Lymphoedema Management

Complete Decongestive Therapy

Complete Decongestive Therapy is the gold standard of care for the management of lymphoedema and the following steps are followed: 

Manual lymph drainage (MLD) – this is a very soft stretching of the skin to allow fluid to re-enter the lymphatic system. We do this with every treatment session for at least 30- minutes. We do MLD to stimulate the lymphatic system so that it can absorb the excess fluid. This fluid will then be directed towards the unaffected areas. 

Deep Breathing Exercises are vital to every treatment as this is stimulating the largest lymph node which is above your belly button.  Also ensuring healthy peristaltic movements of you bowl which in return will also stimulate this large lymph node called the Cysterna Chylli.

Meticulous skin and nail care is one of the most important parts of lymphoedema care. Your skin protects your body from infection, and in a swollen leg you are at high risk for developing infections. Therefore, you and your therapist must ensure that your skin and nails are clean and dry and moisturised before bandaging is done (if this is part of your treatment).

Short stretch compression bandages are used to reduce to swelling. You will have to wear these bandages until your next visit to get the best results.   The bandaging will be stopped as soon as your arm/leg is not reducing anymore, and you will then be put in long term compression

Exercises: Specific exercises will be given to you depending on your diagnosis

Long Term Compression Stockings

After the acute stage of treatment, a compression stocking will be measured and fitted by the orthotist for your specific needs.

You might need a night time device if indicated for your oedema


PHLEBOLYMPHOEDEMA = Chronic swelling caused by veins not pumping blood back to your heart sufficiently, overloading your lymphatic system

Causes of Chronic Swelling:

  • Cellulitis infectionscan cause damage to the lymphatic system. This can lead to chronic swelling
  • Blood clots (DVT) can cause damage to the deep and later superficial veins. This can cause an overload on the lymphatic system and then chronic swelling
  • Chronic Venous Insufficiency (CVI) means that the valves in the veins fail, the blood collects and cause an increase amount of fluid in the interstitial space. This will put pressure on the lymphatic system and can lead to chronic swelling.


  • Reduce the swelling by doing MANUAL LYMPH DRAINAGE (MLD) and compression bandages.
  • Long term stockings
  • Skin care
  •  Exercise
  • Lifestyle and eating habit changes if necessary

Any chronic swelling is lymphoedema


  • Genetic Malformation of the Lymphatic System
  • You are born with the problem, but it can present during different times
  • Mostly just one arm or leg
  • Pitting oedema


  • When damage is done to the lymphatic system
  • Cancer:

Lymph nodes removed

Lymph nodes damage by radiation

  • Surgery/Scar tissue can prevent the lymphatic fluid form moving past a certain point

Burns-destroys the superficial lymphatic vessels



  • Manual Lymph Drainage – using the ‘fill and flush’ technique.
  • Compression with Short stretch bandages or a compression system to reduce the swelling
  • Exercise
  • Skin care
  • Diet adjustments if needed
  • Psychosocial and Psychological aspect of
  • condition will be addressed
  • Long term compression stockings





  • Abnormal Fat Metabolism
  • Only looses weight at certain places on your body
  • Nodules under skin
  • Fat cells are abnormally large
  • Sometimes there is swelling as well
  • Painful


  • Compression stockings/leggings
  • Manual Lymph drainage when there is swelling
  • Exercise
  • Diet adjustments if needed