Manual Drainage, Pumps

Manual lymphatic drainage

Manual lymphatic drainage, also known as "complex decongestive physiotherapy," is a very gentle technique that consists mainly of stimulating the skin and the underlying lymphatic vessels by hand. It's different from more traditional massage, which concentrates on muscles and deeper tissues and can be quite vigorous. That kind of massage might worsen lymphedema rather than making it better.

In manual lymphatic drainage, a physical, occupational, or massage therapist gently stimulates the affected arm by delicately moving his or her hand and fingers on the surface of your skin. The therapist moves the skin slowly, with circular or pumping motions that are generally directed toward the shoulder. The technique requires specific training and certification. Ask potential therapists whether they have taken a special course and how many hours of lymphedema training they have received.

At the end of every session, the therapist applies customized bandages. The goal is to minimize the re-accumulation of fluid and reshape the arm to look more like the unaffected arm. The therapist will prescribe exercises for you to do with the bandages in place.

Lymphedema therapy is often once per day, three to five days per week, for a number of weeks, depending on the extent of your swelling. Each session usually lasts 1 to 1½ hours. The procedure is also expensive and may not be covered by medical insurance plans.

The success of manual lymphatic drainage is closely tied to the skill and dedication of the therapist, as well as your own bandaging skill and dedication to your treatment program. The structure and physiology of your lymphatic system may also affect the success of treatment.

Pneumatic (air-driven) pumps

Pneumatic pumps are the foundation of traditional edema therapy. Your arm is placed into a full-length plastic sleeve that fills with air, compressing your tissues, moving stagnant fluids up and out of the swollen arm. After using the pump you will usually apply compression bandages or a sleeve to maintain the reduction you achieved.

An effective lymphedema pump has two features:

1. Gradient pressure: This means that the pump puts stronger pressure on the hand area than it does on the upper arm, pushing fluid in the proper, upward direction. Less useful lymphedema pumps put equal pressure on the whole arm.
2. Sequential pressure: This means that the pump exerts pressure that moves from the hand up the arm with a sort of "milking" technique.

This treatment requires up to a two-hour commitment each day to get temporary relief. You can do the therapy in your home while you are reading or watching TV. The settings of the machine and your overall plan must be determined by a qualified professional. Over time, a therapist should also check to see how the treatment is working. Good lymphedema pumps are expensive (about $5,000 to $6,000), but you can rent them from a surgical supply store. Most medical insurance plans cover part or all of the cost.

Be cautious about medical practices and independent companies promoting the pump. Some of these companies don't have trained physical or occupational therapists to supervise your care. Buy or rent a lymphedema pump only from a rehabilitation center or through the recommendation of your physical or occupational therapist.