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Lymphatic knowledge

Our aspiration: your well-being

Lymphology is the study of the disorders of the lymphatic system and the lymphatic vessels. Early diagnosis of dysfunctions of the lymphatic system is important due to their serious impact on health. An untreated lymphological illness can lead to serious impairments in everyday life and work. Treatment must therefore commence as soon as possible to counteract any further deterioration of the illness.

The lymphatic system

The human lymphatic system

Fig. 1: The lymphatic system

Fig. 2: Lymphatic vessels drain fluid and “waste products” from the interstitial tissues

Besides the cardiovascular system, the lymphatic system is another very important vessel system of the human body. It also runs through the whole body, mainly parallel to the blood vessels. Unlike the circulatory system, the lymphatic system is not a closed but a semi-open system. 

The lymphatic system constitutes the most important part of the human immune system. It functions as a transport and waste removal system for various substances that reach the intercellular spaces via the blood vessels and which cannot be removed by the body in other ways.

This so-called “lymph obligatory load” can only be removed by way of an intact lymphatic system and an optimal transportation of lymphatic fluid (lymph). The lymph obligatory load consists chiefly of substances such as proteins, dietary fats, cells and cell debris but also pathogens such as bacteria and viruses.

Oedemas

Oedemas are visible and palpable swellings that can appear due to various illnesses, after surgery or sustaining an injury. Oedemas develop due to an increased accumulation of fluid or fat cells in the tissues. Fluid builds up and can no longer be drained fully.

Oedemas often give rise to tenderness and tension and are accompanied by movement restrictions with significant adverse effects on the affected patient. The different types of oedema are not easily distinguishable. 

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Good to know

  • Oedemas are not always pathological, but they do not develop without reason. Therefore it is always important to consult your doctor to investigate the cause.

Oedema therapy

There is currently no cure for lymphoedema and lipoedema. The earlier treatment is started, the better the chances of stopping the progression of the disease. In this way, complications and secondary impairments, such as extreme restrictions in mobility, skin disorders or additional vein problems can be reduced or prevented.

Effective non-surgical oedema treatments: complex (lymphoedema) or combined (lipoedema) decongestive therapy (CDT). They consist of the following components:
manual lymphatic drainage (MLD), compression therapy, skincare/skin rehabilitation and decongesting movement and breath therapy. These are divided into two successive and interrelated phases. Active participation/self-management of the patient is of particular importance here. With the help of these components, lymphoedema and, to a certain extent, lipoedema can be treated effectively, deteriorations can be warded off and improvements can be made and maintained.

The components of CDT (combined decongestive therapy) within non-surgical treatment

Description of combined decongestive therapy


Phase 1: Decongestion phase


The first phase of CDT aims to improve the lymph drainage in the affected body regions, loosen hardened tissues (fibroses) and facilitate the removal of protein-rich oedema fluid.

The components of this phase are continual manual lymphatic drainage (MLD), if possible on a daily basis, supplementary compression therapy with daily compression if possible, as well as movement therapy and skincare.

Phase 2: Maintenance phase

In the second phase of CDT the MLD sessions are reduced in line with individual requirements while an attempt is made to maintain and optimise the current treatment outcome.

Here, flat-knit compression garments (e.g. Juzo Expert or Juzo Expert Strong) and movement therapy are used.

1. Manual lymphatic drainage (MLD)
MLD is a therapeutic massage technique. Special hand movements can be used to activate lymph drainage and decongestion of the tissues.

Stored, protein-rich fluid is eliminated via the lymphatic system. In this way, the oedema can regress and the hardened (fibrotic) connective tissue can relax and soften. The main focus of lipoedema therapy is pain reduction and mobilisation of the tissue. In contrast to normal massage, lymphatic drainage is carried out with gentle and slow movements. Your doctor will advise you if lymphatic drainage is suitable for your condition.

2. Compression therapy
The therapy must be supplemented with compression treatment immediately after MLD to maintain decongestion and reduce new accumulation of lymphatic fluid.

Because significant size fluctuations are to be expected in phase 1 of CDT due to the continuous reduction in circumference, the affected body part must be compressed using special lymphological compression bandages (e.g. Juzo SoftCompress in combination with short-stretch compression rolls). These allow for an individual adjustment to patients and their respective oedema circumferences. Towards the end of the first phase of CDT, when less fluctuations and reductions in size are to be expected, the compression bandages in use are replaced by lymphological, ideally flat-knit compression garments to preserve the therapeutic outcome of the decongestion phase. These garments are tailored to the individual patient and custom-made.

