Table of Contents
What is lymphedema?
Lymphedema is a condition characterised by fluid accumulation in the body, derived from the words “lymph,” meaning lymphatics, and “oedema,” referring to fluid collection. This condition occurs when there’s an obstruction in the lymphatic system, crucial for returning fluid from the tissues to the bloodstream. When the lymphatic pathways are blocked, protein-rich lymph fluid builds up in the tissue spaces (interstitium). This accumulation then increases the permeability of cellular membranes, leading to even more fluid collection in the affected areas.
The lymphatic system is an essential distributive channel of the human body with a network of specialised vessels. These vessels collect extra fluid from the tissue and send it to the bloodstream. Lymph is a fluid of bacteria, white blood cells, protein, cell debris, and water. Its composition is similar to that of blood plasma. The lymphatic system is complex and comprises of lymphatic capillaries, pre-collectors, collectors, and lymph nodes.
According to Dr. Mikel H-G Hoff, the lymphatic system consists of more than 600-800 lymph nodes, which contain 15 litres of lymphatic fluid. These lymph nodes are crucial for body function because they are involved in creating immune responses and memory cells.
The lymphatic system is all over the body, from the skull to the toe. There are four types of immune cells these are:
- B cells
- T cells
- Natural killer cells
- Super B cells
Primarily, there are two types of lymph nodes in the human body: superficial and deep lymph nodes. These superficial and deep lymph nodes are connected via a perforator that collects fluid from the deep fascia to the surface area.
1-Superficial lymph nodes:
Superficial lymph nodes are present subcutaneously and are responsible for draining skin and subcutis area.
2-Deep lymph nodes:
Deep lymph nodes are present subfascial and are responsible for fluid collection from the muscle, joints, tendons, ligaments and nerves.
Pathophysiology of lymphedema:
Dr. Mikel H-G Hoff explains that the lymphatic system is closely connected to the heart, kidneys, and liver, working together as a unified system. A problem in one of these areas can affect the others. The pathophysiology of lymphedema according to the types is as follows:
Primary lymphedema:
Primary lymphedema is usually caused by congenital abnormalities that lead to the maldevelopment of the lymphatic system. It is also associated with vascular irregularities such as Klippel-Trenaunay-weber syndrome and Turner syndrome. This type of lymphedema is characterised by abnormal growth (hyperplasia), underdevelopment (hypoplasia), or absence (aplasia) of lymphatic vessels.
Secondary lymphedema:
Secondary lymphedema occurs when damage or dysfunction occurs within the regular lymphatic system network. In the United States (USA), it most commonly involves individuals undergoing breast cancer treatment such as axillary lymph node dissection and radiotherapy. However, the leading cause of secondary lymphedema worldwide is filariasis, a parasitic infection caused by “Wuchereria bancrofti”, which is transmitted by mosquitoes. This condition significantly impacts millions across tropical and subtropical regions, including parts of Asia, Africa, the Western Pacific, and the Americas.
Statistics:
What causes lymphedema?
Lymphedema occurs when there is a problem within the lymphatic system. This extensive distributive human body system helps fight against infections and drains extra fluid from tissues. The causes of lymphedema depend upon the type. There are two types of lymphedema.
Primary lymphedema:
It occurs due to genetic errors in the human body that are involved in forming the lymphatic system. When there is a genetic error, there is a malformation of lymphatic channels. It can affect individuals of any age, but it usually affects infants, adolescents and teenagers. Congenitally, primary lymphadenoma is subdivided into three categories. These include:
1-Congenital lymphedema:
It occurs at birth and involves infants soon after birth or after 2-3 years of birth. There is a congenital malformation of the lymphatic channel.
2-Lymphedema praecox:
It is the most common form of primary lymphedema, affecting 80% of individuals. It does not involve infants. It usually occurs in puberty or at the start of the 3rd decade of life.
3-Lymphedema tarda:
It affects people in 30-35 years of life due to malformation of lymphatic vessels.
Secondary lymphedema:
Secondary lymphedema is caused by trauma or injury to the lymphatic vessels that damage the lymph flow. The worldwide cause of secondary lymphedema is filariasis, caused by infection by Wucheria Bancroft. Moreover, it is also caused as a result of cancer treatment, particularly breast cancer.
What are the risk factors for lymphedema?
Several factors increase the risk of lymphedema. These factors are as follows:
1-Breast Surgery:
Breast surgery, including mastectomies, is a major operation that can have a significant impact on the body’s lymphatic system, potentially leading to lymphedema. In this condition, excess lymph fluid collects in tissues, causing swelling. The likelihood of developing lymphedema increases with the number of lymph nodes removed during the procedure.
