Lymphoedema programme

The intensive phase combines manual lymphatic drainage, multi-layer compression bandaging, exercise in bandages, and skin care. It runs daily for two to four weeks, and limb volume is measured at the start and at the end rather than estimated.

The bandaging is the part that does most of the work and the part most often skipped. Drainage without compression produces a limb that reduces during the session and refills by evening.

The intensive phase reduces the limb. The maintenance phase — properly fitted compression garments, self-drainage technique, exercise and skin care — is what keeps it reduced. Without it the volume comes back.

So garment fitting, self-bandaging training and a written maintenance plan are part of the programme rather than an afterthought, and we will not run an intensive phase for someone who has no way to maintain it.

Lymphoedema is fluid accumulation from failed lymphatic drainage — usually asymmetrical, and it involves the foot. Lipoedema is a disorder of fat tissue — symmetrical, painful, tender to pressure, and characteristically sparing the foot. They can occur together.

The distinction is made by clinical examination and ultrasound before treatment, because treating the wrong mechanism wastes the programme and allows progression.

Lymphoedema is controlled, not cured. Consistent treatment substantially reduces volume, reduces the risk of cellulitis, and improves function and comfort — and it is lifelong management.

In lipoedema, conservative treatment reduces pain and swelling and slows progression. It does not remove the abnormal fat tissue, and we say so rather than let someone complete a demanding programme expecting a change in limb shape it cannot produce.

Limb volume is measured before the intensive phase and after it, in millilitres, so the change is a number rather than an impression. That measurement is in the discharge document.

Photographs and subjective reports are not enough in a condition where swelling fluctuates daily. Without volume measurement, neither you nor we can say whether the block worked.

The intensive phase reduces volume; compression holds it. Garments have to fit, be replaced when they lose elasticity, and be worn — and a good result is easily lost when an uncomfortable garment is quietly abandoned.

We fit rather than issue, check the fit before discharge, and state when replacement is due.

In two small randomised trials in lymphoedema after breast cancer treatment, compression bandaging alone reduced excess arm volume by 30% to 38.6%, and adding manual lymphatic drainage gave a further 7.11% on average 1. The extra benefit of drainage appeared larger in mild-to-moderate than in more severe swelling, a finding that still needs confirming in randomised comparisons 1.

In a trial of 90 people with lymphoedema of one arm or leg, 18 days of multilayer bandaging followed by elastic hosiery reduced excess limb volume by 31% at 24 weeks, against 15.8% with hosiery alone 2. One-year follow-up reported in the Cochrane review suggests that once swelling has been reduced, people who keep wearing a custom-made sleeve tend to keep it down 1.