Is there any science behind it?

There are several recommendations for a person at risk of developing lymphedema and for those who have lymphedema (to prevent an exacerbation episode). But in the past year, I’ve heard some people say there’s no evidence backing up these precautions. Is that true?

Recommendations

First of all, what are the recommendations? The National Lymphedema Network (NLN) has a page of Position Papers (a summary of their position on topics). They have one called “Risk Reduction.”¹  It was established by their medical committee in 2012. It needs updating but the overall recommendations haven’t changed. If you have lymphedema, the NLN recommends you:

1. Have regular check-ups with a lymphedema specialist (likely to take measurements and assess any problems, garment fitting, etc.)
2. Notify your healthcare provider of any changes in your arm
3. Maintain a healthy body weight (or lose weight if obese)
4. Exercise (see the blog post on exercise here)
5. Wear your compression garments and replace them every 6 month to 1 year
6. Prevent cellulitis infections (and immediately treat any signs or symptoms of infection)
7. Maintain good skin care
8. Avoid trauma of the affected arm (such as needle sticks, bug bites, etc.)
9. Avoid constriction of the affected limb (such as tight bands, restrictive clothing, blood pressures)
10. Avoid extreme heat or cold (such as hot showers, sitting in a sauna)
11. Inform any surgeon of your lymphedema if surgery is planned
12. Avoid stasis (i.e. see exercise above and avoid sitting or standing for long periods)
13. Consider consulting a vein specialist for treatment if you have varicose veins or spider veins
14. Wear your compression and move around during air travel (note it doesn’t say “don’t fly”)

If you are at risk for lymphedema (i.e. if you’ve had lymph nodes removed and/or radiation), the guidelines are nearly the same with a few modifications (such as wearing a compression sleeve). These precautions are backed up by the Foldi Textbook of Lymphology² (a source I often reference).

For NLN guidelines, visit www.lymphnet.org.

(Photo by energepic.com/Pexels)

Rationale behind the recommendations

The NLN explains the rationale behind these precautions. However, it also notes there is limited research backing these recommendations. In theory (and many therapists would say in practice), these precautions make sense. Anything that could increase the blood flow will increase the lymphatic load. And anything that increases lymphatic load can increase your risk of lymphedema development or exacerbation. That doesn’t mean you will experience lymphedema or an exacerbation – just that you could.

My thoughts

Based on the theory and based on my experience of treating patients (and when they first developed symptoms of lymphedema), I recommend patients follow these guidelines. Next month, we’ll look at how to monitor your arm for potential lymphedema development or exacerbation based on symptoms. We’ll also learn how to measure your arm for baseline measurements.

References
1 https://lymphnet.org/position-papers
2 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 268-270. Germany: Urban and Fisher.