Physiotherapy Occupational Therapy

Lymphological physiotherapy

Lymphoedema is a chronic disease of the lymphatic system that can lead to swelling in the extremities or adjacent parts of the body.

Primary lymphoedema is a congenital change in the lymphatic system. Secondary lymphoedema, on the other hand, is “acquired” and can occur, for example, after the removal of lymph nodes or after radiotherapy for cancer.

Lymphoedema occurs when the lymph fluid cannot be adequately removed and accumulates in the tissue. As a result of the accumulation of fluid and proteins in the tissue, particularly in the case of untreated oedema, remodelling processes occur over time which can lead to fibrosis (proliferation of connective tissue) and sclerosis (hardening of tissue).

At the USZ, specialised physiotherapists treat patients with lymphoedema in lymphological physiotherapy, also called complex physical decongestive therapy (CPD).

The aim of physiotherapeutic treatment of a new onset of lymphoedema is to reduce the oedema. To achieve this, we apply compression bandages and promote lymph drainage with manual techniques such as lymphatic drainage. In the course of the treatment, the patients learn how to apply the bandages themselves and a customised compression bandage is made by a bandage specialist.

Therapy

Physiotherapy for lymphoedema takes place in 2 phases:

Intensive phase

The intensive phase lasts 2-3 weeks, with 2-4 appointments per week. The aim is to achieve the best possible decongestion during this time. At the end of the intensive phase, a flat-knitted compression stocking/custom-made compression garment is fitted.

Maintenance phase

After the end of the intensive phase, the patient wears the compression garment during the day, bandages if necessary and controls the oedema independently. The aim of the maintenance phase is to maintain the result of the reduction in oedema from the intensive phase as far as possible. Depending on the extent of the oedema, we arrange further appointments or intensive phases individually.

Long-term therapeutic success is based on the 5 pillars of lymphological physiotherapy

  • Compression/bandaging
  • Manual lymph drainage
  • Skin care
  • Self-management
  • Exercise

Compression involves bandaging the affected limb or body part with compression material. Whenever possible, patients also learn to bandage themselves.

After decongestion, compression is continued with a custom-made compression bandage. This makes everyday life easier compared to bandaging.

Manual lymphatic drainage as a component of lymphological physiotherapy supports the removal of lymphatic fluid. Lymphatic drainage alone, without further bandaging or compression measures, is not sufficient, as drainage without compression only has a very short effective phase… We treat hardened tissue, fibrosis or scars with special grip techniques.

Skin care is central: to prevent infections, it is important that the skin remains elastic, sufficiently hydrated and free of injuries.

Self-management includes informing the patients about their clinical picture, the conservative treatment options and what they themselves can do to contribute to a positive course of the disease. In this way, the patients themselves can become the “main manager” of their oedema.

Exercise, also with bandages and compression, is another important component in keeping the oedema situation stable and, if necessary, reducing it further.

Other points in lymphological physiotherapy are very important for the success of good oedema treatment: good weight management, support in coming to terms with the illness and possible referral to external agencies if there are questions about the social, financial and professional situation.

Collaboration

All specialists who treat patients with lymphoedema in physiotherapy and occupational therapy at the University Hospital Zurich have specific lymphological training. We treat the whole spectrum of oedema diseases and are also specialised in the treatment of the following complex lymphoedema.

Specialisation of complex lymphoedema

Head lymphoedema

After major surgical procedures on the head and neck and/or with radiation. For swallowing and speech disorders, we work closely with phoniatrics and clinical speech therapy.

Genital edema

After gynaecological or urological operations with removal of lymph nodes. In the case of continence problems, we work closely with the stoma consultation and the pelvic floor rehabilitation department. Patients with lipoedema or scleroderma also benefit from the specialised know-how of lymphological physiotherapy.

Close internal and external network

We have a wide internal and external network of other specialists and experts whom we consult for optimal therapy:

Interdisciplinary lymph consultation

Together with the angiology and plastic surgery departments, the lymph therapists advise patients in complex lymphological situations and discuss the optimal treatment options.

Cooperation with trained orthopaedic and bandage specialists

In close cooperation with the therapists, the specialised bandage specialists advise the patients on the various custom-made products (circular and flat-knitted), materials (in case of allergies), donning aids as well as special products for head or genital oedema or adaptations for stoma care.

Wound counselling

For wound care or training in dealing with wounds, we can call on the services of our specialised in-house wound consultants. .

Psycho-oncological service

Patients can make use of the psycho-oncological service in the USZ to help them cope with their illness.

For patients

The therapy services are primarily available to patients of the USZ. The physiotherapy prescription for lymphological physiotherapy including compression measures is issued and sent by your doctor. As a patient, you cannot register directly for a consultation/therapy.

For referrers

Simply assign your patient online.

Tel. +41 44 255 86 88

Universitätsspital Zürich
Disposition Therapien
Frauenklinikstrasse 10
8091 Zürich

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