MLD/CDT treatment
is labor intensive and involves consecutive therapy sessions
to achieve an appropriate response in the involved area.
Integral to the success of any lymphedema treatment program
is an agreement between therapist and patient to work together
toward the desired goal of improved limb function, appearance,
and health. Lymphedema is a chronic and incurable condition
which requires ongoing maintenance, care, and periodic
expert supervision.
Complete Decongestive Therapy
(CDT) is the most successful treatment for chronic extremity
lymphedema. Post mastectomy lymphedema and other related
conditions respond extremely well to this gentle, non-invasive,
and highly effective therapy. CDT is sometimes referred to
as Complete/Complex Decongestive Physiotherapy (CDP). CDT
consists of the following steps:
 1.
Manual Lymph Drainage (MLD)
MLD is a very gentle manual treatment which improves
the function of the lymphatic system throughout the body.
In the 1930s the techniques of MLD were first introduced
by Dr. Emil Vodder, PhD, MT, from Denmark. MLD is becoming
widely recognized in the United States as a treatment for
many pathologies including post surgical swelling, post
traumatic edema (e.g., sports and other accidental injuries),
and combined edemas such as phlebolymphostatic edema and
lipo-lymphedema. MLD is further used to promote general
relaxation, pain management, and the cleansing (detoxification)
of the skin and superficial fascia. In lymphedema therapy,
MLD is used to reroute the lymph flow around blocked areas
into healthy lymph vessels which drain into the venous
circulation.
 2.
Compression Therapy
Compression therapy, through the use of multilayered
bandages, increases tissue pressure and is applied between
treatments to prevent the re-accumulation of evacuated
edema fluid. Compression therapy also increases the efficiency
of the muscle and joint pumps and is used until the limb
is sufficiently decongested to be fitted for compression
garments.
3. Exercises
Remedial exercises, with the bandages in place,
are performed to activate the muscle and joint pumps
of the affected extremity. This results in an increase
in lymphokinetic activity and, over time, in further
reduction of the swollen limb.
4. Skin Care
Skin care and general hygiene are essential
for eliminating bacterial and fungal growth, either
of which can cause repeated attacks of cellulitis or
erysipelas. Because infections are very common complications
of lymphedema, meticulous skin and nail care are integral
elements of CDT.
5. Patient
Education
Because lymphedema management is
an ongoing process, each patient is educated in a unique
and specific program of self-care. Such a tailored treatment
program ensures that each patient remains confidently
in control of his or her lymphedema, decreasing reliance
on continuous medical treatment in the future.
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