Statistics from the National Cancer Institute highlight the varying risks: approximately 5% to 17% of patients who undergo sentinel lymph node biopsies (where only 2-3 lymph nodes are removed) might experience lymphedema. This risk kicks up to between 20% and 53% for those who have more extensive axillary lymph node dissection in which 10-12 lymph nodes are removed.
2-Radiotherapy:
Radiation therapy to areas rich in lymph nodes can increase the risk of lymphedema. Radiation therapy damages the lymph nodes, vessels, and nerves, resulting in scar formation that impedes lymphatic flow and increases the risk of lymphedema.
3-Chemotherapy:
Some chemotherapeutic drugs can cause tissue damage that affects the lymphatic system. This side effect can contribute to the development of lymphedema as the lymphatic vessels become less efficient at fluid management.
4-Old Age:
Ageing is an ongoing process that causes sclerotic changes in the vessels. It makes the vessel walls less efficient for lymphatic flow and increases the risk of lymphedema.
5-Obesity:
Extra weight puts pressure on the lymphatic vessels and impedes lymph flow. Therefore, obese people are at higher risk of getting lymphedema.
6-Rheumatic Arthritis:
Rheumatoid arthritis is an autoimmune disease that causes inflammation of the joints. This inflammation can also affect the nearby lymphatic system. Chronic inflammation in the joint can obstruct lymphatic flow in that area, resulting in lymphedema.
7-Psoriatic Arthritis:
Similar to rheumatic arthritis, psoriatic arthritis involves inflammation that can obstruct lymphatic flow. The swelling associated with psoriatic arthritis can compress lymph vessels, impeding normal lymphatic function.
8-Infection:
The spread of bacterial or fungal infection into the lymphatic system causes lymphadenitis ( inflammation of lymphatic vessels) or lymphadenitis (inflammation of lymph nodes), which results in blockage of the lymph nodes and increases the risk of lymphedema.
9-Travel on an Airplane:
Moving the limb is key to promoting lymph flow, especially during long flights where extended periods of sitting or standing can lead to decreased lymphatic circulation. This reduced flow often results in swelling, typically in the legs, known as transient lymphedema. Fortunately, this type of swelling usually subsides after rest and mobility.
What are the signs and symptoms of lymphedema?
Lymphedema tends to progress gradually over time. Before swelling, there is an unpleasant sensation in the limb that comes and goes. The most common symptoms of lymphedema include:
- A noticeable swelling in the leg, arm, hand and breast
- Fever with rigours and chills
- Generalised body weakness
- A sensation of heaviness in the limbs
- Change in skin texture
- Numbness or tingling sensation
- Change in temperature of the affected area
- Tenderness
- Shooting pain sensation in the affected site
- Putting edema
- Fever or flu-like symptoms
- Skin induration
- Impairment of daily life activities
Classifications of lymphedema:
The classification of lymphedema is based on the grading and staging of the disease, which tells the severity of the disease.
Grading:
The grading of lymphedema is as follows:
Grade 1: (mild oedema)
In grade 1, lymphedema is spontaneously reversible and subsides on the limb elevation. It is primarily pitting oedema. It involves distal parts of the body, hands, legs, and feet. The circumference of this lymphedema is less than 4 cm with no tissue changes.
Grade 2: (moderate oedema)
In this stage, lymphedema is non-spontaneously reversible on limb elevation. It is most commonly non-pitting oedema. It involves the entire limb with noticeable tissue change. The circumference of grade 2 lymphedema is between 4 and 6 cm.
Grade 3: (severe edema)
In this stage, the lymphedema increases in volume and involves one limb and associated trunk. The circumference of the oedema is greater than 6 cm with significant skin changes such as cysts, keratosis or fistula.
Stage 4: (extensive edema)
In this stage, the overall volume of the oedema is huge because the lymphatic vessels are completely blocked.
Staging:
Stage 0:
It includes people at risk of developing lymphedema due to lymphatic injury but contains no songs and symptoms. In this stage, there is damage to the lymphatic channels, which remain asymptomatic.
Stage 1:
In this stage, the swelling is soft and subsides on limb elevation, such as pitting oedema.
Stage 2:
This stage includes
- Tissue fibrosis and thickness
- Swelling does not subside on limb elevation
- Pitting oedema can be present but not assessed due to tissue fibrosis and skin thickness
Stage 3:
In this stage, there is
- Temperature changes
- Tenderness
- Fibrosis
- Cellulitis
What are the differentials of lymphedema?
