Lymphoedema and complementary therapy: Making an informed choice

"I’ve been given a gift of a day at a Health Spa, but I have lymphoedema. Can I have any of the therapy treatments they offer?"

People generally are increasingly using complementary therapies, believing that they can treat minor ailments, ease symptoms of disease, promote relaxation, alleviate stress and promote a sense of well-being.

Many people with lymphoedema would also like to use complementary therapies and frequently ask their nurse/ therapist whether there are specific treatments which could help in their lymphoedema management alongside their maintenance regime.

A survey Cancer Research UK, (2009) showed that almost a third of all cancer patients used some form of complementary therapy during their cancer journey.

The aim of this article is to provide some basic information about complementary therapy (CT) and to answer some of the questions that you may have with regard to using treatments yourself. The information may help you to make, safe, informed choices about using CT in the context of your lymphoedema. The information is for guidance only, however, and you should always ask for your lymphoedema therapist’s advise beforehand.

What is complementary therapy?

Complementary therapy literally means 'a therapy/treatment which works alongside other treatments'. The term therapy is often used to mean a 'hands-on' or 'touch' treatment such as massage.

You may also come across the term alternative therapy/management. This is an ever-widening array of treatments and diagnostic techniques which are not currently considered part of conventional western medicine. It includes homeopathy, Chinese herbal medicine and Bach Flower Remedies.

Collectively all of these therapies are called complementary and alternative medicine (CAM). 

Surprisingly, in spite of their growing popularity, the effectiveness of the claims of most of these treatments is largely untested, unproven and unregulated. Anecdotally, people may report that a treatment has helped them, but this is not the same as scientific proof that the treatment itself has cured the ailment! Properly conducted trials are needed for this.

This leaflet will concentrate on complementary 'hands-on' therapies and lymphoedema. So... do any therapies help lymphoedema? Is there any evidence that they work?

Currently, the only 'hands-on' therapy which has some scientific evidence to support its effectiveness in treating lymphoedema is manual lymphatic drainage massage (Williams.A.F et al 2002). MLD is accepted as part of best practice in the management of lymphoedema when performed by an appropriately trained MLD therapist.

Many beauty schools and health spas offer lymph drainage treatments... these are often not suitable for people with lymphoedema and are intended only for a healthy lymphatic system. Massage may be too firm and may not follow anatomical pathways. As yet there is no firm evidence that any other form of massage actually helps to reduce swelling in lymphoedema.

But evidence does show that firm massage, especially where the system is impaired, can cause further damage to the lymphatic channels (Eliska, Eliskova, 2006). This is why MLD needs to be light and directional and why we advise that you avoid any deep, firm massage/manipulative treatments on your affected area (Lymphoedema Framework Document 2006).

Are there any other benefits of having complementary therapy?

Several trials have shown that massage can improve quality of life, relieve anxiety, provide relaxation and boost self-esteem. Some people with lymphoedema have said that it helped them to 'reconnect' with their changed body image. Others have said that massage helps to reinforce a positive body image and self-worth.

"It made me feel good about myself again... accept my big arm as being part of who I am."

Many lymphoedema services and hospitals have complementary therapy departments where patients can receive massage from therapists trained to adapt their techniques to suit those with lymphoedema.

How do I choose a therapist?

In 2001, the Dept of Health recommended that each complementary therapy should be self-regulated and therapists are encouraged to register with an appropriate professional body.

However, this is a voluntary requirement, there are numerous regulatory bodies, (e.g. reflexology alone has 12) and because there is also no nationally accepted core training curriculum, therapist’s knowledge and skills vary greatly.

But always ask about the therapist's qualifications and knowledge. 

Many people using complementary therapy for the first time choose a therapist based on personal recommendation. You may be able to access treatments via your lymphoedema service.

Some health centres sub-let rooms to independent therapists, but this does not mean that all qualifications and skills have been checked.

Be prepared to ask the therapist the following:

• Where did they train?
• How long was their training?
• Can you see their qualifications and can they tell you about the training?
• What do the 'letters' after their names mean? (some initials simply refer to the regulatory body rather than a qualification, for example, FHT is Federation of Holistic Therapists.)
• Is the therapist insured? Can you see a copy of their insurance?
• What do they know about your condition?
• Are there any contraindications for this therapy?
• Have they had additional training to treat people with lymphoedema?
• Ensure that they understand that only very light effleurage (stroking) movements should be used on the affected quadrant of your body.
• Explain that either none/only plain oils/cream should be used on your affected part.
• Ask how many such people have they treated?

Therapists will be happy to answer these questions and should also ask you for details about your health, medical conditions and any treatments and medications you are receiving. 

The therapist should explain what the treatment is, how it will be performed, if there are any side effects and how much it will cost. 

*Remember you are allowing somebody to treat your body - never be afraid to ask questions and never be afraid to decline or stop treatment if you are not happy with any aspect of it.

