Introduction
‘I’ve been given a gift of a day at a Health Spa but I have lymphoedema. Can I have any of the therapy treatments they offer or should I avoid some of these?’
People generally are increasingly using complementary therapies believing that they can treat minor ailments, ease symptoms of disease, promote relaxation, alleviate stress and promote a sense of well-being.
Many people with lymphoedema would also like to use complementary therapies and frequently ask their nurse/therapist whether there are specific treatments which could help in their lymphoedema management, alongside their regular maintenance regime.
A survey by Cancer Research UK (2009) showed that almost a third of all cancer patients used some form of complementary therapy during their cancer journey.
The aim of this article is to provide some basic information about complementary therapy and to answer some of the questions that you may have with regard to using treatments yourself. This information may help you to make safe, informed choices about using complementary therapies in the context of your lymphoedema. However, this information is for guidance only and you should always ask for your lymphoedema therapist’s advice beforehand.

What is complementary therapy?
Complementary therapy literally means ‘a therapy/treatment which works alongside other treatments’. The term ‘therapy’ is often used to mean a ‘hands-on’ or ‘touch’ treatment, such as massage.
You may also come across the term ‘Alternative Therapy/ Medicine’. This is an ever widening array of treatments and diagnostic techniques which are not currently considered part of conventional Western medicine. It includes homeopathy, Chinese herbal medicine and Bach Flower Remedies.
Collectively, all of these therapies and treatments are called ‘Complementary and Alternative Medicine’ (CAM).
Surprisingly, in spite of their growing popularity, the effectiveness of most of these treatments is largely untested, unproven and un-regulated. Anecdotally, people may report that a treatment has helped them, but this is not the same as scientific proof that the treatment itself has cured the ailment! Properly conducted trials are needed for this.
This article will concentrate on complementary ‘hands-on’ therapies and lymphoedema.

Do any complementary therapies help lymphoedema?
Is there any evidence that they work?
Currently, the only ‘hands-on’ therapy which has some scientific evidence to support its effectiveness in treating lymphoedema is Manual Lymphatic Drainage (MLD) massage (Williams. A.F., et al 2002). MLD is accepted as part of Best Practice in the Management of Lymphoedema when performed by an appropriately trained MLD therapist.
Many beauty schools and Health Spas offer Lymph Drainage treatments, however, these are often not suitable for people with lymphoedema as the massage may be too firm and may not follow anatomical pathways and are intended only for people with a healthy lymphatic system.
As yet, there is no firm evidence that any form of massage, other than MLD, actually helps to reduce swelling in lymphoedema. But evidence does show that firm massage, especially where the system is impaired, can cause further damage to the lymphatic channels. (Eliska, Eliskova, 2006). This is why MLD needs to be light and directional and why we advise that you avoid any deep, firm massage/manipulative treatments on your affected area. (Lymphoedema Framework Project Document 2006).
Several trials have shown that massage can improve quality of life, relieve anxiety, provide relaxation and boost self-esteem. Some people with lymphoedema have said that it has helped them to ‘re-connect’ with their changed body image. Others have said that massage helps to reinforce a positive body image and selfworth.
"It made me feel good about myself again... accept my big arm as being part of who I am".

How do I choose a complementary therapist?
Many lymphoedema services and hospitals have complementary therapy departments where patients can receive massage from therapists trained to adapt their techniques to suit those with lymphoedema.
In 2001, the Department of Health recommended that each complementary therapy should be self-regulated and therapists are encouraged to register with an appropriate professional body. However, this is a voluntary requirement, there are numerous regulatory bodies, e.g. reflexology alone has twelve and because there is also no nationally accepted core training curriculum, therapists’ knowledge and skills vary greatly.
Many people using complementary therapy for the first time choose a therapist based on personal recommendation. You may be able to access treatments via your lymphoedema service. Some health centres sub-let rooms to independent therapists, but this does not mean that all qualifications and skills have been checked.

Always ask about the therapists’ qualifications and knowledge.
Be prepared to ask the following:

• Where did they train?
• How long was their training?
• Can you see their qualifications? And can they tell you about the training?
• What do the ‘letters’ after their name mean? (Some initials simply refer to the regulatory body rather than a qualification e.g. FHT… Federation of Holistic Therapists)
• Is the therapist insured? Can you see a copy of their insurance?
• What do they know about your condition?
• Are there any contra-indications for this therapy?
• Have they had additional training to treat people with lymphoedema?
• Ensure that they understand that only very light stroking movements should be used on the affected quadrant of your body
• Explain that either none or only plain, unperfumed oils/cream should be used on your swollen area
• Ask how many such people have they treated

A reputable therapist will be happy to answer any or all of these questions.
The therapist should also ask you for details about your health, medical conditions and any treatments or medications you are receiving.
The therapist should explain what the treatment is, how it will be performed, if there are any side effects and how much it will cost.
Remember, you are allowing somebody to treat your body... never be afraid to ask questions and never be afraid to decline or stop the treatment if you are not happy with any aspect of it.

