Lymphoedema is progressive with decidedly adverse effects on the patient’s quality of life, mobility, state of mind and ability to withstand infection. The treatment of choice is decongestive lymphatic therapy (DLT) which has been in use for decades in Continental Europe and elsewhere. It consists of a 4 part system of treatment in 2 phases:
Phase 1This intensive phase consists of once or twice daily treatment for 3 to 6 weeks
- Manual lymph drainage (a very precise, specialised massage technique designed to provide an external ‘pump’ to the lymph vessels and enable the therapist to drain oedematous tissue and utilise additional drainage routes)
- Skincare to help prevent infection and deterioration
- Multilayer bandaging (worn throughout the 24 hours) to continue stimulation of the lymph system and help to reshape the limb
- Exercise with an emphasis on movement rather than vigour to complement the bandaging and stimulate lymph drainage
Phase 2
This maintenance phase needs to continue without interruption for the rest of the patient’s life.
- Daily skincare (carried out by the patient)
- Daily wearing of compression garments (these need to be professionally refitted every 4 to 6 months)
- Daily exercise as taught to the patient during Phase 1
- Regular manual lymph drainage according to the patient’s individual need - probably between once a week and once a month.
It may be necessary for a patient to return to Phase 1 after an infection or from time to time in some cases.
DLT for lymphoedema is labour intensive but effective and free from side effects. It can allow this distressing chronic condition to be positively managed to prevent deterioration and the development or exacerbation of secondary health problems.
Availability of treatment
Local provision for lymphoedema patients is highly variable but few clinics are able consistently to offer the full intensive phase of treatment even on an outpatient basis and many can do no more than fit compression garments.
An Arm & a Leg was set up in 1999 by a group of professionals working in this field because they were so frustrated at the UK’s lack of inpatient facilities for intensive treatment. They run 2 or 3 clinics a year, drawing experienced staff from all over the UK (and beyond). Manual lymph drainage, skincare and bandaging are performed twice a day for 3 weeks and these together with daily physiotherapy are further supplemented by education about the management of the condition and a programme of psychological support. (see The programme)
It was always intended that An Arm & a Leg’s service would complement local clinics. They could refer any patients needing Phase 1 intensive treatment beyond their capability to provide, and then receive them back for maintenance (Phase 2).