Never prescribe lymph drainage as an isolated treatment

As part of complex decongestive physical therapy (CDPT), physiotherapists are needed to form an important link in the treatment chain. That’s also how Martin Morand sees things. He has been running a physiotherapy practice specializing in lymphology in Berlin-Wilmersdorf, Germany for nearly 25 years.

With special therapeutic massage techniques, Martin Morand activates lymph drainage for his patient. During the treatment , she visibly relaxes. “Apart from decreasing edema, manual lymph drainage (MLD) also helps to regulate the sympathetic nervous system”, explains the experienced specialized therapist. During Phase I of CDPT , the decongestion phase, he generally treats his patients six days a week. In Phase II, the maintenance phase, MLD is generally performed once or twice a week, especially if lymphostatic fibrosis has developed. “The question of treatment frequency is a delicate point for us at the moment”, says Martin Morand. He explains that new patients with lymphangiological edema are often prescribed lymph drainage only once or twice per week, regardless of the indications. This is not sufficient , he says, particularly if patients come to him with manifest swelling. If needed, employees from the office’s ten-person team will send the patients back to their physician with a request to change the prescription. It is important that prescriptions comply with guidelines. And that means that lymph drainage – with the appropriate frequency – should always be accompanied by compression therapy. As an isolated treatment , MLD is usually just a waste of money,” the therapist explains.

Only with compression

After treatment , the patients always leave the office with compression: either with compression bandages or with compression stockings, if they have them already. “We have a convenient arrangement where a compression specialist comes to us once a week to measure patients right in our office when they are fully decongested. We believe it is important for care professionals to have at least two years of experience with flat knit care,” emphasizes Martin Morand. Most patients are conscientious about wearing their compression supports. But if the patient’s cooperation isn’t what it should be, or if the edema condition does not improve, they will inform the attending physician. “Since we have the most contact with patients, I consider lymph drainage therapists to be case managers as well. We have to do our part to ensure that the care chain works properly.” 

Images: Thomas Lebie