What Is Complete Decongestive Therapy for Lymphedema?
Complete Decongestive Therapy (CDT) is a specialized therapy for initial lymphedema treatment designed at reducing the size of the affected area. It is made up of several visits (usually 3 per week) over about a 6 week period. CDT is generally covered by insurance and is offered one time only.
Complete Decongestive Therapy is usually carried out in a clinical setting such as a lymphedema clinic at a hospital. Since insurance covers this brief lymphedema treatment, it must be done by a physical or occupational therapist in that type of setting.
After those insurance benefits have run their course, people generally switch to a Certified Lymphedema Therapist outside of the hospital system. Almost all insurance plans will not cover therapy after the CDT phase of 6 weeks is over. I am a LANA Certified Lymphedema Therapist (the highest-rank one can achieve in the lymphatic world), and a licensed massage therapist. This means that my rates are cheaper per session once your benefits have run out.
That’s the long-term vision for management. Let’s take a step back now and look at what you can expect from Complete Decongestive Therapy treatment for Lymphedema.
What Is Done During Complete Decongestive Therapy?
Complete Decongestive Therapy (CDT) is the combination of several specific therapies that, when used together in a specific sequence, provide significant relief from swelling and fibrosis (hardened tissue) caused by Lymphedema.
In complex cases where wounds or leaking vessels are present prior to treatment, these conditions often resolve over time and tissue heals and returns to a healthy state.
Complete Decongestive Therapy is divided into 3 main parts: Lymphatic Drainage (Manual or Electro), Compression Bandaging, and garment fitting.
1) Manual Lymphatic Drainage (MLD)
Manual Lymphatic Drainage is a very specialized technique that moves fluid from a swollen (edatamous) area and returns it to the circulatory system (the blood) where it can be removed from the body (peed out).
Lymphatic Drainage can be the traditional Manual Lymphatic Drainage (MLD) that is done entirely by hand, or it can be Electro-Lymphatic Therapy where it is done through the use of a machine (not a pump) that causes lymph to become less sticky so that it flows more easily through the system.
Lymphatic Drainage is done in the initial phase of treatment, throughout the reduction process, and is done periodically to help maintain the size of the affected area after the Complete Decongestive Therapy process is complete.
2) Compression Bandaging
Compression Bandaging is an important part of decongestive therapy because it is super effective in further reducing swelling when done immediately following a lymphatic drainage session. The Manual Lymphatic Drainage prior to bandaging opens the “drains” so that fluid can move more effectively.
In more severe cases of swelling such as late stage Lymphedema, Lipedema, or Chronic Venous Insufficiency (CVI), compression bandaging can make a world of difference in the speed of reducing swelling.
There is probably no one who enjoys wearing a compression bandage as it is usually quite large and bulky, making getting dressed and getting around more complicated. That being said, it is a temporary part of the therapy and its effectiveness can’t be understated. If compression bandaging is part of your recommended therapy, be sure to work with your therapist to make a bandaging plan that will work for you. The results are absolutely worth the temporary discomfort.
TYPE OF BANDAGES THAT ARE USED
It is super important to understand that the type of bandages used are NOT “ACE Bandages.” They are called Short Stretch Bandages. You can find Short Stretch Bandages on Amazon Here.
Note that they come in multiple widths. Smaller widths (4 cm) are typically used for the hands and feet. Larger widths are used as bandaging progresses up the limb (8-12 cm at the top of the limb).
Although they look similar, there are several key differences:
- Short Stretch Bandages are cotton elastic and do not contain latex or rubber.
- Ace Bandages do contain rubber or latex.
- Ace Bandages do contain rubber or latex.
- Short Stretch Bandages, when applied correctly, are safe for use overnight because they do not have a high resting pressure. This means that when you rest, the bandage is not at risk of causing a tourniquet on your limb. They achieve their best results when you are moving and your muscles are causing pressure against the bandaging.
- Ace Bandages have a high resting pressure which means that they become tightest when you are at rest. This can cause a tourniquet and *worsen* the lymphedema. Additionally, they have a low working pressure, meaning that as you move, they stretch with you and do not do an effective job at compressing the limb. This compression is the key to moving fluid.
Alternatives to Short Stretch Bandaging – Velcro Wraps
For several reasons it is not always possible for people to use short stretch bandaging as a method to reduce their lymphedema.
In these cases, and also as a strategy for long-term management, there are velcro wraps that have been designed to achieve a similar result. There are variations in these wraps from one manufacturer to the next. My personal preference is the Juzo brand because they do not stretch. This helps ensure that a person doesn’t over-tighten some areas of the bandage while under tightening other areas. I also like the fact that there are fewer straps to manage.
Here are a few examples and links to Amazon where you can buy these types of wraps.
As part of Complete Decongestive Therapy (CDT), compression bandaging is applied to the affected area.
- Keep fluid from returning to the area
- Assists the lymphatic system in pumping fluid out of the affected area as the body moves
- Breaks up hard (fibrotic) tissues, making the area softer.
3) Compression Garments
and Garment Fitting
Regardless of which kind of garment you require, it is strongly recommended that you obtain at least two so that one can be worn while the other is washed. Swelling can happen in a very short period of time when the garment has been removed, so waiting for your garment to dry can mean that your swelling may increase significantly in the meantime. (Note: Custom garments shouldn’t be put into a dryer. Off the shelf garments generally should be put in the dryer.)
Lymphedema is managed long-term (following Complete Decongestive Therapy) by wearing specially fitted compression garments. The compression garment works in two ways: 1) it helps resist the deposition of more fluid to some degree and 2) it helps move away existing fluid – especially when you move / exercise while wearing your compression.
The final stage of Complete Decongestive Therapy is being fitted for a garment once the maximum amount of swelling reduction has been achieved through Compression Bandaging.
Compression garments come in all kinds of shapes and sizes and for virtually every part of the body. Additionally, there are daytime and nighttime garments. Your therapist will guide you in what type of garment will work best for your condition.
There are two main kinds of garments: “Off-the-shelf,” pre-made garments, and custom-made garments which are measured to fit each individual person. Custom garments are usually necessary when limbs are not consistent with a typical body shape or size.
Measuring for a Custom Compression Garment
If your condition is not severe you may be able to be fitted for an “Off-the-shelf” pre-made garment. These garments are far cheaper than custom-made garments, but good quality ones (which are worth what you pay for them) are a little pricey.
Custom-made garments are necessary for many people who are in later stages of disease where limbs have become very large or have proportions that do not match standard models. Custom-made garments do cost quite a bit. Sometimes it is possible to get insurance coverage for them (usually only with breast cancer-related Lymphedema), but most custom garments must be paid for out-of-pocket. There are organizations that help people to purchase garments.
Exercises for Lymphedema
Part of Lymphedema management is the use of exercise to get fluid moving. This is best done under the care of a Physical or Occupational Therapist who is also a Certified Lymphedema Therapist. In general, exercise should never be suddenly strenuous because that could cause further inflammation and swelling.
Exercise that begins with simple movements and gently progresses to more challenging resistance and weight use is ideal. For detailed guidelines, please see the video below put out by Sloan-Kettering Memorial Cancer Center. These guidelines apply to all people with Lymphedema, not just people who have or have had cancer that caused the Lymphedema.
Exercises should always be done while wearing compression garments or bandages. They help to move fluid more effectively than just exercise alone.