Once a positive diagnosis is given for lymphoedema or lipoedema, DLT may be recommended. There are two phases:
Intensive – with your therapist
Manual Lymphatic Drainage (MLD)
Multi-layer bandaging
Exercises
Skin Care
Weight management
Maintenance – self management
MLD is replaced by SLD (Simple Lymphatic Drainage)
Wearing compression garments
Self-bandaging, or use of Velcro wraps
Daily exercises
Skin Care
Weight management
Components of DLT
MLD: MLD is the use of specific massage techniques which mobilise the skin and stimulate the lymphatic system. It facilitates lymph flow into the venous circulation utilising lymph vessels. MLD is found to be most effective when combined with compression bandaging.
Multi-layer bandaging: in the intensive phase of treatment, bandaging is used to provide compression and support the underlying tissues. The use of foam under the bandages helps increases fluid movement and reduces slippage of bandages. Different density of foam is used dependent upon whether it is an arm or a leg being bandaged, and the type and thickness of foam is dependent on what the tissues are like i.e. thick fibrotic tissue, or soft and pitting. Bandaging is usually performed every day for a minimum of two weeks (excluding weekends).
Exercises: the aim is to enhance the efficiency of the muscle pump working against the compressive bandages. This will increase lymph circulation. Each patient is given individually tailored exercises suited to their particular requirements.
Skin care: good skin care is essential in maintaining skin integrity and reduces the risk of infection. This will involve the use of emollients, monitoring for cuts and abrasions and prompt action at the first sign of infection.
Weight control/maintenance: it is important to maintain a healthy weight. Lymphoedema can be exacerbated by being overweight as fat cells compress the lymphatics, reducing and impeding lymphatic flow. A detailed nutrition and weight loss plan should be followed before, during and after your intensive treatment.
Compression garments: towards the end of the intensive phase, you will be measured for custom fit compression garments. During the maintenance phase, containment of your leg or arm is achieved through daily wearing of these garments. Any exercise should be done wearing your compression. These garments should be replaced every 4 – 6 months.
