Physiotherapy guide to Lymphoedema

Lymphoedema is caused by damage to the lymphatic system which results in swelling of body tissue. Whilst frequently occurring in the arms and legs, it can also be present in the body, groin and head and neck regions.  It may cause discomfort, reduced function, impaired mobility, recurrent infections and significantly affect a person’s emotional well-being.

Lymphoedema can be primary (congenital) or secondary, for example to cancer, cancer treatments or leg ulcers.  The condition is progressive and, if untreated, permanent tissue changes can occur.

The long-term effects of lymphoedema are more effectively managed if the condition is diagnosed and managed before chronic changes can occur.

How Physiotherapy Can Help

Physiotherapy plays a pivotal role in managing this condition, offering a multifaceted approach to alleviate symptoms, enhance mobility, and improve overall quality of life.  This guide outlines key components of physiotherapy interventions tailored to address the complexities of lymphoedema.

Physiotherapy offers a comprehensive and patient-centred approach to managing lymphedema. The following components highlight the role of physiotherapy in addressing various aspects of the condition:

Complete Decongestive Therapy (CDT)

  • Manual Lymphatic Drainage (MLD) – MLD involves gentle, rhythmic massaging movements that follow the natural flow of lymphatic vessels.  Physiotherapists use specific hand techniques to stimulate lymphatic drainage.  Sessions typically start proximally (closest to the trunk) and move distally (away from the trunk) to encourage fluid movement.  Patients can also be taught Self Lymphatic Drainage (SLD) by a physiotherapist and they can then use this as part of their daily management routine.
  • Compression Therapy – In the initial phase, bandaging is often used to reduce swelling.  Short-stretch compression bandages are preferred as they provide support without completely restricting movement.  Once swelling is reduced, compression garments (sleeves, stockings) are custom fitted to maintain the achieved reduction. They should always be fitted by a physiotherapist initially to ensure the appropriate goals will be achieved.


Exercise is one of the most important, but sadly often neglected, elements of lymphoedema treatment. During exercise, muscles naturally act in a pumping fashion to enhance lymphatic return.  By wearing a compression garment while exercising, additional pressure can be applied to assist the muscle pump.  Exercises should generally be guided by a physiotherapist to avoid repetitive overload on the affected limb, as too high a load can place more strain on the system.

Lymphoedema patients may require resisted exercise in their treatment plan to increase lean muscle mass.  As the excessive fluid is added load to carry, it is important that strength is maintained such that function is optimised.  On some occasions, as the swelling weighs down movement, imbalance of muscle activity may arise and compensatory movements may become established.  It is important that control of movement is considered to maintain optimal function.

Being overweight is a risk factor for developing lymphoedema, and patients who have established swelling should try to maintain a healthy weight to avoid placing more load on their already struggling lymphatic system.

It can be very difficult for lymphoedema patents to develop an effective fitness routine. They sometimes find it hard to mobilise, develop concerns with body image and gain weight, causing a further strain on the lymphatic system. This is another reason why physiotherapy guidance is crucial.

A carefully designed exercise program gradually increases in intensity, accommodating individual needs and tolerance levels.

Breathing Exercises

Diaphragmatic Breathing involves practice of slow, deep breaths to promote relaxation and enhance the lymphatic flow. Diaphragmatic breathing can also reduce stress, which may contribute to improved lymphatic function.

Skin Care and Hygiene and Sun Protection

Skin needs to be kept clean and dry with care taken to prevent infections, cuts and scratches. Patients should moisturise daily, with the optimal time being at night after a shower to allow the moisturiser to sink into the skin while a compression garment is not being worn.  Finger and toenails should be kept short and clean to avoid any scratches and appropriate sun protection should be used on a daily basis.


Lifestyle Modifications and Self-Monitoring – A physiotherapist will provide advice to support maintenance of a healthy lifestyle, which includes a balanced diet and regular exercise. They can also educate patients on the risks associated with obesity and how weight management can positively impact lymphoedema.

Aquatic Therapy

Hydrostatic Pressure – The pressure exerted by water can help reduce swelling and improve circulation.  Aquatic exercises are often well-tolerated and beneficial for individuals with mobility limitations.  Some pool environments provide safe access to those who are more disabled and may need 1:1 help to carry out exercise in water. 

Multidisciplinary Approach

Physiotherapists collaborate closely with doctors, nurses, and occupational therapists to ensure holistic and coordinated care.  They also recognise the emotional impact of lymphoedema, such that the holistic treatment plan can incorporate counselling and support groups, to foster resilience and teach coping strategies.

In conclusion, physiotherapy, with its diverse and tailored interventions, is very important in the management of lymphoedema.  By addressing physical limitations, providing education, and promoting self-care, physiotherapists can empower individuals to actively participate in their well-being.  This comprehensive approach contributes significantly to the enhancement of functional abilities and the overall quality of life for those living with lymphoedema.

If you’re experiencing lymphoedema, our physiotherapists at the Home Physio Group can help by implementing the right strategies at the right time which can make a world of difference.

For more information, please contact us on 0330 335 1016 or alternatively please fill out our contact sheet and we will get back to you.

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Why choose Home Physio Group?

We are a dedicated team of Chartered Physiotherapists working exclusively in your home and providing the highest level of care. We recognise the importance of knowing that you are in safe hands and being looked after. With this is mind, our client management team are here to assist you every step of the way and will answer any questions you may have. We are passionate about helping you to reach your goals, relieve your pain, and improve your mobility.

The benefits of using our service include:

  • All our physiotherapists are hand-picked professionals with years of experience
  • We are registered with the Chartered Society of Physiotherapy (CSP) and Health & Care Professions Council (HCPC). All our physiotherapists are checked by the Disclosure and Barring Service (DBS) 
  • We will arrange visits in your own home (or care home or place of work) at a convenient time to you
  • We work at speed and do not have a waiting list
  • We offer daytime, evening and weekend appointments
  • Our team work closely with the country’s leading consultants and specialists in their field
  • You will always have the same physiotherapist visiting you at home
  • You can have as many visits as you require
  • Our fixed pricing structure can be provided in writing so that you can consider it in your own time
  • We believe there is no “one size fits all” approach to care. Your personalised programme and treatment strategy will be unique to you