Complete decongestive therapy (CDT), also called complex decongestive therapy, is an intensive program that combines many of the different treatment approaches discussed in this section, including bandaging, compression garments, manual lymphatic drainage, exercise, and self care. (See the list of links at left to read about these treatments.) As a technique, CDT originated in Europe and Australia but is now becoming more prevalent in the United States. Many studies have demonstrated the effectiveness of CDT for improving lymphedema symptoms such as swelling and pain.
CDT is considered the gold standard of treatment for lymphedema that has progressed beyond stage 1 — meaning there is visible swelling without pitting (a temporary indentation forms on the skin when pressed) and there may be evidence of fibrosis (scarring of soft tissue).
“CDT really is the ‘full-court press’ you want in cases of stage 2 and stage 3 lymphedema,” says Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at Mayo Clinic. “The idea is to bite the bullet and go through an intense aggressive phase to bring it under control and then work to maintain those results.”
CDT has two main phases:
Phase I: Reductive CDT
Phase I CDT is all about getting the extra lymph out of the arm, hand, or other part of the upper body to reduce visible swelling and other symptoms of lymphedema. Although treatment plans are tailored to the individual, phase I CDT generally involves seeing your lymphedema therapist 5 days a week for sessions that include manual lymphatic drainage (MLD), short-stretch compression bandaging (with or without the use of foam pads and chip bags), and exercise. You typically would need to wear the bandages around the clock during this phase, removing them only for showering or bathing and MLD sessions. Your therapist will teach you how to apply the bandages correctly on your own and how to do the exercises.
Phase I can last anywhere from 3 to 8 weeks, depending on how long it takes to bring down the swelling and improve other symptoms affecting the skin. Your therapist will use measurements and/or visual examination of the arm, hand, chest, or trunk to decide when your phase I sessions have done everything they can to reduce your symptoms.
Although daily visits to a lymphedema therapist can be time-consuming, inconvenient, and expensive (if not fully covered by insurance), they are considered a mainstay of lymphedema treatment. Talk to your lymphedema therapist if you feel you can’t keep up with the phase I schedule he or she recommends. There may be ways to modify your treatment plan safely. If you’re concerned about getting time off from work every day or about the cost of treatment, you may find some helpful advice in our sections on Breast Cancer and Your Job or Paying for Your Care.
Phase II: Maintenance CDT
Phase II CDT is about maintaining the results of the initial intensive phase on your own. Although individual treatment plans vary, you can expect to stick with phase II of CDT for many years or even for the rest of your life. Phase II includes getting fitted for and wearing compression sleeves and garments, then learning how to put them on correctly and care for them. It also includes the self-care steps mentioned earlier in this section, such as:
- protecting your arm, hand, chest, or other body part from cuts, injury, overuse, extreme temperatures, and other situations that can increase the risk of lymphedema and lymphedema flare-ups
- learning the signs and symptoms of infection, which is a special concern for people with lymphedema
- designing and then following an exercise and/or weight control plan
To learn more about what’s involved with each of these action steps, you can review the sections on Reducing Risk of Lymphedema and Lymphedema Flare-Ups and Lymphedema and Infection.
Some lymphedema therapists also teach their patients how to do manual lymphatic drainage on their own. Others feel it is such a specialized skill that doing MLD on your own isn’t likely to help that much. Check with your therapist to see what he or she recommends. If you do MLD on your own, be sure to follow your therapist’s guidelines on how and when to do it. Doing more than is recommended, or being more aggressive with the massage strokes for MLD, could be harmful. If you have any infections or areas of irritation on the skin, it’s also important to avoid those places during MLD.
Your lymphedema therapist can work with you over time to make sure your lymphedema stays under control, ratcheting your plan up or down as needed. For example, there may be times that you need to wear a compression sleeve or other device around the clock, and others when you can get away with a few hours a day — or even skip a day or two. You may find that lymphedema never becomes a major problem for you again, or that it’s only a problem in certain situations, such as hot weather or activities involving heavy use of the arm. On the other hand, you may experience periods of worsening lymphedema that require you to go through phase I CDT again at some point.
Every person is a little bit different: Over time, you’ll get to know how your body responds in certain situations and be able to take action accordingly. Just be sure to check with your lymphedema therapist before making any changes in your treatment plan.