LYMPHOEDEMA

I was, in about 1985, qualified in, but inexperienced with, remedial massage. Quite by chance, I was given an opportunity to attend a workshop which was to deal with the application of manual therapy to those affected by lymphoedema.

Several obstacles stood in my path; the workshop was to be held at Adelaide, somewhat similar to the journey from San Francisco to Dallas. The cost of the course was to resemble about three month’s wages for me at that time, and the biggest hurdle of all, the course was only open to degree- carrying physical therapists. Having audacity, but little cash, I used one, and borrowed the other, and enrolled – I can’t tell you why, I just had this idea that it was the correct thing to do, and I was receiving advice from those I respected.

I knew very little about the topic, but what I learnt affected my ability as a therapist, and the knowledge has  stayed with me since that time. Eventually I produced a film on the treatment of lymphoedema, but there is one salient point that I would like to make to those of you who are interested.

Oedema, in its many forms, and from its many causes, is the collection and retention of excessive quantities of fluid in some of the body tissues; either too much fluid has entered the tissue for the drains to deal with, or, something is wrong with the drains, and they can’t deal with even the normal input. There are many causes, and the condition needs to be diagnosed by an expert. I want to discuss with you today one of the many effects.

The unwanted fluid collecting in the tissue is firstly, water, that later attracts protein to itself, forming a thicker-than-water combination that is moveable, but only with persistent effort. This cocktail has the undesirable ability to soften connective tissue that it comes into contact with.

For some strange reason unknown to my primitive mind, the best medium for transporting this oedematous material away from where it lingers, is the lymphatic system. But here is the catch - all of the lymphatic vessels are equipped with a reinforcement of – you guessed it – connective tissue.

So, where lymphoedema resides, the very plumbing system designed to drain it away has overnight become incompetent; the condition of lymphoedema can, in many instances, become self-propagating. In addition, if the oedema was originally caused by say, an ankle joint sprain or strain, then the damaged ligaments around that ankle joint are probably bathing in a fluid that will commence softening their structure, and reducing their tensile strength, furthering the risk of additional failure

The good news is, if well applied manual therapy can move at least some of the offending fluid, the weakened tissues can, fairly quickly, begin to regain some of their lost tensile strength.

Bernard Scully

Newcastle, July, 2010.