Multiple diseases have the same presentation as lymphedema. These diseases include the following:
- Nephrotic syndrome
- Congestive heart failure (CCF)
- Hypoproteinemia
- Drug reaction
- Lipedema
- Deep venous thrombosis
- Cellulitis
- Liver cirrhosis
- Post surgeries complications
- Venous insufficiency
- Baker’s cyst
- Myxedema due to hypothyroidism
How to prevent lymphedema?
Here are some preventive measures to help reduce the risk and severity of lymphedema:
1-Elevate the Affected Limbs:
Regularly elevate the limbs above the level of the heart to promote lymph fluid drainage and reduce swelling.
2-Stay Active:
Avoid prolonged immobility. Gentle exercises, such as walking or swimming, can help maintain fluid movement in the lymphatic system.
3-Avoid Prolonged Standing or Sitting:
Change positions frequently to avoid excessive fluid accumulation in any one area, which can exacerbate lymphedema.
4-Maintain a Healthy Weight:
Obesity can increase the risk of developing lymphedema or worsen existing symptoms, as excess fat can interfere with the optimal flow of lymphatic fluids.
5-Avoid High Temperature Areas:
Exposure to intense heat (like saunas or hot tubs) can cause blood vessels to dilate and increase swelling, aggravating lymphedema symptoms.
6-Wear Compression Garments:
If at risk or in the early stages of lymphedema, wearing prescribed compression sleeves or stockings can help manage and reduce swelling by promoting lymph fluid circulation.
Complications of lymphedema:
Lymphedema can cause several complications or remain unaddressed. These complications include the following:
- Lymphadenitis
- Psychological impairment
- Deep venous thrombosis
- Superficial bacterial infection
- Amputation
- Severe functional impairment
Surgical complications:
Post-surgery complications of lymphedema include:
- Seroma formation
- Hematoma
- Skin or tissue necrosis
- Partial wound separation
Management of lymphedema with ANF Therapy®:
ANF Therapists diagnose this condition clinically. In the early stages of lymphedema, it resembles oedema, or swelling and remains dismissed. It progresses gradually and increases in circumference with time. Moreover, in the early stages, pitting is clear with no surrounding skin and tissue changes and resolves on limb elevation. As it progresses, the surrounding skin becomes hard, and tissue changes occur and do not resolve on the limb elevation. The diagnosis is based on a detailed history and physical and neurological examination.
History:
ANF Therapist will ask some questions regarding the disease. They gather information, including presenting complaints, disease onset and duration. The history includes:
- Biodata
- Onset of swelling
- Location of swelling
- Does it resolve limb elevation or not?
- History of injury or trauma
- History of previous medical illness
- Travelling history
- Occupation history
- Family history
Physical examination:
In physical examination, ANF Therapist thoroughly examines the body of the patient to check the following:
- Location of oedema
- Size of oedema
- Thickness of the skin
- The colour of the skin of the affected area
- Temperature and tenderness of the area
- Lymphorrhea (leakage of the lymph)
- Positive stemmers test (inability to pinch a fold of skin)
Neurological examination
In the neurological examination, the ANF Therapist examines the patient’s nerve function. It includes:
- Reflexes of the limbs
- Sensations of the limb
- Power of the limbs
Treatment of lymphedema with ANF Therapy®:
ANF Therapy® effectively treats lymphedema layer by layer. Dr. Mikel H-G Hoff states that cardiac, lymphatic, and kidney protocols are given to treat lymphedema. Because these are the main distributive organs of the human body, problems in one can cause problems in others, too. ANF Therapy® treats this condition through applications of ANF Devices that aim to restore neurological oscillations and muscle contraction and remove free radicals from the body. These devices include:
Anti-inflammatory device:
An expert ANF Therapist applies positive and negative anti-inflammatory devices over the affected area. These devices reduce the active and chronic inflammation in the body and relieve pain.
Antioxidant devices:
These devices are applied between the anti-inflammatory devices and work by removing the harmful free radicals from the body.
Fibromyalgia protocol:
According to Dr Mikel H-G Hoff, the human body’s muscles play an essential role in lymph circulation. If these muscles do not work correctly due to trauma, muscle spasms, or any other condition, lymph circulation is compromised.
Therefore, fibromyalgia protocol is given to remove muscle spasms and inflammation and to improve muscle function.
Principle of ANF Therapy®:
ANF Therapy® uses ANF Devices that specifically target and strengthen the weakened neurological frequencies to optimise lymphatic functions. This frequency aims to optimise cellular communication and promote tissue regeneration. This approach restores equilibrium within the lymphatic system, providing a non-invasive solution that significantly improves lymphedema management and overall quality of life.
