Lymphedema is a common health issue that affects the quality of life, especially in the advanced stages. Physical therapy for lymphedema has emerged as one of the best treatments for lymphedema and the mainstay of lymphedema management.
With an estimated 140–250 million people globally living with lymphedema, physical therapy for lymphedema is a key approach to addressing a common health condition that affects the lives of many people and requires a thorough understanding of its causes and treatment options.
What is lymphedema, and why does it occur?
Lymphedema is in the form of swelling in the tissues, due to the accumulation of protein-rich fluid that is usually drained through the body’s lymphatic system, as this system collects excess fluid, proteins and toxins from the tissues and returns them to the blood, and lymphedema often occurs in the arms or legs, but it can occur in the chest wall, abdomen, neck, or genitals.
Lymphedema may occur for primary reasons, as a result of a genetic defect that affects the development of the lymphatic system and can appear at any age, but it usually begins in childhood, and sometimes in early adulthood, and may be caused by secondary causes due to damage to the lymphatic system or issues with the movement and drainage of fluids within it, and may be due to radiation therapy for cancer, infection, injury or inflammation in a limb, or as a result of lack of movement of the limb.
Stages of lymphedema development and symptoms of each stage
If a patient is diagnosed with lymphedema, the doctor will examine the symptoms and determine the stage of the condition, as lymphedema usually progresses through a series of 4 stages, ranging from stage 0 to stage 3.
Stage 0 lymphedema
At this stage, the patient does not suffer from visible swelling or a permanent finger impression in the skin when pressed, but may feel a slight tingling or heaviness in the affected area, and this condition can last for years before any obvious symptoms appear.
Stage 1 lymphedema
In this case, visible swelling appears, lymphatic fluid begins to accumulate, and a temporary finger impression is formed on the skin when pressed, but no permanent damage to the skin or deep tissues occurs, and the swelling in the arm may disappear if it is lifted, however, people who reach this stage have a risk of developing more advanced stages.
Stage 2 lymphedema
People in this stage experience visible swelling with a permanent finger impression in the skin with an increased risk of infection, raising the affected limb does not help reduce the swelling, this indicates inflammation, stiffness or thickening of the subcutaneous tissue, specialists can manage the condition with physical therapy for lymphedema, but the damage to the tissue is irreversible.
Stage 3 lymphedema
The most advanced stage, where the patient suffers from obvious swelling and the affected area becomes enlarged and deformed, as the skin hardens and thickens in a way that prevents the appearance of a finger impression, and lymphatic fluid may leak through the damaged tissue. This stage is rare in breast cancer patients.
The importance of physical therapy for lymphedema
The outlook for lymphedema patients is better than ever, due to the role of physical therapy for lymphedema in improving their condition, and its importance is highlighted as the main non-surgical treatment that helps reduce swelling and improve the patient’s quality of life, as physical therapy for lymphedema helps with the following:
- Prevent complications: Regular treatment minimizes the risk of infections such as cellulitis, which is caused by stagnant lymphatic fluid.
- Improving motor function: It helps restore mobility and flexibility in the affected limb, reducing the feeling of heaviness and stiffness.
- Reducing swelling: By stimulating lymphatic drainage.
- Teaching patients how to manage the condition
- Improving quality of life
One type of physical therapy for lymphedema is manual lymphatic drainage (manual lymphatic drainage-MLD); other treatment options include compression stockings, compression bandages, and movement exercises.
Manual lymphatic drainage (MLD) techniques
Manual lymphatic drainage is one of the best types of physical therapy for lymphedema, as this physical therapy for lymphedema treatment moves fluid from the swollen area to an area where the lymphatic system is functioning normally, with the specialist using special skin movements to drain the target area. The patient usually lies down during manual lymphatic drainage, but if the edema is in the head or neck, the patient may sit upright. There are different types of manual lymphatic drainage techniques used by the lymphedema specialist, namely:
- Vodder
- Foldi
- Casley-Smith
- Leduc
How and when to use manual lymphatic drainage
Although there are different manual lymphatic drainage techniques in physical therapy for lymphedema, they share the following steps:
- Execute the movements slowly and rhythmically during physical therapy for lymphedema
- Usually performed with the patient in the supine position in physical therapy for lymphedema
- The specialist begins by using light pressure and specialized massage techniques in physical therapy for lymphedema to stimulate the lymphatic system
- The specialist stimulates the lymph nodes by massaging specific areas of the body that contain the nodes (armpits, neck, and groin) as part of physical therapy for lymphedema
- After stimulating the lymph nodes, the specialist pushes excess lymphatic fluid from the swollen tissue into the nodes, where the fluid is absorbed by the lymphatic system during physical therapy for lymphedema
Manual lymphatic drainage as physical therapy for lymphedema is used when there is persistent swelling that does not improve with elevation or bandages, to reduce the risk of recurrent infections such as cellulitis, to relieve the sensation of heaviness, tightness, or discomfort in the affected area, and can be used in the early stages to help drain fluids before the condition progresses.
Movement exercises and stimulate lymphatic circulation
Lymphedema often occurs in the legs and leads to discomfort and reduced mobility, but physical activity helps to effectively control symptoms, as muscles act as pumps for lymphatic fluid, and when muscles contract they exert pressure on the affected limb, which helps move the lymphatic fluid out of the affected area.Regular exercise helps to treat lymphedema and its symptoms through:
- Joint flexibility: Lymphedema leads to stiff joints and reduced range of motion in the legs, and including exercise helps reduce discomfort and joint flexibility.
