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Lymphedema is swelling caused by damage to the lymphatic system.
Providence physical therapist Victoria Eder explains how education and early intervention can help manage symptoms.
Physical therapy and compression tools can help ease swelling.
Picture your lymphatic system as an interconnected series of streams that run throughout your body. When you’re healthy, the system flows smoothly, clearing fluid from the body while also transporting proteins and waste products. But if there’s a disruption, like with a blocked stream, it causes problems — in this case, lymphedema.
Breast lymphedema occurs because of damage to the lymphatic system. This can stem from a genetic abnormality, or trauma. In the United States, it typically happens as a result of cancer, surgery for cancer or radiation. It’s also not limited to the breast but can occur in the chest area and the armpit as well.
Breast lymphedema can have a lasting impact on your health. If left untreated, it can become painful by putting pressure on the nerves. The tissue can harden, which may affect range of motion in the nearest limb as well affecting posture or contributing to upper back pain. In the worst-case scenario, there is research that a swollen limb is more prone to infection because the lymph nodes aren’t cleaning the area, making it more like a stagnant pond than a stream.
There is, however, the opportunity to manage the effects of lymphedema with early education and proactive measures, says Victoria Eder, a licensed physical therapist in the outpatient program at St. Luke’s Rehabilitation Institute in Spokane, WA.
“Once the lymph nodes and vessels are damaged, you are always at risk for lymphedema. What we are seeing, though, is that if you start early, you can control the swelling.”
Signs of breast lymphedema
The first sign of lymphedema you may notice is a sense of heaviness or tingling in the affected area, Eder says. Naturally, there is also swelling from the fluid not flowing as it should through the lymphatic system, and the surface of the skin can take on a texture similar to that of an orange peel, a condition called peau d’orange.
But some people don’t wait for symptoms to appear before facing breast lymphedema head on.
“I think as more people are aware of it as an issue, they, and their physician, are being proactive about it,” Eder says. “I had a young woman come in today who doesn’t have any symptoms but wants to do everything she can ahead of time to make sure she doesn’t develop any obvious swelling.”
So, a big part of Eder’s work is educating patients on how the lymphatic system works — the stream analogy is one she uses — as well as precautionary measures.
“What has been found is you can minimize the chance of getting swelling and having it go out of control, so we take certain steps such as education,” Eder says. “We give patients an awareness of things that can trigger lymphedema, what we call the lymphedema precaution list. We use one put out by the National Lymphedema Network. It is a list of things that have been shown over the years to aggravate and put increased stress on the lymphatic system. For instance, there have been documented cases of people going years without any problems and then they get a bug bite, which can overload the lymphatic system.”
Breast lymphedema treatment
Eder often treats her patients with a physical therapy technique called manual lymphatic drainage. This hands-on process can help improve the function and flow of the lymphatic system.
“You can manually reroute around lymphatic blockages to healthy lymph nodes, and from there it goes to the venous circulation and it is processed like it normally would,” Eder says, adding that she can also train people in the technique so they can perform the drainage on their own.
Eder says a patient’s medical history from the physician helps her to know which areas of the lymphatic system haven’t been affected and what areas are still healthy. She also observes the patient to check on swelling, which indicates a blockage. With some patients she can visually see the swelling go down during the treatment and feel a softening in the body tissues as the fluid buildup is released; she also measures the swollen area before and during the course of treatment to make sure the fluid is draining. The time involved in drainage and the need for repeated treatments can depend on the individual patient, depending on factors such as how long they’ve had swelling and their overall health.
There are other tools you use to control lymphedema. “The use of compression becomes a critical point because what you are doing is giving tissue some external support so fluid doesn’t pool in the breast area,” says Eder, adding that garments such as compression vests and camisoles or support bras may be helpful. Another compression tool is a chip bag, also called a Schneider pack, which can be used in areas of heavy swelling.
You may also find lymphedema relief from kinesiotape. “It’s used primarily as an athletic tool to support tissue during healing, but it can also be helpful in supporting lymphatic flow.”
Eder says that over the last five to 10 years, microsurgery has been emerging as a promising therapy. It’s only available in certain areas of the country for the time being, so for now, fast action against breast lymphedema is crucial in successfully managing the condition. “That’s what we are trying to do when we get someone early — we want to give them all the tools so they’re optimizing their lymphatic function.”
Contact St. Luke’s Rehabilitation Institute to learn more about lymphedema treatment and other physical therapy programs. Learn more about breast cancer treatment and other cancer services at Providence St. Joseph Health:
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.