The components of a comprehensive lymphedema treatment/management program include:
1. Evaluation - to determine the appropriate course of treatment to take and to determine limitations an individual may have with lymphedema.
2. Education - is an essential component to ensure self management and control of lymphedema. Patients "modify" their activity level to accommodate for lymphedema. It is important to be knowledgeable about prevention of infections, recognizing onset, signs and symptoms of infections, and what steps to take if an infection is suspected. Proper skincare, elevation techniques and nutrition also play roles in successful self management.
3. Manual Lymph Drainage (MLD) / Complete Decongestive Physiotherapy (CDP) - These are special massage techniques consisting of a very gentle massage of the trunk and the limbs that stimulates the flow of lymphatic fluid through the system and back into the bloodstream. Lymphedema therapists are trained at different "schools" with differing, but effective techniques. The basic principles of treatment seem to be common; however the techniques may vary depending on where the therapist is trained.
4. Compression Bandaging - bandaging for lymphedema is done with low-stretch bandages (Jobst or Lohmann Rauscher) which enhances the muscle pumping action of the limb, facilitates lymphatic flow and reduces swelling. Graduated medical compression (non-elastic support) is worn during the night. The CircAid (non-elastic) velcro-wrap arm and leg garments can be used in place of low-stretch bandages for home maintenance of extremity lymphedema.
5. Therapeutic Exercise - includes flexibility exercises and strengthening to enhance lymph flow.
6. Compression leg stockings and arm sleeves/hand gloves or gauntlets - graduated medical compression (elastic support ), such as Juzo, Medi, Sigvaris, and Spa is worn during the day to maintain increased circulation and help prevent recurrent edema (swelling) and infection.
7. Compression Pump - this device can be used as a component of a comprehensive lymphedema treatment. The trunk is cleared with massage prior to pumping; if not, the region just proximal to the pump sleeve can form fibrous tissue like a "cuff" around the proximal part of the limb.