Home
C.P.T
Diet
Products
Clinic
Therapists
Courses
Laser
Bandaging
View Cart

Lympaction
Self Massage
Rutin
Books
Diet
Laser
Courses

Poppy Lane Skin Care & Lymphoedema Clinic

Complex Physical (Lymphatic / Lymphedema) Therapy (C.P.T. / C.L.T.)

This is called Complex Physical Therapy (C.P.T.) because a number of physical therapeutic approaches are combined to produce the results. (It is also called 'Complex Lymphatic (or) Lymphedema Therapy' - C.L.T. - or 'Complex Decongestive Physical Therapy' - C.D.P.T.) It achieves the fastest reduction of lymphoedema; even better results are obtained if C.P.T. is used in conjunction with dietary change and other vitamins where dietary intake is insufficient and it become possible to stimulate beneficial effect.

A full course of this treatment normally lasts from 2 to 6 weeks, depending on the severity of the condition and the number of limbs involved.

C.P.T. consists of four main parts: 

  1. skin care to prevent any infection adding to the lymphatic load and to improve the skin condition;

  2. a special form of massage each day, which removes the excess fluid and protein and opens collateral lymphatics so that unaffected regions can drain the affected one in the future; 

  3. compression bandages applied during the course, followed by

  4. compression garments after it, to stop the reduced limb from rapidly resuming its former size; 

  5. special exercises to supplement the massage

The special lymphatic massage first empties the lymphatics of the trunk (even of quite distant regions) and the normal areas adjacent to the lymphoedematous one are further cleared. Then the limb is massaged. This is always in the direction of lymph flow, i.e. towards the body. It starts on the part of the limb adjacent to the trunk. Gradually more and more of the limb is involved, until the hand or foot is reached. Reduction will only continue to improve after treatment if the drainage from the blocked area to the normal adjacent areas has been improved by enlarging the size and number of the lymphatics which join one drainage area to the next (the collateral lymphatics).

C.P.T. gives by far the most rapid reductions. The first 618 limbs treated in Australia using the C.P.T method advocated by the Casley-Smiths had average reductions of 50 percent of the oedema, with three-quarters of the patients achieving reductions of better than 20 percent. Of course, these are only the average results. Extremes range from 25 to 110 percent reduction. The average results can only give an indication of the results one can expect; everyone is different! With a longer-term lymphoedema, when the reduction does return the limb to 'normal', sometimes it is less than normal - because of muscle wastage. A year later, the reductions still averaged 45 percent. More information about these results is published in the book Modern Treatment for Lymphoedema ISBN (fifth edition) ISBN 0 646 31664 8

Maintaining these reductions depends on the patient being willing to wear gradient compression garments at all times, looking after their limb and treating any infection promptly, and persevering with their exercises. (The specially-designed exercises make a great difference both during the C.P.T. and after it.) Oral and topical molecules of the benzo-pyrone family may help greatly with maintaining the reductions. With these precautions, after a year in many cases a limb may stay at the reduced size, or even somewhat smaller, and have softened further. Now another course of the therapy, which can commence six months to a year after the first, can result in a further removal of about half of what swelling remains.

The cost of a course of treatment varies from one therapist to another, and also depends on the time necessary for treatment, the number of bandages required and the type of garment necessary afterwards. Some hospitals are now providing lymphoedema bandaging services. 

With all bandaging applications it is important that a space is cleared for fluid to drain into prior to evacuation of fluid from a lymphoedematous area. Lymphatic drainage massage and /or combination laser therapy may be used to effect this clearance. Without this prerequisite being met there is a possibility of overloading an adjacent area to swelling and lymphatic overload in a previously unaffected part of the body.

To achieve good results, C.P.T. consists of two to four weeks of treatment (longer in severe cases), of at least one hour per limb per day. Is should be given at least 5 days per week for best results. With a full course of C.P.T., correctly done, most of the reduction will usually occur in the first 7-10 days. The rest of the (usually) four weeks is spent maintaining this, opening-up collateral lymphatic drainage, increasing pumping by the deep drainage pathways, breaking down excess fibrotic tissue and sometimes performing special work on skin conditions.

