To complement the MASSAGE Magazine article, “Expert Advice,” in the June 2013 issue. Article summary: Bruno Chikly, M.D., D.O., answers the question, “How can I address clients’ inflammation in my massage practice?”

Lymphedema: Causes and Treatment, MASSAGE MagazineGenerally, it can be said one out of eight women in the U.S. will develop breast cancer during the course of their lives. At the present time, about 232,340 new cases of breast cancer in females and 2,240 cases in males are estimated in the U.S. annually, according to the National Cancer Institute. (Worldwide, the most widespread cause of secondary lymphedema is an infection by a threadlike worm known as wuchereria bancrofti, which leads to a condition named filariasis.)

The highest incidence of secondary lymphedema in the U.S. is observed following surgery and radiation for malignancies, particularly among those individuals affected by breast cancer.

The swelling in lymphedema is caused by an abnormal accumulation of protein and water molecules in the tissue and results from the inability of the lymphatic system to perform one of its basic functions: to remove water and protein from the body tissues.

This insufficiency can be caused by developmental abnormalities of the lymphatic system (primary lymphedema); or damage to the lymphatic system due to the removal or radiation of lymph nodes in cancer surgery or infection of the lymphatic system (secondary lymphedema).

In order to reduce swelling, it is necessary to reroute stagnated lymph flow around the blocked area(s) into more centrally located, healthy lymph vessels. This goal is achieved by a combination of different treatment modalities, all of which are integral components of complete decongestive therapy (CDT), the internationally recognized gold standard treatment system for the vast majority of patients affected by lymphedema. CDT components include:

  • Manual lymph drainage (MLD)
  • Compression therapy
  • Decongestive and breathing exercises
  • Skin and nail care

CDT is performed in two phases. In the first phase, also known as the intensive phase, treatments are administered by trained lymphedema therapists on a daily basis until the affected body part is decongested.

The duration of phase one varies with the severity of swelling and averages two to three weeks for patients with lymphedema affecting the arm, and two to four weeks for patients with lymphedema of the leg.

The results of measurements, taken by the therapist, on the affected body part determine the end of the first phase of CDT; once measurements approach a plateau, the end of phase one is reached and the patient progresses seamlessly into phase two of CDT.

Phase two, also known as the self-management phase, is an ongoing and individualized part of CDT, in which the patient assumes responsibility for maintaining and improving the treatment results achieved in phase one.

During the intensive phase, patients are instructed in the individual components of self-management, which include a skin-care regimen, home exercises, self-manual lymph drainage and the application of compression garments for daytime use.

Joachin E. Zuther, MASSAGE MagazineJoachim E. Zuther has been involved in the field of lymphology since 1985. He is the founder and educational director of the Academy of Lymphatic Studies ( and author of the textbook Lymphedema Management.