Lymphedema: Prevention and Management

by Courtney Steele  MScPT
Registered Physiotherapist
updated Mar 12, 2026

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What is your Lymphatic System?

Your lymphatic system is part of your immune and cardiovascular system.  It includes lymph vessels (similar to arteries & veins) that travel throughout the body, and lymph nodes which are located around joints (e.g. the shoulder and hips).  Its job is to remove waste (e.g. bacteria, viruses, metabolic waste, parasites etc.) from the body.

 

What is Lymphedema?

Lymphedema, once it develops, is a chronic condition (our job is to PREVENT this!).  It occurs when there is an abnormal accumulation of lymphatic fluid (protein rich fluid) which gradually builds up and resembles edema or swelling.

Cancer patients are at the highest risk of developing lymphedema after surgery (even just from lymph node biopsies), radiation and chemotherapy.

“Lymphedema is one of the most poorly understood, relatively underestimated and least researched complications of cancer or its treatment” National Cancer Institute 2015

 

Signs of Lymphedema

• Persistent swelling (measurable changes in girth)
• Heaviness, tightness and/or the feeling of pins & needles
• Pitting (indentation) of the skin after pressure is applied
• Aching discomfort
• Skin thickening or texture changes
• Decreased range of motion or muscle weakness

Lymphedema can occur on one or both sides in your upper extremities (arms), chest/abdomen and lower extremities (legs).  Surgery and radiation that occurs in the upper half of your body (e.g. breast, lung, neck) can lead to lymphedema in the chest and arms.  Surgery and radiation that occurs in your abdomen or below (think colorectal and pelvic cancers) can cause lymphedema that occurs in your abdomen, groin and lower extremities (legs).

 

Why Does Lymphedema Develop?  What are the risk factors?

Think of the lymphatic vessels like a hose; they take waste material to the  lymph nodes, which then pump it out of the area.  If anything is adding pressure to these vessels (i.e. think of a kink in a hose) then they can’t move this fluid that needs to be pumped out and this results in an accumulation of it in that area.

These following issues can cause occlusive pressure on these vessels and nodes or prevents the lymphatic system from working optimally:

• Scars/scar tissue (which is not as flexible as regular tissue)
• Radiation Fibrosis (thickens tissue and makes it firm) – to some extent, this can happen after any amount of radiation treatment
• Muscle tension (trigger points or “knots” in muscles through which these vessels run). This is common after surgery due to the typical periods of limited mobility that accompany it.
• Joint stiffness (if a joint isn’t moving smoothly, it will not only add pressure to the vessels but will not allow the nodes to do their job as well)
• Decreased breathing capacity or chest and upper back stiffness. Parts of the lymphatic system are located around the ribs and spine and movement of this area helps to pump lymphatic fluid. Lack of movement can cause stagnation of fluid.
• Lymph node biopsy or removal which is often done to stage cancer or as treatment to prevent further spread). If there are fewer lymph nodes to aid in pumping fluid out, this results in the entire system working at a decreased capacity.
• Chemotherapy places an additional burden on the lymphatic system. By introducing toxins that the body must filter out, it can overwhelm the system’s capacity to manage fluid and waste.

While each of these is an individual risk factor, cancer treatment often requires a combination of therapies. The risk of developing lymphedema is cumulative; as treatments like surgery, radiation, and chemotherapy are layered together, the strain on the lymphatic system increases significantly.

 

Stages of Lymphedema

Early stages

• Temporary swelling
• Reversible swelling that decreases with elevation
• Pitting (indentation when pressing on skin)
• No skin thickening/fibrosis

Late stages

• Swelling that does not reverse with elevation
• Fibrosis
• Skin thickening
• No pitting

 

How does Physiotherapy play a role in preventing and managing Lymphedema?

As physiotherapists, our main goal is to PREVENT lymphedema from developing.  It is best to see a physiotherapist as early as possible in your cancer care journey, to provide the education you need to manage your condition and the exercises and treatment required to prevent lymphedema from developing.

We work with patients to prevent lymphedema by:

• Providing manual therapy (hands on therapy) to release any tension/trigger points/knots in the area that could be compressing on their lymphatic vessels
• Joint mobilizations to ensure proper mobility of all joints in the area
• Individualized exercise programs focused on stretching where you are tight, strengthening where you are weak (so other muscles aren’t compensating and getting tight) as well guidance on appropriate/safe levels of cardiovascular exercises depending on when and where you are in treatments
• Prioritize pacing to manage your energy and fluid levels. Many patients naturally try to maintain their old routines (like cleaning the entire house in one go) only to experience increased heaviness or swelling. When your lymphatic system is compromised, it is essential to break larger chores into smaller, manageable chunks to avoid sudden spikes in blood flow and fluid volume.

Although there is no cure for lymphedema we can work to manage it if it is already there.  Our team uses Complete Decongestive Therapy to manage lymphedema which is considered the gold standard for lymphedema treatment.  The components to this type of care are:

1. Manual Lymphatic Drainage: Think of this as a very gentle “skin-stretch” massage. It wakes up your lymph vessels and encourages them to pump fluid away from the affected area.
2. Compression Therapy: This involves wearing specialized sleeves, stockings, or bandages. These tools provide the necessary pressure to keep swelling down and stop fluid from building back up.
3. Smart Exercise: Movement is medicine! Strong muscles act as a natural pump for your lymph vessels. The key is finding your “sweet spot” i.e. the right amount of activity that strengthens your body without overwhelming your system and causing more swelling.
4. Skin Care & Protection: Your skin is your first line of defense against infection. To keep this barrier strong, it’s vital to keep it hydrated with a lotion that has a pH between 4 and 6. This helps prevent the small cracks or irritations that could lead to serious issues.

 

If you have undergone surgery, radiation, chemotherapy, or lymph node removal and are concerned about your risk for lymphedema, we are here to help. Early intervention is key. Schedule an assessment today so we can create a proactive plan to help prevent this chronic condition.