Complex Physical Therapy for the Lymphoedematous Arm

Abstract

Complex physical therapy was used in 78 patients with post-mastectomy lymphoedema (17 with grade 1 and 61 with grade 2). This involves: skin hygiene, a special lymphatic massage, compression bandaging and garments, and special exercises which supplement the massage. Two courses of treatment were given, lasting four weeks each, with a year between them. There was a highly significant decrease in the oedema in both grades, with more than 50% removed in the first course of treatment and 50% of the remainder in the second. There was even a small, but very significant decrease during the interval between the two courses.

Treatment of Breast-Cancer-related Lymphedema With or Without Manual Lymphatic Drainage: A Randomized Study

“…In a study by Boris et al comprising 16 patients with a mean lymphedema before treatment of 690 ml, the edema reduction was 73% (9) and in a study from the Adelaide Lymphedema Clinic an average reduction of 64% after one month was described for the first 78 consecutive arm lymphedemas treated in the clinic (17). Long-term results of DLT have been published by Boris et al (18), who reported an initial arm lymphedema reduction after DLT averaging 62.6% in 56 consecutive patients.…”

Liposuction Gives Complete Reduction of Chronic Large Arm Lymphedema After Breast Cancer

“…His massage technique was somewhat crude compared with that introduced by Vodder in 1932; Vodder used a specific light massage technique, manual lymph drainage, to improve lymph flow, especially in patients with primary lymphedema (18). The edema reduction achieved by these methods could not be maintained, however, because suitable compression garments were not available at that time (19). In 1969, Stillwell developed a variant of complex decongestive treatment, quite unaware of von Winiwarter's published work.…”

“…The technique is also known as combined physiotherapy (22). In Australia, the Caseley-Smiths adopted the concept and called it complex physical therapy (CPT) (19). The various methods described above (MLD and CPT) are generally called manual lymph therapy.…”

“…The accuracy of the method depends on the number of measuring points used. Measurements made at 10-cm intervals have been proposed (19,60,61), but give a rather crude approximation of the arm edema volume. A more accurate estimate can be obtained by reducing the measuring intervals, for instance, to 4 cm, as described by Kuhnke (62).…”

Conservative approaches to lymphedema treatment

“…It has been recommended that patients receive treatment 5 days a week for 4 weeks, although this is starting to be questioned by clinicians. Morgan et al 25 found that the greatest reduction in lymphedema occurred within the first 10 days of treatment, and Boris et al 26 found that reduction can be maintained up to 3 years if patients are compliant with wearing their compression garments. Thus, there is more research to be done in this area.…”