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  4. What does Lymphoedema Management entail? (CLT/DLT)

Whether you are here in South Africa, in the USA, Australia, or Europe, or in any other country that offers comprehensive treatment and management for chronic Lymphoedema, across the globe lymphoedema management relies on the integration of four areas of focus:

  1. Skin care
  2. Exercises
  3. MLD (manual lymph drainage)
  4. Bandaging/compression garments

Each one of these areas is vitally important, not only to try and reduce the oedema already present, but also to prevent it becoming worse.

Lymphoedema patients often do not realise that there is a lot they can do for themselves at home, and thus education of patients is of utmost importance in empowering them to help themselves. Often patients feel that this chronic condition is given a bit of a ‘back seat” in their dealings with other health professionals, as it is not life-threatening, and is usually secondary to a much more serious illness/ condition, the treatment of which then naturally becomes the focus of the attending health professional.

There is frequently a feeling of hopelessness and despair – a sense of having had to deal with eg cancer, and everything that goes with cancer treatment, and then, as a last straw, also having to then deal with a chronic, uncomfortable and unsightly condition, which will be with them, to a greater or lesser degree, for the rest of their lives.

I always leave about 90 minutes for the first appointment exactly for this reason – often the workings of the lymphatic system and the four areas of treatment have not been thoroughly explained, as the main focus has been on the underlying pathology, and how to treat that. Patients really appreciate understanding how things work, and being given the time to ask questions and describe how they are feeling and what impact lymphoedema has had or will have in their lives. The impact is usually felt very acutely, and patients sometimes feel guilty for not just being grateful that the pathology has been or is being treated. It seems to them that complaining about a swelling is ungrateful and unimportant. Few people realise the enormous impact lymphoedema has on the quality of life of these patients, and it is my hope that after speaking to me, and being educated about the do’s and don’ts of living with lymphoedema, my patients feel understood, more hopeful, and more empowered.

The management is usually quite intense at first, with patients coming in up to three times a week, but then gradually tapers off, and the home programme becomes more the focus.

Patients often find the commitment in terms of time and energy, as well as the financial aspect, hard to come to terms with, but they also need to realise that this treatment is the “gold standard” across the world, and the programme has been worked out to ensure the best possible results. In addition, every programme can be altered/modified, to cater for the needs of each patient.

Treatment will only begin once I have established, by contacting the referring doctor/other health professional, that this is lympoedema, and not oedema from another cause. Throughout the treatment I will be in touch with the doctor as and when needed, so that the patient is properly monitored. Sometimes patients need to have tests done before the first treatment – this will be on the advice of the doctor, too. The reason for this caution is that MLD, unlike “normal” muscle massage, can be detrimental to your health if there is an underlying cause of the oedema that has not been properly diagnosed and investigated. The fact that the MLD is so light and gentle, does not mean that it cannot create more problems if used for conditions where it is contraindicated.


In these pages, I have tried to give you as much information as I could to give you a better insight into the working of the lymphatic system and why MLD is so effective in the treatment of both oedema and lymphoedema.

In addition, I have dedicated an entire page to skin care, because it is so vital to managing lymphoedema.


The use of compression garments is one of the cornerstones of lymphoedema treatment. They enable medically appropriate pressure to be applied to the swollen region. This means that the pooling of fluid can be reduced, the limb size and shape preserved and the lymphatic circulation supported and improved.

Compression garments provide graduated compression and are available in a variety of styles, sizes, colours and grades of compression (class 1-IV). Severe swelling usually requires stronger support than mild swelling.

Lymphoedema therapists are skilled at garment prescription and can advise on garment style and whether a pre-sized (Ready to Wear) garment or a custom made garment is required. Garment fabric may be constructed as a circular knit or a flat knit design. Most commonly garments are worn during the day and removed at night. Compression garments need to be replaced regularly in order to provide optimal support. Some people with mild lymphoedema may not require compression garments.

In addition to compression garments, there is also a graded, multi-layer bandaging method which also helps with oedema reduction.


Lymphatic fluid moves mainly due to muscle movement. Thus exercise is a vital part of lymphoedema management.

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