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Lymphedema Rehabilitation

Physical Therapy St. Louis

Missouri Baptist Outpatient Rehab achieves National Lymphedema Network (NLN) affiliation status.

In May 2013, Missouri Baptist Outpatient Rehab became an Affiliate Treatment Center of the National Lymphedema Network (NLN). Missouri Baptist is the first and only NLN Affiliate Treatment Center in the St. Louis area.

The NLN is an internationally recognized non-profit organization founded in 1988 by Saskia R.J. Thiadens, RN, to provide education and guidance to lymphedema patients, health care professionals and the general public by disseminating information on the risk reduction and management of lymphedema. The mission of the NLN is to create awareness of lymphedema through education and to promote and support the availability of quality medical treatment for all individuals at risk for or affected by lymphedema.

“I am so proud of the OT lymphedema team for the 5 years of hard work & dedication in developing and cultivating a program that drives successful outcomes for our patients,” said Michelle Wheelehan, manager of Therapy Services. “It is exciting and very deserving that this team received recognition from the NLN.”

What is lymphedema?

Lymphedema is a type of chronic swelling that can occur if there is damage to the lymphatic system or if the lymphatic system becomes overloaded by excess fluid due to infection or other medical issues. 

The lymphatic system transports fluid out of the tissues through lymphatic vessels and nodes that lie just beneath the surface of the skin and extend deeper into the body’s structures. A healthy lymphatic system is able to transport excess fluid out of the tissues, break down the waste and transport the protein rich fluid back towards the heart for recirculation. If the lymphatic system is damaged or there is an increase in fluids within the body, the system may become overloaded. The accumulation of this protein rich fluid in the body is known as lymphedema. While there is no cure for lymphedema, the symptoms can be effectively reduced and managed with prompt care.

What does lymphedema look like?

One of the first signs of lymphedema is a feeling of fullness or heaviness in the affected area, which may be an arm, a leg, the trunk, groin, or head and neck. This fullness may progress to a noticeable swelling. Over time, your rings, shoes, or clothing may feel tight in the affected area. 

When detected at these early stages lymphedema can be treated effectively. This type of edema, or swelling, typically does not go away over time and it does not get better with rest or elevation. If left untreated, lymphedema can lead to pain and permanent changes in the limbs appearance and function.

What causes lymphedema?

The primary cause of lymphedema in the United States is treatment for cancer, though not everyone treated for cancer gets lymphedema. Lymphedema is often the result of damage to the lymphatic vessels through surgery, radiation, trauma to the lymph vessels, or by the removal of lymph nodes. In other cases venous edema (a result of the veins not being strong enough to pump fluid from the legs) can cause the lymphatic system to become overwhelmed by excess fluid leading to mixed or combination lymphedema. The development of lymphedema may also have a genetic component and is typically characterized by having too few lymph nodes or ineffective drainage pathways.

How is lymphedema treated?

The treatment of lymphedema remains relatively misunderstood because the current standard of treatment, Complete Decongestive Therapy, was not introduced in the United States until the mid-1980s. Prior to that time, individuals with lymphedema were told there was no treatment available for them. Unfortunately, many patients are still being told this misinformation. The truth is that through this structured treatment of layered short stretch compression bandages, manual lymphatic drainage massage, skin care, and exercise, even those with a long history of lymphedema can be treated and enjoy improved function and quality of life.

Treatment must be provided by a Certified Lymphedema Therapist (CLT). This treatment involves two phases: the Intensive Phase 1 and the Maintenance Phase 2.

The Intensive Phase typically consists of daily treatments that include the following:

  • Manual Lymph Drainage (MLD) - This specialized light massage moves lymphatic fluid from the swollen area to intact lymph vessels
  • Compression Bandaging - special short stretch bandages are applied daily to further assist with pushing the excess fluid out of the affected limb
  • Targeted Exercises - Exercising while wearing bandages serves as an external pump. Contracting your muscles against the bandages assists with moving the lymphatic fluid.
  • Meticulous skin and nail care - A damaged lymphatic system is less able to recover from injury or infection to the skin or nails.
  • Self Care Training - In preparation for the maintenance phase, you will learn self-massage, self-bandaging, and skin care.

Once the swelling of the affected limb has been successfully reduced, you are ready for the next phase.

Maintenance Phase

The Maintenance Phase includes the following:

  • Compression Garments - To keep the swelling from returning, a compression garment is worn during the day, replacing the compression bandages
  • Bandaging - As needed, nightly bandaging is used to prevent the limb from swelling overnight after the daytime garment is removed.
  • Meticulous skin and nail care
  • Targeted Exercises - performed daily
  • Self-massage - performed daily
  • Follow-up visits as needed with a CLT
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