fever, or any other signs of being ill. Even though it is not an emergency, promptly informing your healthcare provider will make it easier to address and begin to manage the situation. Untreated lymphedema worsens and has the potential to be a serious condition.

Treatment of lymphedema must be performed by professionals who have special training in evaluation and treatment of the condition. Currently, there is no nationally recognized certification process, though many institutes that train therapists issue a certificate. The people who might market themselves as lymphedema therapists are physical therapists, occupational therapists, and, occasionally, massage therapists. Massage therapists are generally not covered by insurance for treating this diagnosis, and they are not licensed to assess for range of motion deficits or give any exercise prescriptions.

A visit to a lymphedema therapist includes a thorough discussion of your history, including exercise habits, past orthopedic injuries, recent surgeries and treatments, and what your lifestyle is like in terms of hobbies, job activities, and other elements. Assessment includes range of motion, measurement and palpation of swelling, and inspection of surgical incisions. Depending on findings, patients may need treatment in the clinic or taught how to care for themselves independently. The three major elements of lymphedema treatment are lymphatic drainage massage, compression, exercise and education about self-care. Each of these elements needs to be specifically tailored to the individual.

If you are experiencing lymphatic swelling, or are at risk for the condition, make a point of learning about it from reliable sources. There are many simple strategies for managing it, and the research in the field is progressing at an exciting pace! The more you know, the better you can care for yourself.

Written by Peg Maas, PT
Seattle Athletic Club Northgate

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