By: Megan Repko, MPT & Melissa Bennett, MS, ATC; Mishock Physical Therapy & Associates
One cause of chronic swelling could be lymphedema. This is a condition where swelling occurs in the extremities due to a compromised or damaged lymph system. Lymph is the fluid that bathes the cells with needed nutrients, oxygen, and white blood cells provided by the circulatory system. Lymph is very important to the health of cells and tissues, and helps the body fight infection. Lymph vessels remove waste products from the cells encouraging healthy circulation.
When an injury occurs, the body’s normal response is to swell. The body’s response is to send an increased amount of blood carrying nutrients, oxygen, and white blood cells to the involved area. Under healthy circumstances the body can handle a 20% increase in lymph fluid. This is why swelling does not linger for more than a few days following a minor injury. However, when the lymph system is damaged, even the slightest increase in fluid is difficult to clear. This fluid continues to build up causing increased swelling to the injured area as well as the affected extremity. The lymph system can be damaged through surgery, radiation, or trauma. This damage prevents the flow of lymph back into the circulatory system.
Lymph flows in only one direction, toward the heart. All lymph fluid is passed through the lymph nodes that act as filters, and eventually this fluid makes its way back into the blood. Unlike the circulatory system the lymph system does not have a pump to push the fluid along. The lymph vessels rely on external pressure from the movement of surrounding muscles to carry the lymph through the system where the excess fluid can be reabsorbed back into the circulatory system.
Lymphedema is best treated in physical therapy with three primary interventions:
- Manual lymph drainage to encourage the lymph nodes and vessels to take up the excess fluid and move it into the correct drainage area.
- Compression therapy to provide the proper gradient pressure to the involved limb.
- Therapeutic exercise for joint flexibility and muscle contraction necessary for optimal lymphatic mechanics
*Please note, if you are suffering from chronic swelling, it is important to see your family physician first to determine whether or not your circulatory system is involved.
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