Related Health Conditions The Lymphatic System The lymphatic system plays a major part in the body's immune system which is the main defence mechanism against disease and infection. It usually does a good job in protecting us from illness. However where there is an impaired lymphatic system, lymphoedema may result and eventually lead to long term health problems. Conversely some health conditions can cause an overload of the lymphatic system over time resulting in lymphoedema. Unfortunately, the medical profession is often slow to recognize any link, if at all, and appropriate treatment can be very much delayed or non-existent. Below are just a few of the many health related conditions that effect or are effected by the functioning of the lymph system. We have limited the information primarily to those conditions that we have seen and successfully treated in clinic, however the list is by no means exhaustive. Venous Insufficiency and Ulcer Care  Arteries bring oxygen-rich blood from the heart to the rest of the body and veins return oxygen-poor blood back to the heart. When the leg veins cannot pump enough blood back to the heart, chronic venous insufficiency (CVI) can develop. In an upright position, the blood in the leg veins must go against gravity to return to the heart. To do this, the leg muscles squeeze the deep veins of the legs and feet to help move blood back to the heart. Valves in the veins keep blood flowing in the right direction. When the leg muscles relax, the valves inside the veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump. Use of the lower leg muscles [the calf pump] and the foot [plantar pump] are critical to the optimal pumping of blood back to the heart. For this reason people who are unable to walk easily or spend much of their day seated or standing without moving are at greater risk of venous problems. What are the symptoms? • Ankle swelling • Calves may feel tight • Legs may feel heavy, tired, restless, or achy • Pain while walking or shortly after stopping • Discolouration of the lower legs and ankles • Leg Ulcers • Varicose Veins As a result of blood pooling in the lower legs there is an increased filtration of fluid into the tissues which initially is returned into the circulation by the lymphatic system providing it is working efficiently. With time however the lymph system is unable to cope with the excess fluid and the ankles and legs may start to swell. What causes CVI? • Chronic venous Insufficiency can be caused by: • Any condition that increases blood pressure in the leg veins • Damage or deficiency in the valves of the veins • Deep Vein Thrombosis [DVT] • Phlebitis Contributory Factors • Factors that can increase the risk for venous insufficiency include: • Family history of varicose veins, • Being overweight, • Pregnancy • Lack of exercise • Smoking • Standing or sitting for long periods of time Chronic Venous Insufficiency Treatment Therapy using Manual Lymphatic Drainage Massage will help with the symptoms of venous insufficiency.  However, as the primary problem is within the venous system, Manual Lymphatic Drainage will not reverse or remedy the underlying problem. Manual Lymphatic Drainage will ease the symptoms but not solve the underlying problems except in lymph-venous cases where venous insufficiency and lymphoedema occur concurrently. If venous ulcers are present they can be very successfully treated - wound healing is greatly enhanced and re-occurrence reduced, by treatment with MLD. In addition to treatment with MLD Massage, the use of compression stockings will help to support the venous system and prevent the back flow of blood and associated swelling. By supporting the veins the healing of wounds and ulcers can be greatly enhanced. Leg swelling and other symptoms of venous insufficiency will also be helped by raising the legs and avoiding standing or sitting for long periods of time. The need to exercise and keep the venous leg pumps working is very important. Even when unable to walk, simply working the ankle joint and applying pressure or weight through the foot will help pump blood via the calf and plantar pump mechanism. Cellulitis Cellulitis is an acute spreading inflammation of the skin and subcutaneous tissues. It is generally thought to be a Streptococcal Infection. Symptoms include: • Warmth in the affected area • Swelling in the affected area • Erythema • Fever and Flu like symptoms Cellulitis can occur in cases of lymphoedema and also, in its own right, may cause lymphoedema. Cellulitis may cause damage