Lymphedema Risk Seems to Be Lowered by Physiotherapy

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Lymphedema is swelling of the arm, hand, or chest wall caused by a build up of lymph fluid in those tissues after breast cancer surgery, especially surgery that removes underarm (axillary) lymph nodes. (Edema is the medical term for swelling.)

A small study found that a special massage technique called physiotherapy can stop lymphedema from developing in some women when done after surgery.

Between 10% and 90% of women develop some level of lymphedema after breast cancer surgery. Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues near the surgical site. Radiation therapy and chemotherapy can increase the risk of lymphedema.

Physiotherapy to prevent or treat lymphedema also is called decongestive manual lymphatic drainage or complex decongestive physiotherapy. During physiotherapy, a specially trained therapist gently massages the skin and soft tissues of the arm where lymphedema could develop or has developed after surgery. Each physiotherapist may use different techniques. A typical regimen might include an hour-long massage once a day, 3 to 5 days a week. Many therapists wrap the arm with bandages or gauze after the massage and the bandages stay on for the other 23 hours per day.

Physiotherapy is very different from traditional massage therapy, which focuses on muscles and deep tissues and can be quite forceful. Traditional massage therapy can sometimes make lymphedema worse rather than better.

This Spanish study split 120 women who had breast cancer surgery that removed some of the axillary lymph nodes into two groups. Half of the women received physiotherapy to the arm and surgical scar tissue that also included shoulder exercises; they also were given educational materials about the exercises. The other group only received educational materials about shoulder exercises that could help minimize their risk of developing lymphedema. The women were followed for 1 year.

Overall, 16% of the women developed lymphedema: 25% of the women who didn't get physiotherapy and 7% of the women who got physiotherapy. This means that the women who had physiotherapy were 72% less likely to develop lymphedema compared to women who didn't have physiotherapy.

This study was small and the different physiotherapists used different techniques. Also, there were many differences among the women that could have affected whether lymphedema developed, including:

  • weight
  • number of lymph nodes removed
  • surgical complications

So these results are considered preliminary. More research is needed to better understand which physiotherapy techniques work the best, how useful physiotherapy can be in reducing lymphedema risk, and which women physiotherapy can help the most.

For some women who do develop lymphedema, the swelling is mild and goes away over time with treatment. For other women, the swelling is severe and can be an ongoing problem. Other research has shown that decongestive physiotherapy can help reduce the swelling, discomfort, and stiffness of lymphedema that developed after breast cancer surgery.

You can learn more about the risks for lymphedema, steps you can take to minimize that risk, and tips for managing lymphedema in the Lymphedema section.

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