When choosing a therapist it is important they understand the principles of C.P.T and its practical application. Every therapist must have a staring point and where the principles of complex physical lymphatic therapy are applied I have seen cases where an elderly gentleman with no prior experience and a next door neighbor of a patient without  the financial means for professional therapy, who after minimal instruction was able to achieve a 45% reduction of oedema over a four week period. in this case the patient performed self massage as the clearance technique to clear room for fluid form the affected limb prior to the bandaging. As you can see from this scenario, treatment options are relative to levels of understanding and application, not necessarily from the length of time someone has been trained. From this scenario it  can be seen, it is understanding and application of C.P.T that can provide good results, not just the length of time someone has trained.

Prior to concluding a condition is lymphoedema it is best if all other possible causative reasons for chronic oedema have been investigated and dealt with. It is strongly suggested that your own doctor ensures that your limb is free of any infection before you go for treatment, since it places much more of a load on your lymphatic system and interferes with treatment. (However chronic ulcers and fungal infections can be treated satisfactorily during C.P.T.) It is also strongly believed that your diet should include foods high in vitamins of the benzo-pyrone family  while waiting for an appointment for the C.P.T.; these will improve the results considerably where dietary intake strengthens blood and lymphatic structure - continuing in this manner has potential for easier maintenance of reductions afterwards. The treatment also reduces chronic venous insufficiency (which has a component of lymphoedema), including intractable ulcers caused by this disease.

After C.P.T. you MUST wear a good compression sleeve or stocking, look after it properly, and change it when necessary. It is a waste of time and money to have this course of treatment but to let all the oedema come back just because you do not wear the compression garment properly! You must also continue with the exercises and eat foods that will assist control rather than be detrimental. If you can bandage your limb as it was done during treatment, you will probably find this more comfortable to sleep with than a garment.

You may wish to come back in six months to a year and repeat the course, and possibly do the same after another year. These return visits are because after this time the body has remodeled itself and it is possible to reduce the oedema still more. Some patients benefit from more frequent but possibly shorter courses. The sooner lymphoedema is treated, the better. A recent, soft one can often be reduced to almost normal size, but good reductions occur even with very long-standing ones. Elderly patients often have very good reductions and cope well with the firm bandaging.

 

 

Explaining the causes of lymphoedema 

Abstract:  Lymphoedema Cause 
The real “why” or lowest common denominator of all lymphoedema is often overlooked or missed yet is of extreme importance when considering lymphoedema treatment options. 

Research indicates the causes activating lymphoedema swelling can be many and varied. An accidental bump; an insect bite; an operation; radiation therapy, or cancer therapy. Any of these things can be the trigger to cause lymphatic dysfunction to subsequently cause lymphoedema.  

This page explains the ‘why' and common denominator causing all lymphoedema swelling. It shows the simplicity and real objective for all lymphoedema reduction and control procedures regardless of the trigger.


The common denominator of all Lymphoedema.
The common denominator of all lymphoedema (regardless of cause) is the accumulation of excess (plasma) proteins in the interstitial fluids contained in soft tissues of the body, under normal load conditions, and over a prolonged and indefinite period of time due to insufficiency of the lymphatics. Remove the excess proteins and the lymphoedema will reduce. This hypothesis was put forward by Willoughby (UK 1970) and proved by Casley-Smith J.R and Casley-Smith J. (Australia 1980) (4) 

To explain, in every living person proteins are deposited from the capillary ends of the blood circulation system into body tissues. Proteins are messengers to instruct you body what it must do to survive. 

The percentage of protein inside the blood is greater than the percentage level of protein in the body tissues. As proteins by their osmotic action act like a magnet for water, this percentage difference then forms the basis for fluid exchange between the blood circulatory system and the body tissues.. Proteins control how much fluid is retained in your body tissues..