to lymph vessels and following an episode there may be damage to lymphatic vessels and symptoms of lymphoedema may occur. Once a limb has been affected by cellulitis it will be more prone to recurrent episodes as tissue metabolism becomes sub-optimal. Cellulitis Treatment In the acute phase of cellulitis the first line of treatment is with antibiotics. The Lymphoedema Support Network [LSN] has produced a fact sheet giving useful advice on antibiotic treatment of cellulitis : 'Management of Cellulitis in Lymphoedema'. The leaflet is available on the LSN website or from the LSN office. Website: www.lymphoedema.org/lsn  Once the acute infection has settled, treatment with manual lymphatic drainage is indicated and, in most cases, the use of compression hosiery. Correct management can both prevent incidence of cellulites and greatly reduce the chances of recurrence. It is important for anyone who has suffered or is at risk of cellulitis, that the condition os treated correctly. The BLS and LSN have produced a consensus document on the Management of Cellulitis in Lymphoedema, a copy of which is available at www.thebls.com/files/208.pdf Dermatitis/Eczema Dermatology and lymphoedema are intrinsically linked. Many dermatological conditions may lead to lymphoedema and increase the risk of cellulitis or conversely, occur as a result of chronic lymphoedema. The skin has an amazing capacity to regenerate and even severe dermatological changes to skin and tissue can be reversed with the use of Combined Decongestive Therapy - MLD massage, compression and skin care. Complex Regional Pain Syndrome [CRPS] CRPS is also known as Sudek's Atrophy, Reflex Sympathetic Dystrophy and Causalgia. Complex regional pain syndrome (CRPS) is a chronic pain condition. It occurs following trauma or injury or surgery and the key symptom is continuous pain out of proportion to the severity of the injury, which gets worse rather than better over time. CRPS most often affects one of the arms, legs, hands, or feet.  Often the pain spreads to affect the entire arm or leg.  Typical features include changes in the colour and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling.  The cause of CRPS is unknown however in some cases the sympathetic nervous system plays an important role. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area. It has been found that many of the symptoms of CRPS may be relieved by MLD massage and deep oscillation therapy. The gentle nature of these treatments allow application to even the most sensitive and painful of limbs. Compression may be applied following treatment were symptoms include swelling but care is taken in the application given the painful nature of the condition. Inflammatory Arthritis - Rheumatoid and Psoriatic Arthritis  Lymphatic Drainage has been found to be significantly reduced in some cases of inflammatory arthritis. The swelling and pain experienced in joints affected by auto-immune disease can be reduced and eased with manual lymphatic drainage. In addition the use of Deep Oscillation Therapy has been found to be very beneficial in the treatment of the symptoms of these conditions. Trauma and Injury [Including burns, fracture, sprains, strains, contusions, lacerations] Any trauma or injury to the body whether it is caused by an accident or as a result of surgery has the potential to cause lymphoedema. Trauma and Injury will cause increased demand on the lymphatic system and, in itself, causes damage to lymphatic vessels. Major trauma to the body may cause Secondary Lymphoedema whilst more minor trauma may highlight an insufficiency in the system and trigger an underlying Primary Lymphoedema. Thyroid Dysfunction When the thyroid is dysfunctional, changes in the dermis will affect the transport of fluids and cause oedema. The condition is similar to lymphoedema in presentation but the skin is normally dryer, rougher, often cooler and paler. Treating the dysfunctional thyroid will often control and sometimes reverse the condition. The condition is referred to as myxoedema, the most common form of which is the pretibial form with skin and tissue changes presenting in the lower leg. It is associated with hyperthyroidism. Lymphoedema Clinic Sports Injury Clinic Personal Training Personal Aesthetics  Lipoedema  Related Health Conditions  Venous Insufficiency & Ulcer Care Cellulitis Complex Regional Pain Syndrome Rheumatoid Arthritis  Dermatitis & Excema  Trauma & Injury  Media and Research  Appointments Tel: 01529 469278 Mob: 07899 964163 E-mail: ann@lighterlimbs.co.uk