Pain Management Capabilities:
These devices also serve as an effective tool for pain management by delivering targeted neurological frequencies that help alleviate discomfort associated with lymphedema and its related complications. This method not only helps reduce pain but also modulates pain perception and promotes relaxation, offering a non-pharmacological option for symptom relief.
Benefits of ANF Therapy®:
By utilising ANF Therapy®, individuals can enjoy the dual benefits of improved lymphatic health and pain management without invasive procedures or medications. This innovative technology offers a holistic path to enhancing well-being and managing symptoms associated with lymphatic disorders.
Expected outcome:
The integration of ANF Therapy® plays a crucial role in treating lymphedema. Within the first few weeks, the patients experience a substantial reduction in arm swelling and decreased pain levels. These improvements not only enhanced the patient’s ability to perform daily activities but also alleviated her mental distress.
Follow-up:
A regular follow-up is necessary to check the device’s efficacy and reduction in the symptoms. ANF Therapy® treats lymphedema layer by layer.
Join ANF Therapy® To Upskill Your Clinical Practice:
ANF Academy offers clinical training for medical professionals to provide them with detailed knowledge about frequency medicine. It mainly focuses on neurological oscillations, neurobiochemical processes and their bodily functions, advanced palpation skills, and techniques to assess the neurological system. The ANF Clinical Training Program provides expertise on the ANF methodology for managing injuries and inflammation effectively, aiming for optimal patient outcomes.
Training Highlights Include:
- Mastering advanced clinical skills and techniques for neurological examinations.
- Techniques for identifying the differences between healthy and inflamed nerves.
- Methods to investigate the physical effects (signs and symptoms) of disrupted neurological oscillations.
- Strategies to pinpoint and treat the underlying causes of pain, injury, or pathology, focusing on addressing root causes rather than merely symptoms.
The ANF Clinical Training Program:
- It starts with developing the ability to locate, palpate, and evaluate nerves and the level of inflammation.
- Enhances advanced clinical skills to discover the interconnections among different body systems and the underlying causes of symptoms.
- It provides education on the various stages of treatment using ANF neurotech Devices tailored to match the healing phases of injured tissues.
For further information about ANF education programs and clinical training, visit www.anfacademy.com
References:
1. Sleigh, B. C., & Manna, B. (2023, April 19). Lymphedema. StatPearls NCBI https://www.ncbi.nlm.nih.gov/books/NBK537239/
2. Mph, R. a. S. M. (n.d.). Lymphedema: Practice Essentials, background, pathophysiology. https://emedicine.medscape.com/article/1087313-overview?form=fpf#a7
3. Lymphedema: symptoms, treatment, and risk factors. (2021, April 30). https://www.breastcancer.org/treatment-side-effects/lymphedema
About Authors
Writer:
Dr. Shahzaib Nasir
Dr. Shazaib Nasir, MBBS, RMP, is a medical writer at ANF Academy. He graduated from Multan Medical and Dental College, Pakistan. He works as a medical officer in the Oethpaedics department at Ibn-e-sina Hospital and Research Institute, Multan. He deals with patients suffering from chronic orthopaedic problems and pain. He is passionate about healthy eating and exercising. Moreover, he believes that frequency medicine can be the future of Orthopaedics.
Editor:
Dr. Shama Nosheen
Dr. Shama Nosheen, MBBS, RMP, is a skilled medical editor and writer at ANF Academy, specializing in medical communications. For 5 years, she has been working with renowned international healthcare companies as a medical writer, aiming to bridge the gap between patients and doctors. She is a graduate of Nishtar Medical University Multan. She grabbed American Board certification (ABAMS) in Aesthetic Medicine after graduation. Working with ANF Academy, she has developed a thorough understanding of ANF Therapy®️ that works on the principles of frequency medicine.
Reviewer:
PT. Irina Heinisuo Berná
Her background includes a Degree in Physiotherapy and a Master’s in Innovation and Research in Health Sciences, enriching her expertise in holistic health care. At ANF Academy, she seamlessly integrates clinical practice, academic teaching, and research into her daily activities to shape the future of ANF Therapy®️. Irina’s work symbolizes integrating education and compassionate care to improve global health outcomes.
Final Reviewer:
Dr. Mikel H-G Hoff
Dr. Mikel H-G Hoff, Founder of ANF Therapy®️, holds a bachelor’s degree in medicine and a Ph.D. in biochemistry, specializing in the bio function of the human body, specifically the neurological system. He is a manual therapist and sports psychologist. He is committed to revolutionizing healthcare by educating medical professionals and directly treating patients to enhance their quality of life. His extensive background in sports injury therapy, manual therapy, and various medical specializations, including biochemistry and nerve system signalization, empowers him to deliver pain-free solutions and lasting patient outcomes.
