One of the essential questions that should be on all massage therapist’s Intake Forms is whether or not your client has active, or is at risk for lymphedema. Regardless of whether you work as an oncology massage therapist or in a day spa setting, it is imperative that both client/patient and massage therapist know this medical history. This can avoid causing any injury to the client/patient. It is just as important for the client/patient to be sure to let your MT know if you have or are at risk for lymphedema when you are seeing a new therapist for the first time.
We most often hear about lymphedema of the arm secondary to breast cancer surgery, both lumpectomy and mastectomy. Many of my patients ask why this is so important for an MT to know. It is occasionally not explained to them by their medical doctor. Newer protocols are having many breast surgeons sending their patients for a physical therapy consult with a lymphadema specialist prior to surgery. The physical therapist will take measurements of the arm/arms to be affected by lymph node removal. Then, after surgery, should the arm begin to swell from lymphadema, there will be an accurate measurement of the normal size of the arm, and determine how much fluid the arm is holding.
In layman’s terms, which many of my patients have told me was a good way to understand lymphedema, I use the following analogy:
Picture a street drain and how the water flows freely down that drain when we have a rain storm. The heavier the rain, the faster it flows down that drain. Now, picture that same drain in the fall with leaves beginning to lay on some of the holes of the grate. We have more rain, but the rain is now flowing through that grate at a slower rate because some leaves are occluding the natural design of the grate. Water is beginning to back up onto the streets. Now, even more leaves fall and there are only about half of the holes in the grate which are open. The rest are no longer functioning to allow water to flow through them. So the water becomes backed up and streets begin to flood. This is basically what happens when lymph nodes are taken and someone develop lymphedema. There are other places in the body this can happen as well – commonly seen in the face with head and neck cancers.
Depending on how many nodes have been removed, and whether you develop active lymphedema secondary to the node removal, will often determine how bad the lymphedema can be – but not always. Sometimes it only takes one node to be removed to trigger lymphedema, and others have many nodes removed and do not develop this condition.
The first lymph node in a “cluster” of nodes is called the sentinel node. Normally, if cancer cells have spread to the lymph node, this is the first one to be affected. From there it spreads to the other nodes in the cluster. Having only the sentinel node removed can trigger lymphedema for many, and not cause any issues for just as many others. Lymph fluid normally flows freely through our bodies. Getting back to the drain analogy above, picture the cluster of lymph nodes with some missing. The normal flow of lymph is now interrupted because there are fewer nodes to process the fluid. Fluid that remains in the arm (or area of lymphedema) is extremely painful and can be very dangerous. You should contact your physician and/or lymphedema specialist immediately if you are experiencing a swollen, painful area where there is a lymphedema risk.
The reason it is so important for a massage therapist to know this information is because, when trained, we direct the lymph flow differently than we would in a massage with no lymphedema risk. If the therapist is not trained, then they should avoid the arm, or site all together. Just as you are no longer able to have blood pressure taken from the affected arm, or blood draws, there can never be any deep tissue massage to the affected area or effleurage or other strokes that direct lymph fluid to the area where the node/s were removed. Even if you do not have active lymphedema, you are always at risk once a node/s are removed, so this is a lifetime precaution.
It is not understood yet why some people develop lymphedema and others do not. More intense studies by the Lymphedema Society are now being done where they are following lymph fluid with dye. However, it is known that there are certain pathways the lymph fluid does follow and when working with a client/patient with lymphedema, the trained therapist will redirect that fluid pathway where there is active lymphedema or risk of the same, allowing for you to have a safe and enjoyable massage.