Proteins are an integral part of your body function. Eating less protein will not reduce oedema. 

Once protein has performed its task in the body tissues, any excess protein should be removed and returned back into the blood circulation by the lymphatic drainage system. This way proper equilibrium between blood and tissue protein levels are maintained.

What causes lymphoedema?

Soft tissues of the body functioning within normal parameters contain in their interstitial fluids an optimal level of 2% of protein. The level of protein in interstitial fluids contained in the tissues of the body should be approximately one fourth of that found in blood plasma (6) 

The lymphatic system is the primary drainage system responsible for maintaining equilibrium of protein in interstitial fluids. It is helped by a secondary system of macrophages which phagocyse (eat up or dissolve) excess protein.

When due to lymphatic dysfunction, levels of protein in interstitial fluids become greater than 2%, which also causes macrophage inactivity, swelling and oedema will occour in body tissues. This swelling and oedema is resultant from the osmotic action of excess trapped protein in the body tissues caused by lymphatic dysfunction..

Conclusion: Lymphoedema is caused by an accumulation of (plasma) protein greater than 2% of interstitial fluids contained in the soft tissues of the body. The cause of accumulated excess protein in the interstitial fluids is resultant from lymphatic dysfunction or lymphatic insufficiency and cessation of macrophage activity from protein overload for a prolonged period of time where lymphoedema swelling is apparent.

It is only by returning the level of proteins back to a ratio of 2% in interstitial tissue fluids will the oedema in Lymphoedema be controlled. This is the real and main objective for all Lymphoedema control procedures. This website provides information and resources to help and assist you achieve this objective. 

© Copyright June 2009 Poppy Lane Skin Care & Lymphoedema Clinic, Lansvale. N.S.W. 2166 Australia.  
Last Update 22nd June 2009. 

For more detailed information go to the Lymphoedema control page

For lymphoedema diet information go direct to Lymphoedema Diet Page

References:
1. Casley - Smith JR "
Benzo pyrones in lymph.dema" Int Angiol, 1997 in press
2. Casley-Smith JR & Judith R "High Protein Oedema and the Benzo Pyrones, Lippincott Sydney & Balt (1986) History of Lymphatics & Lymphoedema; Chap1, p2 
3. C.R O'Kennedy, R.D Thorns, N.Y Wiley, "Coumarin -
'Biology, Application and modes of action".1997a: 143 - 184
4. Casley-Smith JR & Judith R "Modern Treatment for Lymphoedema "Fifth Edition (Pg 233) Bowden Printing, Adelaide
5.  Robert Twycross, Karen James & Jacquelyne Todd. "Lymphoedema" Ausmed Publications P/L. ISBN 0 9579876 68.
6. Eldra Pearl Solomon, Linda R. Berg, Diana W. Martin.  “Biology”, Fifth Edition,  Saunders College Publishing, Orlando Florida , USA . ISBN: 0-03-022299-0.  Internal Transport
42 p925.

 

Website Sponsor

Poppy Lane Skin Care & Lymphoedema Clinic
139 Hollywood Drive Lansvale NSW 2166 Australia


 (02) 9723 5402

E-mail julietgeorge@lymph.com.au
Supplier of;
Lymphoedema Drainage Massage
Lymphoedema Laser Therapy
CPT Therapy for Treatment of Lymphoedema
 

 

Low Level Laser & Equipment with education for home use
Bandaging
Specialized Creams; Compression Garments
Lympaction dietary supplement

 

Home                                                           Next Page

 

 

 

 

 

Lymphoedema can be described as the localised swelling in the body, caused by problems with the lymphatic system. It can happen after surgery, particularly cancer surgery and it is many times not fully realised that breast cancer and lymphoedema present a real risk ...


Shopping cart software
and credit card processing provided by ezimerchant