{"entity":{"id":"lymphoedema-decongestive-therapy","kind":"technology","name":"Compression, decongestive therapy and exercise for lymphoedema","aka":[],"tldr":"Arm or leg swelling after lymph node surgery or radiotherapy is managed with compression garments, specialised massage, skin care and exercise. Weight lifting, once forbidden, was shown in a randomised trial to reduce flare-ups rather than cause them.","summary":"Lymphoedema follows axillary or groin node dissection and radiotherapy in a substantial minority of patients. Complete decongestive therapy combines manual lymphatic drainage, multilayer bandaging then fitted compression garments, skin care and exercise, and reduces limb volume in randomised and cohort studies; compression is the element with the most consistent effect, and pneumatic pumps add modestly. The PAL trial of 141 breast cancer survivors with lymphoedema (Schmitz et al., NEJM 2009) found that slowly progressive weight lifting halved the proportion with exacerbations and improved strength, overturning decades of advice to avoid lifting. Newer options include lymphaticovenous anastomosis and vascularised lymph node transfer for selected patients, and prevention by axillary reverse mapping and sentinel node biopsy instead of dissection. Reflexology, laser and herbal diuretics have no reliable evidence.","status":"standard-of-care","asOf":"2026-09-10","wikipedia":"https://en.wikipedia.org/wiki/Lymphedema","links":[{"label":"Weight lifting in women with breast-cancer-related lymphedema (NEJM 2009)","url":"https://doi.org/10.1056/NEJMoa0810118"},{"label":"NCI PDQ: lymphedema (health professional version)","url":"https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq"},{"label":"NICE NG101: early and locally advanced breast cancer, recommendations (updated 2025)","url":"https://www.nice.org.uk/guidance/ng101/chapter/Recommendations"},{"label":"Macmillan: lymphoedema","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/lymphoedema"},{"label":"Cancer Research UK: lymphoedema after breast cancer treatment","url":"https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/lymphoedema-after-treatment"},{"label":"NHS: lymphoedema","url":"https://www.nhs.uk/conditions/lymphoedema/"},{"label":"NHS: lymphoedema, treatment","url":"https://www.nhs.uk/conditions/lymphoedema/treatment/"},{"label":"Breast Cancer Now: lymphoedema","url":"https://breastcancernow.org/about-breast-cancer/treatment/lymphoedema"}],"tags":["complementary","supportive-care","evidence:strong"],"related":["reflexology-cancer","breast-cancer-related-lymphoedema"],"cancers":["breast-hr-positive","tnbc","melanoma","vulvar","breast-cancer"],"sections":["supportive-care","surgery","rejuvenation"],"technologies":["sentinel-node","exercise-oncology","survivorship-care-plan","lymphoedema-surgery-and-early-detection"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects"],"trials":[],"people":[],"bottlenecks":["b-survivorship"],"keyPapers":["paper-schmitz-n-engl-j-med"],"journals":[],"dependsOn":[],"notes":["After breast surgery and radiotherapy, NICE NG101 (2025) says people should be told their risk of lymphoedema before treatment and given information to take away; it states there is no consistent evidence that air travel, hot countries, manicures, hot tubs, blood tests, injections or blood pressure checks on the treated side raise the risk, that physical activity does not cause or worsen it, and not to use compression sleeves to prevent it.","Macmillan says the risk is lower after a sentinel node biopsy than after removal of a group of nodes, that early signs are clothing, rings or a watch feeling tighter and the arm feeling heavy or tight, and to ask the team as soon as you notice them. The NHS says cellulitis (a hot, red, painful swollen area) is the commonest complication and needs antibiotics quickly. NICE says anyone who develops lymphoedema should be referred to a specialist lymphoedema service as soon as possible.","Breast cancer: NICE NG101 rewrote its lymphoedema recommendations in 2025. It says to refer people who develop it to a specialist lymphoedema service as soon as possible (1.14.6); to assess for other treatable underlying factors such as nodal disease and cellulitis before starting any management programme (1.14.8); to offer compression therapy as the first stage of management, with a shared decision about the form (1.14.9); that kinesiology tape may be tried if compression is not appropriate or comfortable (1.14.10); and to reassure people that physical activity will not worsen their lymphoedema and may improve quality of life (1.14.11). It made no recommendation on manual lymphatic drainage, because the clinical evidence was uncertain and the treatment is labour-intensive.","The NHS describes the treatment as decongestive lymphatic therapy: compression bandages or garments, skin care to reduce the chance of infection, exercises that use the muscles of the affected limb to improve drainage, and specialised massage, followed by a maintenance phase you run yourself with self-massage, garments, exercise and skin care.","NICE NG101 (1.14.4) says not to offer compression therapy as a risk-reducing measure to people who are only at risk, which is a different question from treating lymphoedema that has developed; and (1.14.7) that people who have it should be told how to recognise the serious complications that need urgent medical attention, for example cellulitis or deep vein thrombosis."],"principle":"External compression and rhythmic muscle activity increase lymphatic return and prevent re-accumulation; resistance exercise strengthens the muscle pump and improves the limb's tolerance of load.","strengths":["Randomised evidence that exercise is protective","Compression is effective and widely available","Surgical options for refractory cases"],"limitations":["Lifelong garment use","Specialist therapists in short supply","Advanced fibrotic lymphoedema responds poorly"]},"route":"/technologies/lymphoedema-decongestive-therapy/","neighbours":{"technology":[{"id":"rejuv-mind-visible-difference-head-and-neck","kind":"technology","name":"A changed face and voice: body image after head and neck cancer treatment","route":"/technologies/rejuv-mind-visible-difference-head-and-neck/"},{"id":"rejuv-access-survivorship-care-germany","kind":"technology","name":"After treatment in Germany: a rehabilitation entitlement, not a leaflet","route":"/technologies/rejuv-access-survivorship-care-germany/"},{"id":"rejuv-access-survivorship-care-uk","kind":"technology","name":"After treatment in the UK: personalised care, and 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treatment","route":"/terms/breast-cancer-related-lymphoedema/"},{"id":"lymphoedema-after-breast-cancer","kind":"term","name":"Lymphoedema after breast cancer treatment","route":"/terms/lymphoedema-after-breast-cancer/"}],"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"vulvar","kind":"cancer","name":"Vulvar cancer","route":"/cancers/vulvar/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & 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