Alternative Therapies for the Management of Lymphoedema
Alternative therapies for the management of lymphoedema
By Rebecca Elwell, Msc Lymphoedema, Macmillan Lymphoedema CNS and Denise Hardy, CNS Lymphoedema, Cumbria
This article is taken from the Spring 2016 issue of LymphLine, the LSN’s quarterly newsletter available to all LSN members. For details of how to become a member, click here.
The standard approach to the management of lymphoedema as stated by the International Consensus, Best Practice for the Management of Lymphoedema (2006) – often referred to as the ‘gold standard care model’ – includes an intensive treatment phase of Multi-layered Lymphoedema Bandaging, Manual Lymphatic Drainage, Skin Care and Exercise followed by a maintenance phase of compression hosiery or wraps and Simple Lymphatic Drainage. The gold standard care model outlined above, has been adapted over the years by lymphoedema therapists from all over the world, to include a wide range of alternative or novel techniques, often with a focus on symptom management rather than volume reduction. However, a number of different therapies exist for the management of lymphoedema but the evidence to support their use is often poor and sometimes their use relies solely on the experience of the therapists who use it (anecdotal evidence) or of the patients who receive the therapy. Not all clinics have access to such therapies, which are often extremely expensive and not funded by all providers. This article simply aims to inform you of an interesting new tool to measure how much fluid is being retained under the skin, and some alternative therapies including:
- Moisture Meter
- Low Level Laser
- Hivamat (Deep Osscilation)
- PhysioTouch (Negative Suction)
- BodyFlow (Mild electrical stimulation)
A recent article in LymphLine highlighted the extensive use of Sequential Pneumatic Compression Pumps in the management of lymphoedema and they will therefore not be discussed further in this article.
A brief overview of the moisture meter and 4 therapies will be given, describing how it is thought that they work, what you might experience if you were to undergo the therapy and if there is any robust evidence to support its use.
The overall aim of lymphoedema treatment is to facilitate a reduction in the volume of fluid, often within a limb. However, there are an increasing number of people living with breast oedema in the UK as a result of more conservative breast cancer treatment. Measuring the amount of swelling in this area is more difficult than measuring swelling in an arm or leg. Subjective measures are therefore put in place to demonstrate improvements, such as how the tissues have softened, how the breast feels, or how much the bra digs into the skin. With the introduction of innovative products, some clinics are combining these measures with more objective measures such as by using moisture meter readings (a ‘pen like’ device which when held onto the skin can work out exactly how much fluid is being retained under the skin). The same device can also be used after treatment, to demonstrate oedema reduction more accurately.
‘Novel approaches to lymphoedema cannot be ignored, many clinics are now offering these techniques, obtaining good results and increasingly patients are reporting a benefit in symptoms.’
Low Level Laser Therapy (LLLT)
LLLT is light therapy, also known as LED therapy, rather than a true laser therapy, it is therefore safe and does not burn the skin or harm the eyes in any way.
LLLT aims to soften the skin and underlying tissues to increase lymphatic drainage by increasing the amount of oxygen in the cells. It is thought that it may have the ability to encourage the growth of new lymphatic vessels, though this is as yet not proven. As it has an effect on the regeneration of cells, LLLT should not be used in those with untreated cancer; if you are concerned in any way you should discuss LLLT with your oncologist or cancer specialist nurse. You should also not undergo LLLT if you are pregnant or under 18.
LLLT has anecdotally been reported as being beneficial to treat pain and increase range of movement e.g. in softening the skin and scar tissue in head and neck lymphoedema (following surgery and/or radiotherapy) to increase head turn and improve posture/discomfort.
LLLT should be given regularly to start with, e.g. 2-5 times in the first 2-3 weeks and then may be reduced over time. The LLLT probe (different sizes exist from a small pen type probe to one that looks like a shower head) is held on the skin in each affected area for 1 minute, with a total treatment time of 10-30 minutes. Most people do not feel anything, though some may experience a “creeping sensation”.
Limited robust evidence exists to support the use of LLLT in lymphoedema management and larger, wide-scale studies are required before it will become part of standard lymphoedema practice in the UK.
