5 Things You Need to Know About Lymphedema

You’ve seen these legs in the course of your clinical practice: weeping. Red. Dry, scaly dandruffs. Disfigured.

Blocked on the inside.

I suffer along with my patients every time I see how bad their leg swelling has become.

As physical therapists, we can do a lot to alleviate the suffering of patients who have chronic lymphedema. We can promote activity, bandage the swollen limb, check for open blisters.

But these are the top 5 things you should know when your patient has lymphedema:


The most common condition that leads to lymphedema in the U.S. is breast cancer.

Surgery to remove cancer followed by radiation treatment usually wreaks havoc on the lymphatic system of the upper limbs.

However, in other parts of the world, filariasis is the main cause of lymphedema. The parasitic roundworm is spread by mosquitoes and black flies. The larvae then lodge themselves in the host’s lymph nodes, resulting to edema and skin thickening.


You can only bill for Manual Lymphatic Therapy under Manual Therapy.

Multiple layer compression bandaging can be billed under Therapeutic Activities only if you do patient education with either the patient himself or the caregiver.

Otherwise, bandaging is non billable.


Never do a treatment if your patient has been diagnosed with an acute deep vein thrombosis.

Also, refrain from treating a patient who’s displaying spasticity or who has peripheral arterial disease.

Just practice an overabundance of caution.

Your goal is to get the edema down with each treatment session but we can’t do that when complex comorbidities are present.


Lymphedema management is part and parcel of physical therapy practice so no certification is required to treat a patient suffering from this condition.

However, if as a clinician you don’t feel confident about treating a full-blown lymphedema case, you can make recommendations and route the order to a certified lymphedema therapist.

Only proceed when you have absolute certainty that the delivery of the plan of care will be safe for your patient.

LVA Surgery

The go-to procedure for severe cases. LVA stands for lymphovenous anastomosis, a surgical technique for early lymphedema.

It’s performed to bypass blocked lymph vessels in the affected arm or leg and restore a healthy flow.

LVA is only resorted to when solids start accumulating in the edematous limb.

However, this doesn’t completely cure the condition and compression therapy needs to continue post-op.

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