Complete Decongestive Therapy: A Guide

Complete or complex decongestive therapy (CDT) is a treatment for lymphedema, a condition in which excess fluid (lymph) collects in a part of the body. Damage to the lymph nodes or vessels, or a blockage leading to chronic swelling, usually causes lymphedema.

It’s important to treat or manage lymphedema. If left untreated, it can worsen and cause other complications such as skin infections. While there’s no cure for lymphedema, CDT is a noninvasive way to help manage it.

Medical professionals consider CDT an effective treatment for lymphedema because it includes many approaches. The goal of CDT is to reduce the pain and swelling associated with lymphedema.

The key components of a CDT program are:

  • Manual lymphatic drainage (MLD). Certified therapists use manual techniques to gently massage your affected limbs. This helps to release and move trapped fluid so that the body can reabsorb it.
  • Compression. Bandages or compression sleeves wrapped around the affected area provide pressure. This helps to move excess fluid and prevent it from returning. This can reduce swelling and allow fluid to be drained.
  • Exercises. Remedial exercises are an important part of both CDT phases. Regular exercises can help improve the flow of lymph fluid in your body and help prevent swelling. Wearing compression sleeves or garments while exercising can help.
  • Skin care. Common side effects of lymphedema include skin infections and skin changes. Additionally, wearing compression garments may make your skin dry and itchy, increasing the risk of infections. It’s important to clean your skin regularly and protect it from the sun by wearing sunscreen.

In addition to multiple components, CDT also takes place in two phases.

Phase 1: Intensive therapy

Also known as the decongestion phase, this first phase aims to bring down swelling and allow the skin to improve. How long this phase takes depends on how severe your lymphedema is. Typically, according to healthcare professionals at OncoLink, it can last 2 to 4 weeks.

The same healthcare specialists recommend that you wear your compression garments for up to 23 hours a day during this phase. You should remove them only to cleanse your skin. If your lymphedema is not severe, it may be okay to skip to the second phase, depending on what your doctor and therapist say.

After your doctor has approved a treatment plan, a certified physical or occupational therapist will perform MLD. In some cases, as detailed in this 2017 study, a compression machine might drain the lymphatic fluid.

You can also perform lymphatic drainage techniques on yourself (or have a family member do them) by using simple hand techniques.

Phase 2: Maintenance therapy

The goal of the second phase of CDT is to build upon the success of the first phase. Phase 2 should begin right after phase 1, as a delay can trigger swelling to return.

Maintenance treatment can last for a few months or years. It depends on the extent of your lymphedema.

Several health conditions can cause lymphedema. It can also sometimes happen on its own. People with lymphedema for any reason may benefit from decongestive therapy.

According to this 2018 study, although it’s rare, primary lymphedema can be an inherited genetic condition that can affect children and adults.

Secondary causes of lymphedema are more common. It can result from:

  • injury, either short-term or long-term
  • side effect of medical treatment
  • chronic cellulitis

This 2021 overview indicates that the most common cause of lymphedema in the United States is cancer treatments, like chemotherapy and radiation.

CDT is generally safe. Research from 2020 on CDT found no serious safety issues with this therapy and reported that most people had positive results.

As with any therapy or treatment, CDT may have some risks or side effects.

CDT may not be right for people with certain conditions. A 2020 study lists several such conditions, including:

  • rapid heart failure
  • deep vein thrombosis
  • asthma
  • low blood pressure
  • thyroid disorder
  • severe arterial insufficiency
  • severe nerve damage

Ask your doctor or therapist about any concerns you may have prior to treatment.

The key components of CDT for a child are the same as for an adult. However, a child or teenager undergoing this therapy may require additional emotional support from their caregivers or a mental health expert.

Children who need CDT will require custom-made compression garments ordered by their doctor or physical or occupational therapist. As they grow, their garments will need to be replaced.

How effective is decongestive therapy?

According to research from 2017, complete decongestive therapy is considered one of the best therapy programs for people with lymphedema. Many studies, such as this study from 2020, have found positive results if therapists correctly follow the steps.

What are decongestive exercises?

Remedial exercises used in CDT include light stretching and range of motion exercises. Initial exercises are designed to improve the lymphatic system. The National Health Service (NHS) says that you may also perform activities like cycling and swimming, which exercise the whole body.

Can I do lymphatic draining on my own?

Check with your doctor or therapist before trying any lymphatic drainage methods on yourself. You should not do manual draining if you have congestive heart failure or an active infection. If your doctor has cleared you, you can try lymphatic massage on yourself.

How do I find a certified therapist to do lymphatic draining?

Your doctor can refer you to a certified lymphatic therapist. You can also find therapists in your area using tools provided by the Lymphatic Association of North America (LANA) and the National Lymphedema Network.

You’ll want to ensure they have the letters CTL (“certified lymphatic therapist”) as part of their credentials. LANA-certified therapists will have the letters CTL-LANA. Per the LANA, they complete 135 hours of training as part of their certification.

Are there alternatives to complete decongestive therapy?

There are alternatives to CDT, including multi-layer compression bandaging (MCB). A 2018 study that compared these two types of therapies found that MCB is not only more accessible for people with lymphedema but is a more cost-effective alternative for elderly patients.

This 2021 study notes other treatments that may also help treat lymphedema, such as acupuncture, laser treatments, and deep oscillation.

Does insurance or Medicare usually cover complete decongestive therapy?

Some kinds of medical insurance may cover CDT. Check with your insurance company before beginning CDT.

According to the Medicare Coverage Database, Medicare will pay for only certain parts of your decongestive therapy program. You’ll require a diagnosis of lymphedema and services to be completed by a qualified clinician.

Lymphedema should not be left untreated as it can gradually worsen and cause other health complications.

Complete decongestive therapy is an effective treatment for people with lymphedema. The many components of CDT help to manage your condition and improve your health-related quality of life.

Discuss any concerns you have with your doctor prior to starting treatment.

Leave a Reply

Your email address will not be published.