Lymphatic drainage for lymphedema
The edema manifests itself as a swelling in the tissues caused by the backlog of lymphatic fluid. Indications for manual lymphatic drainage are post-traumatic edema, primary and secondary lymphedema, venous insufficiency (CVI), lipedema, chronic pain syndromes (e.g. CRPS- Morbus Sudeck), scleroderma and lymphedema due to rheumatic processes. Causes of edema can be injuries to lymph vessels, e.g. due to accidents or operations.
In these cases, the lymphatic system itself is healthy, but more so-called “lymphatic loads” (post-traumatic edema) arise due to acute inflammatory processes. Although the body is able to increase the transport capacity of the lymphatic system (lymphatic time volume), this change is not permanent. Particularly in the case of larger injuries, the body is no longer able to cope with this additional work on its own.
This is known as “dynamic insufficiency” of the lymphatic system. It becomes dangerous when the lymph in the edema begins to clot.This happens when lymph is not transported for a longer period of time. An edema is soft at the beginning and usually painless.
If the lymph begins to clot, proteins are stored, the edema becomes firm and can no longer be moved. Once proteins have been deposited in the edema and the tissue has hardened, it takes much longer to correct this change. We then speak of protein-rich edema, which can develop into chronic lymphedema.
To prevent this process, manual lymphatic drainage should always be performed after operations and major injuries where oedema is present. The treatment goals of manual lymphatic drainage in acute inflammation are to reduce pain and accelerate regeneration. Pain reduction because the edema stimulates pain receptors and this process is reduced by reducing the swelling with manual lymphatic drainage.
Manual lymphatic drainage also stimulates the formation of new lymph vessels. In addition to post-traumatic edema, there are disease processes that can result in lymphedema. We speak of lymphedema when it is a protein-rich accumulation of fluid in the tissue.
Without treatment, this condition worsens steadily because it is a mechanical insufficiency of the lymphatic vessel system. This means that the transport capacity of the lymph vessel system is reduced to such an extent that the normally formed lymphatic loads can no longer be transported away. At the beginning, even this edema is still soft and can be removed by means of regular manual lymph drainage.
If treatment begins too late, the edema cannot be completely repaired, it hardens and can lead to restricted movement and a significant reduction in quality of life. The tissue is so severely altered that even elevation of the limb cannot cause any change and inflammation due to infection is encouraged (e.g. fungi, erysipelas). In the most advanced stage, this is called lympohstatic elephantiasis, as the edema can sometimes take on monstrous forms.
In this stage, lymph fistulas and lymph cysts can also occur, as well as simultaneous venous insufficiency and diseases of the internal organs. The cause of a mechanical insufficiency of the lymph vessel system is either the congenital lack of lymph vessels or their valves (primary lymphedema) or operations in which lymph vessels are injured or lymph nodes are removed (e.g. vein operations, lipectomy) and radiation therapy. Malignant cancers can also cause lymphedema.
