WHAT IS EDEMA?

By Emily Attard, LMT, BCTMB & Desirée Gagné, MA, OTR/L

Edema is a symptom and consequence of a disease, surgery, or injury, and not a disease in itself. A simple definition of edema is swelling caused by too much fluid trapped in the tissue. Your lymphatic system is what moves interstitial fluid through the body to remove metabolic and cellular waste (remember, not “toxins”!). When this interstitial fluid between the cells gets trapped and builds in the tissues, that is when it is termed “edema.” 

Edema can affect any part of the body but often affects the feet and lower legs. This kind of swelling can be caused by an injury such as an ankle sprain, certain medications, radiation therapy, removal of lymph nodes, and even pregnancy (swollen ankles). Sometimes if we eat salty foods, our body can retain more water causing swollen hands and/or feet, but this can be remedied by reducing our salt intake. More serious causes of edema can be related to congestive heart failure and kidney (renal) failure. Edema can be a temporary issue and will resolve as an injury heals. However, it can also be a chronic issue that needs to be managed by a doctor, such things as diet changes, encouraging blood flow with movement, compression garments, and possibly with Manual Lymph Drainage (MLD) massage with a trained therapist. 

 
Primary lymphedema is caused by a congenital malformation of the lymphatic system, whereas secondary lymphedema is caused by a mechanical obstruction of lymph flow (surgery, removal of lymph nodes, trauma, infection, or immobility).

 
Lymphedema is different from Lipoedema (abnormal deposition of adipose tissue) and Phlebedema (chronic venous insufficiency). While at times edema can be treated with Manual Lymph Drainage (MLD) massage, other causes of edema require a medical assessment to establish a diagnosis and to see if MLD is indicated. For example, those with congestive heart failure or renal (kidney) disorders may not be able to receive MLD, and this is where a cardiologist or nephrologist would make that call. Remember edema is just a symptom of a bigger issue.

SIGNS OF EDEMA

Signs of edema may include:
1. Visible swelling, or puffiness, of the tissue directly under the skin
2. A heavy, warm, or tight feeling in the affected body part
3. Skin changes such as shiny or stretched skin
4. Skin that retains pits or indentations after being pressed
5. Imprints from clothes or jewelry or clothes/jewelry not fitting
6. Difficulty moving joints and reduced range of motion causing stiffness
7. An increased abdominal size can lead to a visibly distended belly
8. Shortness of breath or difficulty breathing

WHAT CAN HELP?

1. Manual Lymphatic Drainage (MLD): This is a specialized massage technique aimed at promoting the flow of lymph fluid through the lymphatic system. MLD can help to reduce swelling by directing excess fluid away from the affected area and back into circulation. Massage therapists and physical therapists, trained in MLD, can perform this technique to improve lymphatic drainage and reduce edema. Both disciplines are trained to look for areas of swelling and should refer the client to their primary care physician to get a correct diagnosis if the client hasn’t done so already.

2. Compression Therapy:  Orthotists can measure the affected area and order appropriate compression garments, per your doctor’s prescription. Compression helps to prevent fluid from accumulating and encourages fluid movement back toward the heart, reducing edema.

3. Exercise Prescription: Edema can sometimes lead to stiffness and reduced range of motion in the affected limb. Gentle exercises, including range of motion exercises, and various movements can facilitate the circulation of blood and lymphatic fluid, promoting fluid drainage and reducing swelling. Physical and occupational therapists can design customized exercise programs that cater to the individual’s specific needs and limitations to improve joint mobility and flexibility.

4. Elevating the Affected Area: Keeping the swollen body part elevated above the heart level can help reduce edema. Physical and occupational therapists may educate patients on the proper positioning and recommend regular elevation as part of the treatment plan.

5. Compression Bandaging Techniques: In cases of severe edema, physical and occupational therapists, who are specifically trained, can apply specialized compression bandages to reduce swelling effectively.

6. Education and Self-Management: Physical and occupational therapists play a crucial role in educating patients about managing their edema. They can provide guidance on lifestyle modifications, such as diet and exercise, as well as self-massage techniques and the use of compression garments at home.

7. Modalities: Physical therapists may use various modalities such as ultrasound, electrical stimulation, or cold therapy to reduce inflammation and promote tissue healing.

It’s important to note that edema can be a symptom of various underlying health conditions, such as heart failure, kidney disease, liver disease, venous insufficiency, or certain medications. If you or someone else experiences unexplained or persistent edema, it is crucial to seek medical attention to determine the underlying cause and receive appropriate treatment.

DISCLAIMER: This article is intended to provide general health information and is not intended to provide individual-specific medical advice, diagnosis, or treatment.