CHECK LIST... ‘Act First’
1. A sk to see certificates
2. C heck credentials
3. T ell all medical history, including other treatments
4. F eedback if pressure is too heavy
5. I nsist plain oils/creams only on affected quadrant
6. R eally light touch only on affected quadrant
7. ST OP treatment if you are not happy with it!

Which therapies can I try?
It is beyond the scope of this article to give a comprehensive account of all complementary therapies available in the UK so I have focussed on some of the more popular ones which you may see advertised locally and in Health and Beauty Spas.

• MLD – light, directional anatomical technique carried out by a practitioner trained to Advanced Level for Lymphoedema. (Techniques recognised by British Lymphology Society and MLD^UK are Leduc, Vodder, Casley-Smith and Földi)
• Body Massage/Therapeutic Massage – using plain oils/ creams and only light touch on affected quadrant, or avoiding affected area
• Bowen Technique – gentle, manipulative, relaxing technique… avoid deep moves on swollen areas
• Reflexology – firm pressures using unproven system of reflex points on feet, hands and ear lobes. Use instead of massage over swollen areas. Lighter pressures to be used if working on swollen hands/feet
• Cranio-sacral Osteopathy – very light spinal manipulation with no evidence base... can be relaxing
• Reiki – light touch/hands-off relaxing technique based on unproven ideology of re-balancing ‘mind, body and spirit’. No physical manipulation or pressure used
• Therapeutic Touch – light touch/holding technique, unproven... no physical manipulation or pressure used
• Indian Head Massage – Westernised sequence of massage performed with recipient seated or lying down. Uses oils/ creams and deep pressure massage to upper back, shoulders, neck, head and face. Can be adapted by skilled practitioner to use light pressure only on affected parts. Should be avoided if you have facial oedema and avoid essential oils on swollen areas
• Facial Massage/facials/facial saunas – avoid if you have facial oedema or sinusitis

• Shiatsu – uses deep thumb pressures and strenuous manipulations of joints and tissues; may damage micro lymphatics and can be painful
• Osteopathy and Chiropractic – used for spinal and postural problems. Sometimes uses powerful manipulations and positioning to ‘re-align’ spine, some moves may compromise lymphoedematous areas
• Aromatherapy Massage with essential oils – avoid on lymphoedematous areas, may cause skin reactions and damage hosiery
• Swedish Massage – deep pressures used, working deep into muscles. Could damage micro lymphatics and can be very painful
• Acupuncture – unproven system of body’s energy channels (meridians)... invasive, uses needles, avoid on affected quadrant. (However there are ongoing scientific studies into its use to help reduce some of the symptoms of lymphoedema)
• Moxibustion – acupuncture with special needles which are ‘burnt’ to produce heat in the underlying tissues and meridians
• Acupressure – as above, uses deep thumb pressures instead of needles, therefore contra-indicated on affected quadrants
• Cupping – heated glass ‘cups’ applied to skin to increase blood flow to surface. Based on ancient medical practices, since discredited
• Hot Stone Massage – uses heated basalt stones/shells and aromatherapy oils to massage superficial and deep tissues
• Hydrotherapy treatments – some use high pressure water sprays to ‘treat’ cellulite, this can be painful and possibly damaging to micro lymphatics

This information is intended only as a guide and is based on the author’s knowledge of therapies discussed and on patients’ positive and negative experiences of complementary therapies. Always seek your lymphoedema practitioner’s advice before using any complementary therapy.

Conclusion
Remember that the best treatment for your lymphoedema is provided by your lymphoedema practitioner because it is evidence based, guided by International Framework Recommendations and MLD training schools that are self-regulated.
However, many patients report that complementary therapy treatments boost self-esteem, promote relaxation, ease some of the symptoms of heaviness and discomfort of lymphoedema, re-affirm positive body image and enable people to share in the same experiences as those without lymphoedema.

GIVE IT A TRY...
Many therapy centres offer short ‘Taster’ treatments. This is a good way to sample a new therapy. But use the ACT FIRST check list and be aware of the therapies that should be avoided – choose a treatment that suits you, your needs and your lymphoedema.

Useful references and websites:

• Lymphoedema Framework, 2006. Best Practice for the Management of lymphoedema. International Consensus. London: MEP Ltd.
• Singh, S and Ernst, E. 2008. Trick or treatment. Alternative Medicine on Trial. Bantam Press. London.