Does sitting too long cause your legs to swell at the ankles? Have you found the recent prolonged heat has increased the circumference of your ankles or are your shirt sleeves feeling tighter than usual? Do you have a history of trauma or surgery to your arm, leg or abdomen. Have you noticed a progressive feeling of heaviness in your arms or legs? Have you experienced surgery, chemotherapy or radiotherapy for cancer related illness?
March is lymphoedema awareness month and answering yes to any of the above questions could mean you are experiencing some form of congestion or sluggishness in your lymphatic system.
The lymphatic system plays a significant role in our immunity, identifying and responding to external and internal agents that are trying to invade the body, such as bacteria and viruses as well as mutant normal cells that can become cancer cells.
Our lymph nodes, found all over our body, are hubs of activity that act to contain any ‘invading’ cells before they spread. Spread can include into the skin tissues, where cellulitis might occur, or around the body to different organs such as the breast, prostate, bowel or lung as cancer cells.
The lymphatic system also functions like a garbage system ridding the body of cellular ‘junk’, much of which is protein based and water. This works hand in hand with the vein system. The body has a wonderful way of ensuring all of these systems are well balanced, however, the balance can be upset when the lymphatic transport system is injured or disrupted.
Lymhoedema is a chronic condition where the lymphatic system can no longer keep up with the disposal of fluid that accumulates in the tissues of the limbs. It can be a result of a genetically incompetent lymphatic system (primary lymhoedema), or due to injury or disruption to a normal lymphatic system, as can occur with cancer related treatment, (secondary lymphoedema).
The signs and symptoms of lymphoedema include thickening of the skin in the arms and legs, often after an event, such as radiation, skin infection ( secondary) or pregnancy (primary lymphoedema ), heaviness, swelling that goes down at night or progressive swelling/thickening in the inner arms, thighs forearm or ankles. Removal of lymph nodes for cancer related treatment is a major cause of secondary lymphoedema and has been the focus of much research.
Management of lymphoedema is based on early education regarding risk reduction. This includes optimising skin care, our first line of defence for the immune system, and exercise to encourage the lymphatic pump via the muscle system. Maintaining a healthy body weight is also ideal.
If lymphoedema is diagnosed, usually by a lymphoedema therapist, GP or medical specialist, management revolves around improving the lymphatic transport system and reducing the fluid load on the tissues. This can be assisted with exercise, cardio and resistance training, ensuring good flexibility of the affected limbs, excellent skin care, graded well fitted compression and education. Evidence increasingly promotes exercise and skin care as major components in the treatment of lymphoedema. The local cancer support groups promote healthy lifestyles following treatment, offering dragon boat racing, Nordic pole walking, hydrotherapy and tai chi.
If you have any concerns about the swelling you might be experiencing, speak with a qualified health professional for a thorough assessment and management plan.
Louise Humphrey is a physiotherapist and member of the National Lymphoedema Practitioner Register.