A perfectly and optimally fitting compression garment should not be constrictive or slide down. Using your specific body measurements, specially trained experts develop a compression garment which will then be made to fit you perfectly and precisely. Have the fit checked regularly with your medical products supplier in the future and get measured for any new garments.

3. Decongesting movement and breath therapy
Targeted exercise or movement while applying compression in general further promotes lymph drainage during the maintenance phase.

In this way, treatment success of MLD and compression therapy can be maintained over the long term and further reduction of the oedema is possible. It is of vital importance that you actively participate in your treatment to ensure the best positive result.

4. Skincare and skin rehabilitation
Daily skincare is especially important in both phases of CDT. The skin of oedema patients is a lot more sensitive and prone to inflammation and infection than that of patients without oedema or healthy people.

The skin dries out due to constant contact with compression bandages and daily wear of compression garments and can become itchy. If not sufficiently cared for, it can develop scaly patches and cracks, making it easier for bacteria to enter the skin. With lymphoedema, this can result in complications such as erysipelas or other bacterial inflammations.

Clean your skin with soap that has an acidic pH-value (all values below 7) to protect the acid mantle of your skin. In addition, also moisturise your skin with a rich and hydrating care product (e.g. Juzo Lymph Lotion) in the morning and evening. Make sure that the lotion has been fully absorbed by the skin before putting on your compression garment.

5. Education and training for individual self-therapy
The active engagement of the patient is important for the long-term success of the treatment. Within this context, the patient needs to be educated about the function of the lymphatic system, the interaction between individual therapy components and the consequences of not complying with therapy requirements.

Training in the area of breathing techniques, decongestive exercises, self-bandaging, skincare and working with self-help organisations can be helpful. Psychological support can also be useful in some cases. The aim is to improve self-management, positively impact the course of the disease, make everyday living easier and enhance quality of life.

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Good to know

  • Compression garments fit very closely like a second skin. This is why you need a little practice at the beginning. Don't be disheartened, with some practice and useful aids, putting on your garment will get easier over time.

Tips for everyday life

A positive attitude towards yourself and your body is a crucial factor: accept your oedema. Live WITH your oedema, not FOR your oedema. The general rule is: avoid injuries, overexertion, extreme heat and cold.

Woman with lymphoedema and umbrella

Body care and hygiene

Daily body care is of particular importance for oedema patients as the skin around affected areas can be very sensitive and prone to inflammation and infection.

  • Clean your compression garment every day – this is the only way the elastic properties are retained over the long term.
  • Use soap with an acidic pH-value (all values below 7) to care for your skin. This preserves the protective acid mantle of your skin.
  • Moisturise and pamper your skin using a rich and hydrating care product (e.g. Juzo Lymph Lotion). Only put on your compression garment once the body lotion has been completely absorbed by the skin.
  • Consult a doctor if you experience any signs of extensive redness, sudden fever, spontaneous pain and swelling or a fungal infection (itchy redness, yellow, brittle nails, cracks between the toes).
  • Make sure to exercise proper nail care and do not cut the cuticles.
  • Always carry a disinfectant so you can take care of any injuries right away.
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Diet
A healthy diet is always advisable as every extra pound puts an additional strain on your body:

  • try to reach and maintain your normal weight.
  • Eat enough fibre and reduce your sugar and fat intake.
  • Avoid or reduce alcohol and nicotine consumption if possible.
  • Drink at least 2 litres of fluid per day, water or unsweetened drinks are best.
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Sport
The answer to what is good for the individual cannot be provided in general terms for lymphoedema or lipoedema patients. Listen to yourself and pay attention to your body’s messages:

  • sports activities such as light jogging, Nordic walking, swimming or aqua aerobics in water that is not too warm are all suitable and support the therapeutic measures. Water pressure also has a “natural” compressive effect.
  • Give preference to endurance sports and physical activities with gentle movements. Wear your compression garments when exercising.
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Clothing
It can be difficult for oedema patients to find suitable clothing and shoes due to larger leg and/or arm circumferences or other affected body parts.

  • Wear comfortable clothing that does not restrict your movement.
  • Pay attention to cuffs or straps to avoid pinching or constriction.
  • Favour comfortable shoes, preferably with a low heel, possibly orthopaedic shoes.