- Lymphatic drainage: The muscle contractions that occur during exercise help move stagnant lymphatic fluid.
- Strengthening muscles: Strong muscles support the lymphatic system and stabilize the body.
- Weight management: A healthy weight is an important part of treating lymphedema.
- Improving mental health
Examples of exercises suitable for lymphedema patients
All exercise is suitable as physical therapy for lymphedema, including walking, swimming and cycling, and there are some simple exercises that can be done at home without the need for any equipment.
Bridge exercise
Lying on your back with your knees bent and your feet flat on the floor as physical therapy for lymphedema, tighten your abdominal muscles, lift your hips slightly off the floor, and then return them to the floor, repeating the movement 10–15 times.
Leg raises
The patient lies on the floor with one leg extended and the other left bent, then tightens the abdominal muscles, then lifts the extended leg and returns it to the floor, repeating the movement 10-15 times, then switching the leg.
Heel slide exercise
The patient lies on his back with the knees bent, keeps one knee bent, starts sliding the heel of the other foot on the floor until the leg is fully extended, then returns the heel to the starting position, the movement is repeated 10-15 times, then the leg is switched.
Hip abduction exercise
The patient stands up straight and rests on a stable surface, then moves one leg to the side and then brings it back to the center, repeats 10-15 times, and then switches the leg.
Light squats
The patient stands on a stable surface as physical therapy for lymphedema, lowers slightly as if about to sit down and then returns to standing, paying attention to sending the hips back and not allowing the knees to go beyond the toes, the movement is repeated 10–15 times.
Toe and heel raises
Standing on a stable surface, raise your heels to stand on your toes, then lower your heels and raise your toes to stand on your heels, alternating between the two movements and repeating them 10-15 times.
Use of compression bandages and stockings
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Edema compression bandages and stockings are designed as physical therapy for lymphedema to apply pressure to the affected limb in order to reduce edema and maintain the improvement achieved during treatment. Edema compression stockings aim as physical therapy for lymphedema to reduce the symptoms and signs of lymphedema, as they apply external pressure to the affected limb so that the pressure is as high as possible at the ankle or wrist and gradually decreases towards the center of the body; this gradation allows the lymphatic fluid to move towards the center of the body where it drains naturally and prevents the fluid from returning to the affected limb.
Depending on the type of condition and the location of the swelling, the specialist will provide the patient with one or more of the following types of compression garments as physical therapy for lymphedema:
- Compression arm sleeves
- Compression leg socks
- Compression garments for lymphedema affecting the genital area
- Compression bra or vest to treat lymphedema around the breast and chest area
- Compression straps, a system of straps with Velcro hooks that can be adjusted as needed
How to choose and wear compression bandages and socks for edema
The type of bandages and compression stockings for edema is chosen by the specialist based on the assessment of the clinical case, through the type of edema and the degree of swelling in addition to paying attention to the presence of fibrosis or skin changes. Compression bandages are worn in the morning after the manual lymphatic drainage session and should not cause pain and numbness, provide gradual compression, and wrap in a firm manner without twists and folds.
As for compression stockings, they are worn in the morning before the swelling begins to appear, preferably lying down for 10 minutes before putting them on, and taking them off before going to bed.
Tips for preventing worsening and optimizing outcomes
There are some tips that the patient can do to prevent the condition from worsening and improve treatment outcomes:
- Body monitoring: By regularly measuring the affected area of the body to watch for subtle changes that may be signs of lymphedema.
- Elevate the affected limb: Elevate the affected arm or leg above the level of the heart whenever possible.
- Keep moving: To help move fluids within the body.
- Avoid high temperatures, which increase the risk of lymphedema.
Factors that increase swelling and ways to avoid them
There are several factors that aggravate and worsen lymphedema, including:
- Infections such as cellulitis that damage the vessels and lead to poor drainage
- Injuries such as severe bruising, burns, or crushing that damage tissue and increase the risk of infection
- High temperatures cause vasodilation and increased fluid accumulation
- Being overweight and sedentary
These factors can be avoided by keeping the skin clean, using compression sleeves and socks for edema, avoiding high heat and very hot showers, and watching for any signs of swelling or redness and going to the doctor when they occur.
The role of nutrition and lifestyle in physical therapy
Healthy eating habits may help control swelling as part of physical therapy for lymphedema, as the lymphatic system is more effective when fed with nutrients found in fruits, vegetables, whole grains, and lean proteins, and healthy eating helps the patient maintain an appropriate body weight, and the patient must minimize salt intake because it leads to fluid retention, in addition to drinking sufficient amounts of water, which helps flush excess fluids from the body.
In conclusion, physical therapy for lymphedema is the mainstay in the management of the condition, as it contributes to reducing swelling, improving lymphatic fluid drainage, and enhancing the patient’s quality of life, and it is important that the treatment is under the supervision of a lymphedema specialist to ensure safety and effectiveness.
Sources:
- Centers for Disease Control and Prevention. (n.d.). Lymphedema. U.S.1. Department of Health and Human Services. Retrieved May 15, 2025
- National Health Service. (n.d.).Lymphoedema. NHS. Retrieved May 15, 2025
- National Cancer Institute. (n.d.).Lymphedema and Cancer – Side Effects. U.S. Department of Health and Human Services. Retrieved May 15, 2025