Hivamat/Deep Oscillation Therapy
Deep Oscillation Massage Therapy originated in Germany in 2007 and uses the Hivamat to create low frequencies of gentle electrostatic impulses that ‘vibrate’ your skin’s tissue by attracting and releasing it between 5-250 times a second. It is thought to remove excess inflammation caused by products, protein solids and lymph fluid build-up.
Your therapist is connected to the Hivamat machine using an electrode and you will hold a light neutral titanium bar loosely between your fingers. Wearing vinyl gloves and sometimes using talc, your therapist massages your swollen area allowing the pulsed oscillations to penetrate your skin to a depth of 8-12cm. The therapy can also be self-administered using an applicator which is moved over the skin, similar to an ultrasound probe.
The Hivamat Deep Oscillation Massage Therapy is extremely relaxing and enables your therapist to provide an effective deep tissue massage, without causing you pain or discomfort or further damage to your lymphatic system.
Extremely limited robust evidence exists to support the use of Hivamat in lymphoedema management, limited evidence exists to support its use as a treatment for breast pain post operatively and larger, wide-scale studies are once again required before it will become part of standard lymphoedema practice in the UK.
Contraindications to Hivamat therapy include
- Acute infections
- Infectious diseases of the skin
- Non-treated blood clots and vascular diseases
- Untreated cancer
- Cardiac pacemakers
- Hypersensitivity to electric fields
METAL PROSTHESIS ARE NOT A CONTRAINDICATION
Physiotouch (formerly known as Lymphatouch)
Originating from Finland, this device has a number of different sized suction cups a therapist can use in different areas of the body, using negative pressure to stretch the skin and underlying tissues. It is thought to enhance the opening of the cells of the initial lymphatic channels to allow them to absorb more fluid, thus reducing swelling. Therapists often use it as they report, anecdotally, that it leads to a softening of thickened tissues and scar tissue (allowing lymph to flow through the areas more easily) and some say it also alleviates pain and increases range of movement.
When the device is applied to the skin it gently sucks in the skin and there is a sensation of ‘pulling’ (which can be adjusted and should not be unpleasant) followed by a ‘release’.
Contraindications are quite vague but include:
- Acute infection
- Recent blood clot
- Swelling caused by heart failure
- Patients on active cancer treatment
- Caution should be observed when treating the neck area in patients over 60 years of age
- Under 18
Anecdotal evidence exists to support the use of Physiotouch or Lymphatouch but there is currently no robust evidence to support its use in the management of lymphoedema.
BodyFlow/Mild electrical stimulation
This therapy uses an electrical current to stimulate the lymphatics, and to a lesser extent, the smooth muscles. Such muscle stimulation has been shown to change tissue pressure which helps in lymph absorption and increases lymph flow.
The treatment involves attaching a number of electrodes to the appropriate part of your body, which apply a mild transdermal (through skin) electrical stimulus.
You may experience a light tingling sensation, felt through your skin under the electrode and a minor muscle twitch may occur, indicating the stimulation effect.
BodyFlow treatment is not suitable if you:
- Have an internal cardiac device such as a permanent pacemaker or internal defibrillator
- Are pregnant
- Have a DVT
- Have active cancer
- Have an acute infection
- Under 18
Some limited evidence exists to support the use of BodyFlow, but as is becoming a familiar story, larger wide-scale studies are required before it will become part of standard lymphoedema practice in the UK.
Novel approaches to lymphoedema cannot be ignored, many clinics are now offering these techniques, obtaining good results and increasingly patients are reporting a benefit in symptoms. There are testimonials to this on many of the company websites and health fora, e.g. The HealthUnlocked forum frequently features threads related to alternative therapies for lymphoedema. Some of the therapies can be used at home with portable machines which can be bought directly. If you would like further information please ask your lymphoedema therapist.
It is important to remember, however, that none of these therapies should be offered alone, they should only be offered as part of lymphoedema management in association with compression, skin care, exercise and massage and caution should be exerted if claims are made related to their efficacy and success in treating lymphoedema, as for the main part, little or no robust evidence exists to support their use.