Lymphedema is swelling that occurs when protein-rich lymph fluid accumulates in the areas in between cells of our bodies. This space is called the interstitial space and the fluid that is in this space is typically about 16% of a human’s total body weight. Lymphatic fluid may contain items such as plasma proteins, extravascular blood cells, excess water, and metabolic waste.
Lymphedema is diagnosed for one of two reasons. Either the body's transport capacity to remove the lymph fluid is reduced, or the protein rich lymph fluid volume has exceeded the transport capacity of the body. Fun fact: Normal daily lymphatic transport = 10% of our actual functional capacity to transport lymphatic fluid!
Some lymphedema risk factors may include:
Lymphedema is considered a specialized segment of physical therapy. It is intended for anyone who has just been diagnosed with lymphedema ("Prehab") or is at any point along a course of medical care.
Activcore offers these services at the Princeton location. Our lymphedema specialists are fully equipped to help minimize the effects of oncology treatment and surgeries. They are also specially trained to gently guide you into more progressive physical activities for a safe return to sports and everyday life.
• Limb, abdominal or facial heaviness
• Skin tension
• Increased size of affected area
• Decreased ability to see veins or bony landmarks
• Limb, abdominal or facial discomfort
• Pain (more common with Lipedema)
• Reduced range of motion of affected area
• Reduced strength
• Recurrent infections
NOTE: If there is current redness, swelling, warmth, lack of blanching of an area, fever, please consult your doctor immediately for assessment, as these can be signs that an infection is present.
Lymphedema is typically not a big part of a physical therapist's education. It is a specialization requiring much further study, training and practice following graduation. At Activcore, we offer specialized lymphedema services on an outpatient basis — without having to step inside a hospital. You will have your own dedicated physical therapist (not an aide or technician) for 55 minutes of undivided attention at every visit.
The gold standard treatment for lymphedema is called Complete Decongestive Therapy. This is a two phased approach. The first phase is to decongest or remove as much lymphatic fluid from the affected area as possible. This is done with a four pronged approach of: manual lymphatic drainage; appropriate and effective compression wear or compression bandaging; exercise with said compression wear; proper skin and nail care. The second phase consists of self management of each of the “legs of the chair” that are the foundation for the first phase.
Exercise while wearing proper compression will optimize the lymphatic fluid uptake by the vessels. Exercise causes muscles to pump into appropriate compression wear, which leads to the pressure gradient that results in the lymphatic fluid uptake necessary to reduce the swelling. This is the only method at this time for removing protein rich fluid from the interstitial spaces in our bodies. The fluid will then make its way to lymph nodes at specific locations throughout the body. The job of the lymph nodes is to: filter toxins/bacteria/metabolic waste; aid in fighting infections; and regulate lymphatic fluid & protein concentration in the system. Lymph nodes facilitate the transport of lymphatic fluid into the circulatory system where that fluid is ultimately able to be processed by the kidneys and urinated out as waste..
When there is a build up of lymphatic fluid, the fluid does press on our muscles and nerves resulting in reduced strength, range of motion or changes in sensation (peripheral neuropathy). Activcore stands apart from traditional therapy in that the Redcord system idealizes the neuromuscular reeducation necessary to reduce swelling, increase strength & range of motion and not only enable you to return to your previously enjoyed activities but also elevate your function and performance with these activities. There is no “rushing through” treatment at Activcore. You have the therapists undivided attention and expertise for 90-minute evaluations and 55-minute treatment sessions. This is extremely important for future self management of lymphedema, as lymphedema requires lifelong maintenance.
• Post lymph node dissection (typically cancer related)
• Post mastectomy reconstructive surgeries (DIEP flap, Latissimus dorsi flap, TRAM flap)
• Upper or lower extremity lymphedema
• Post mastectomy syndrome
• Axillary web syndrome/Axillary cording
• Head and neck lymphedema
• Genital lymphedema
• Post lymph node transplant
• Peripheral neuropathy
• Radiated tissue
• Orthopedic/general surgery
• Traumatic injuries
• Chronic infection
• Venous insufficiency/vein harvesting or vein stripping procedures
• Deep vein thrombosis
• IV drug use
• Malignant disease (metastasis to lymph nodes, lymphoma)
• Inflammatory disease (arthritis, psoriasis)
• Pregnancy related lymphedema or venous insufficiency
• Milroy’s disease
• Lymphedema praecox (Meige’s disease)
• Lymphedema tarda
• Primary lymphedema (born with developmental issues of lymph nodes or vessels)
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Activcore gave me back my strength, flexibility, and belief that I could move in the ways I wanted to and had before my treatment for Stage II Breast Cancer. Before my diagnosis, being physically active was one of my favorite ways to spend my time. However, after a double mastectomy, I couldn’t reach my arm past shoulder height without pain. I was so weak that lifting my 16 pound dog was a challenge. I was mortified and devastated. With endless patience and a depth of empathy I have rarely encountered, my PT worked with me each step of the way to restore my range of motion, strength, and retrain my body how to move again. My PT did not want me to just survive cancer, she wanted me to thrive after it. I cannot recommend her more highly whether you’re currently in treatment or still having complications years later.
I started going to Activcore one month after I finished treatment for Stage II Breast Cancer that included a unilateral mastectomy with reconstruction, axillary node dissection, chemotherapy, and radiation. As a professional dancer and full-time dance professor, my entire career centered around the physical training and expressive potential of the human body. It was quite a shock to be diagnosed at age 35, and go into chemically-induced menopause immediately. Following my year-long cancer treatment, I had limited range-of-motion of my left arm, and had lost a significant amount of my physical strength, overall muscle tone, flexibility and stamina. I was consumed with fear of developing lymphedema and unsure if I would ever return to working in my field at the same level.
I knew I needed to find an expert physical therapist who understood post-cancer rehab and could also address the needs of an athlete. I am incredibly grateful for Adrienne and her specialized work at Activcore because I am back to dancing! She addressed all of my concerns about regaining strength and mobility, and helped me reach milestone after milestone on my recovery journey. The survivorship stage can feel very overwhelming, but I feel really lucky to have found such a compassionate clinician who has helped me feel whole again. I adore Adrienne, and the way she utilizes the Redcord suspension system for cancer rehab is brilliant.
I love a lot about Activcore. The system of ropes and pulleys are unique and help you to get stronger without hurting yourself. This is therapy for people who are and want to remain active! It's not your grandmother's type of PT, but yet the approach is very individual and geared to you specifically. It challenges you without overtaxing your body and is very specific to your needs. Best of all, it works!!
I highly recommend Activcore, especially for those who have difficult injuries or persistent pain. It is unlike any other physical therapy; highly personalized with one on one attention. All the staff are professional, caring and knowledgeable. I'd definitely recommend this to ballet dancers or others who've had bad experiences with typical physical therapy. I'm very thankful to have found Activcore following my surgeries, and continue to benefit from their services.