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Most people are familiar with the body’s vessel system that carries blood to and from the tissues, but few understand there is another equally vital system of vessels that removes cell wastes, proteins, excess fluid, viruses, and bacteria. The lymph system picks up fluids and waste products from the spaces between the cells and then filters and cleans them.

Like the roots of a tree, the lymph system starts as tiny vessels--only a single-cell wide--that eventually branch into larger and larger tubes that carry these fluids back to the blood stream. This network of delicate vessels and lymph nodes is the primary structure of the immune system. The lymph nodes act as check points along the pathways of the vessels. They filter the fluid (called lymph) and serve as the home for lymphocytes—little Pac Man-like cells that attack and destroy foreign bacteria and viruses and even abnormal cells, like cancer cells.

When the lymph system works well, we feel healthy and have a strong defense against illness. When it’s sluggish or blocked—say after surgery or an injury—we can have swelling, feel tired, and be more susceptible to colds and infections.


Lymphedema is a swelling of a body part, most often an arm or leg, caused by an abnormal accumulation of lymph fluid. It can also occur in the face, neck, chest, breast, abdomen, groin and lung. Lymphedema is a chronic condition, and progressive if left untreated. Early intervention is important, as advanced stages are difficult to reverse.

Primary Lymphedema

Some people are born with a faulty lymphatic system; it may be inherited or can occur as the fetus develops. When lymphedema is caused by a defect of the lymphatic system, it is called primary lymphedema. It may be present at birth, develop when puberty begins or in adulthood.


Primary lymphedema is a lifelong condition with no known cure at this time. Ongoing management and care is the key to the best quality of life with primary lymphedema.

Secondary Lymphedema

Other people develop lymphedema due to an event, or condition that damages or blocks part of their lymphatic system. In this case, it is called secondary lymphedema.


Some of the common causes of secondary lymphedema include:   obesity,venous insufficiency, cancer treatment  (breast, cervical, prostate and melanoma- cancer surgery may remove or damage lymph vessels and nodes, radiation therapy for cancer may also cause lymph vessel and node damage), surgery, or trauma caused by an accident, injury, or  burn.


For people at risk for secondary lymphedema, knowledge is the first step towards prevention. 


Stage 0 - Latency or Subclinical Stage: Swelling is not evident despite impaired lymph transport. This stage may exist for months or years before edema becomes evident. The patient has reduced transport capacity of their lymphatic system, but has no swelling. Most patients are asymptomatic. The patient may have subjective complaints, such as heaviness in the limb or mild aching or tightness. There is no swelling or pitting present on exam. This patient is at risk to develop lymphedema.

Stage 1-  Mild Stage:  Early accumulation of protein-rich fluid that subsides with elevation. The skin is typically soft with no dermal fibrosis. There may be edema present which pits. This is often called the reversible stage since the edema will go away with elevation or compression.

Stage 2 -  Moderate Stage:  Accumulation of protein-rich fluid with limb swelling that does not resolve with elevation.  There is early dermal fibrosis starting to develop. The limb may no longer pit on exam.  This stage will not reverse with compression alone. With prolonged treatment and compliance dermal fibrosis can improve and reverse.

Stage 3 - Severe Stage (Lymphostatic Elephantiasis):  On exam there is swelling. Pitting can be absent. Trophic skin changes such as acanthosis, fat deposits, papillomatosis, and hyperkeratosis develop. The patient can develop lobules with deep skin creases, which can be problematic hygienically. Skin crevices become prone to fungal infection, skin breakdown, and secondary skin infection.


Combined Decongestive Therapy (CDT) is a technique designed to accelerate the normal functioning of the lymph vessel system. CDT cleanses the connective tissue of inflammatory materials and toxins, enhances the activity of the immune system, decreases pain and enhances functioning of the parasympathetic nervous system. CDT integrates manual lymph drainage, myofascial release, scar work, rehabilitative exercise including self-massage.


It thereby facilitates the healing of injuries, chronic conditions, inflammations and edemas. Some examples of conditions which can be successfully treated with CDT are:

Primary and Secondary Lymphedema, Traumatic Injuries, Burns, Sinusitis, Headaches, Whiplash, Ulcers, Sports Injuries, Varicose Veins, Pre and Post Operative, Scars, Rheumatic Diseases, Fibrocystic Breast Disease.

Combined Decongestive Therapy is a treatment protocol which includes:

  • Manual Lymph Drainage: a special form of massage that re-directs lymph flow.

  • Compression therapy: the use of compression garments (e.g. elastic bandaging, sleeves, gauntlets or tights) to control swelling.

  • Education: to learn about how best to manage lymphedema.

  • Exercises: to promote lymphatic flow.

  • Skin care: to prevent infection.

The goal of therapy is to reduce swelling, manage the lymphedema and reduce your risk of it getting worse and leading to other health problems. Your certified lymphedema therapist will guide you through the treatment program and show you how to control your lymphedema with self care.

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