Combined Decongestive Therapy (CDT)
Complete decongestive therapy (CDT), sometimes referred to as complex decongestive therapy, or combined physical therapy is the internationally recognized “gold standard” treatment system for the vast majority of patients affected by lymphedema.
PHASE: 1 Manual Lymph Drainage (MLD)
MLD is a massage technique that stimulates the lymphatic system by moving the fluid away from the swollen areas of the body and toward healthy regions.
MLD requires specific hand strokes that are applied to the body in a distinct pattern and direction to move fluid away from the swollen body region. MLD is very slow and light, using just enough pressure to allow the skin to be gently stretched.
The specific sequence is different for every patient and requires a skilled therapist to evaluate the areas of the body that are healthy and to devise an appropriate plan of treatment.
MLD is used to clear and open alternate pathways for the fluid congestion to flow to.
The treatment techniques are very specific in the way they are applied and should be done by a therapist who has received specialty training in decongestive therapy.
As the limb decongests and gets progressively smaller, the therapist will measure for a compression garment that is appropriately fitted for you.
Compression bandages are applied to the swollen limb after the MLD sequence and the lymphatics have been stimulated to move fluid. The goal of the bandages is to decongest the limb by applying pressure to the tissue and pushing fluid through the system.
Compression bandages used in treating lymphedema are short-stretch, non- elastic bandages
The following effects are achieved with compression bandages:
Increases the pressure in the tissue themselves as well as on the blood and lymph vessels contained in these tissues
Improves venous and lymphatic return, external compression forces these fluids in the proximal direction
Improves the effectiveness of the muscle and joint pumps during activity
Prevents the re-accumulation of evacuated lymph fluid and conserves the results achieved during MLD
Helps to break up and soften deposits of connective tissue and scar tissue
Short-stretch bandages will provide for a high working pressure and a low resting pressure
At this time, you will start Phase 2 of CDT.
PHASE: 2 Self-care to maintain the gains achieved in therapy
During this phase, you will not be seeing your therapist as regularly since you will be taught to manage independently your condition.
Some patients however find it helpful to maintain a monthly follow-up appointment to review their program.
The health benefits of regular exercise cannot be ignored, especially for patients with lymphedema or at risk for lymphedema.
Exercise that is performed during the intensive phase of CDT is called remedial exercise.
These specific exercises are performed while the compression bandages are in place to assist the body with remodelling the tissue and decongesting the affected tissue by increasing the return of lymphatic fluid to the circulatory system.
Exercises given as part of the CDT program are for gentle, active motion of the body regions affected by the swelling. The movement of the limbs, while bandaged, increases the uptake and removal of fluid from the swollen area.
The exercises will be recommended by the therapist as part of the CDT program.
Skin & nail care
Skin care to keep the affected area clean, moisturized and protected is important for all individuals with lymphedema and is especially important for patients with severe swelling, fibrosis or a history of infections.
Patients suffering from lymphedema are susceptible to infections of the skin and nails. Meticulous care of these areas is essential to the success of CDT.
When an individual has a compromised lymphatic system, daily skin and nail inspection is recommended so the patient can quickly respond to any injury, infections, or other issues.
The therapist will give you skin and nail care recommendations at the start of your program.