TREATMENT OPTIONS

Complex Decongestive Therapy (CDT) is the recommended best practice for the treatment of lymphedema and is provided by Certified MLD/CDT Therapists (massage therapists, physiotherapists, kinesiologists or nurses who have additional education and training in Complete Decongestive Therapy (CDT)).  The treatment is designed to reduce your swelling, improve the condition of your skin, increase your mobility and educate you on self care to minimize the progression of the disease.

Currently there is no cure for Lymphedema, but research into the lymphatic system is progressing around the world. 

The two phases of CDT are:

Phase 1: Decongestion/Reduction which includes:

Compression Therapy to reduce

Skin care/wound care

Manual Lymphatic Drainage (MLD)

Self-Care

Exercise movement

Phase 2: Maintenance which includes:

Compression Therapy to maintain

Skin care/wound care

Manual Lymphatic Drainage (MLD)

Self-Care

Exercise movement

Some of the MLD/CDT therapists are also compression fitters, while others are only MLD/CDT therapists or are only compression fitters.

To find an MLD/CDT therapist or a compression fitter, we have an online professional listing of members:

Online Professional Listing

COMPRESSION THERAPY

In Phase 1 decongestion/reduction - Compression therapy consists of regular wrapping of the limb for several weeks with short-stretch bandages or coban wrap or velcro garments until the extra fluid has reduced as much as possible.  Measurements are taken before and after treatment.

In Phase 2 maintenance - Compression therapy consists of round knit or flat knit compression garments - off-the-shelf or customized to fit the shape of your limb and/or night garments. 

There are also compression bras, vests, shorts for compression of swelling to your chest or abdominal area.

Short-stretch Bandages:

There are two distinct types of compression bandages – short-stretch and long-stretch bandages. The difference refers to the extent the bandages can be stretched from their original length. Short-stretch bandages are made from cotton fibers, which are interwoven in a way that allows for about 60% extensibility of its original length, whereas long-stretch bandages, commonly known as “Ace” bandages contain polyurethane, which allows for an extensibility of more than 140% of the bandages’ original length.

The high working pressure of short-stretch cotton bandages provide the necessary solid counterforce and make them the preferred compression bandage in the management of Lymphedema. Due to the low resting pressure of short-stretch bandages, tourniquet effects are prevented – provided these bandages are applied correctly.

Long-stretch (“Ace”) bandages have the exact opposite effect and are not suitable for Lymphedema management. The low working pressure these bandages provide does not offer adequate resistance, and fluid would inevitably accumulate. In addition, the high resting pressure of long-stretch bandages could constrict veins and lymph vessels during rest.

Coban Wrap:

Coban Wrap is an alternative to short stretch bandages providing the same type of compression, which once applied can stay on for several days with less volume, waterproof and has less slippage due to the cohesive quality.

Round knit or Flat knit compression garments:

There is a wide array of compression garments to choose from and deciding which one is suitable can be daunting. Having the right fit is the most important aspect  - at no time should the garment have a tourniquet effect which will cause more swelling below the level of the tight area.

Please consult with your lymphedema therapist, doctor and fitter to find the best one for your unique needs as well as one that is the most comfortable for you to wear:

The “grades” for compression are measured in mmHg (millimeters of mercury just like the pressure of a blood pressure cuff):

·   15-20mm Hg – no prescription required; preventative; for tired achy legs; good for mild swelling experienced on airplane flights

·   20-30 mmHg (class I) – prescription required; for mild lymphedema in upper or lower extremity

·   30-40 mmHg (class II) – prescription required; for moderate lymphedema in upper or lower extremity

·   40-50 mmHg (class III) – prescription required; for severe lymphedema especially of lower extremity

·   50-60 mmHg (class IV) – prescription required; for severe lymphedema of lower extremity 

Most ready-made garments are circular knit and flat knit are generally custom made. Higher levels of pressure (>50mmHg) can only be achieved with flat knit garments. Circular knit fabrics are less expensive and cosmetically more attractive because they do not have a seam and can be produced using finer and sheerer materials. Flat knit garments are more dense but provide a more precise fit, but because of their construction when stretched over a limb there are more holes for the skin to breathe. 

Custom fitted garments are made for limbs that have an unusual shape such as the top of the limb is much larger than the bottom, or the limb does not fit into the manufacturer sizing charts. Since the greatest compression needs to be at the distal end (lower arm or leg) of the limb if the garment fits the top of the limb and is loose at the bottom this may cause the fluid to travel down to the hand or foot.  If the limb is symmetrically larger all over, the person may be able to fit into a ready-made “off the shelf” garment.