Checklist - 'ACT first'

• Ask to see certificates
• Check credentials
• Tell all medical history. Including other treatments.
• Feedback if pressure too heavy
• Insist plain oils/creams only on the affected quadrant
• Really LIGHT EFFLEURAGE only on the affected quadrant
• STOP  treatment if not happy with it!

Which therapies can I try?

It is beyond the scope of this article to give a comprehensive account of all complementary therapies available in the UK. So we have focused on some of the more popular complementary therapies which you may see advertised locally and in health and beauty spas.

• MLD... light, directional anatomical technique, by practitioners trained to advanced level for lymphoedema (techniques recognised by BLS; Leduc, Vodder, Casley-Smith and Foeldii).
• Body massage/therapeutic massage... using plain oil/cream and only light effleurage to affected quadrants, or avoiding the affected area.
• Bowen Technique... gentle, manipulative, relaxing technique - avoid deep moves on lymphoedematous areas.
• Reflexology... firm pressures using a system of reflex points on feet, hands and/or ear lobes. Use instead of massage over lymphoedema. Lighter pressures to be used if working on oedematous hands/feet.
• Craniosacral therapy... very light spinal manipulation - can be relaxing.
• Reiki... light touch/hands-off, relaxing technique based on an ideology of re-balancing energy. No physical manipulation or pressure used.
• Therapeutic touch... light touch/holding technique - no physical manipulation or pressure used.
• Indian head massage... A westernised sequence of massage performed with recipient seated or lying down. Uses oils/creams and deep pressure massage to upper back, shoulders, neck, head and face. Can be adapted by skilled practitioners to use light pressure only on affected parts. Should avoid if facial oedema and avoid essential oils on lymphoedematous areas.
• Facial massage/facials/facial saunas... but avoid if facial oedema/sinusitis

Are there any complementary therapies I should avoid?

Once again, we have looked at the more commonly available treatments and have highlighted some which may cause a level of discomfort:

• Shiatsu... uses deep thumb pressures and strenuous manipulations of joints and tissues; may damage micro lymphatics and be painful.
• Osteopathy and chiropractic treatment. Used for spinal and postural problems. Sometimes uses powerful manipulations and positioning to `re-align’ spine, some moves may compromise lymphoedematous areas.
• Aromatherapy massage with essential oils... avoid lymphoedematous areas, may cause skin reactions and damage hosiery.
• Swedish massage... deep pressures used, working deep into muscles. Could damage micro lymphatics and be very painful.
• Acupuncture... uses a system of body’s energy channels (meridians), invasive, uses needles, avoid affected quadrant. (However, there are ongoing scientific studies into its use to help reduce some symptoms of lymphoedema.)
• Moxibustion... acupuncture with special needles which are `burnt’ to produce heat in the underlying tissues and meridians.
• Acupressure... as above uses deep thumb pressures instead of needles, therefore contraindicated on affected quadrants.
• Cupping... heated glass 'cups' applied to the skin to increase blood flow to surface. Based on ancient medical practices.
• Hot stone massage... uses heated basalt stones/shells and aromatherapy oils to massage superficial and deep tissues.
• Hydrotherapy treatments... Some use high-pressure water sprays to 'treat' cellulite, this can be painful and possibly damage micro lymphatics.

This information is intended only as a guide and is based on the author’s knowledge of therapies discussed and on patients positive and negative experiences of complementary therapies. Always ask your lymphoedema practitioner’s advice.

Conclusions

Remember that the best treatment for your lymphoedema is that provided by your lymphoedema practitioner, because it is evidence-based, guided by International Framework Recommendations, and MLD Training Schools are self-regulated.

However, many patients report that complementary therapy treatments, boost self-esteem, promote relaxation, ease some of the symptoms of heaviness and discomfort of lymphoedema, reaffirm positive body image and enable them to share in the same experiences as those without lymphoedema.

Give it a try

Use ACT FIRST tips and our suggestions of ` Try and avoid’, to safely choose a treatment that suits you, your needs and your lymphoedema.

Many therapy centres offer short `taster’ treatments. This is a good way to sample a new therapy. But still use the ACT first tips. 

References

• Lymphoedema Framework, 2006. Best Practice for the Management of Lymphoedema. International Consensus. London: MEP Ltd.
• Dept of Health, 2001. House of Lord’s Select committee on Science and Technology ‘s Report on Complementary and Alternative medicine. CM5124 Stationary Office. HMSO. London.
• Kirschbaum. M, 1996 Using massage in the relief of Lymphoedema. Professional Nurse. Jan 1996.11(4).
• Breolin.M. 1999 Mastectomy, Body Image and therapeutic massage- a quantitative study. Journal of Advanced Nursing 29(5) pp1113-1120.
• Eliska.O, Eliskova. M. 2006. Are peripheral Lymphatics damaged by high-pressure massage? BLS Conference. Oct 2006 UK.
• Williams.A.F, Vagdama.A,Franks.P.J, Mortimer. P.S. 2002. A randomised controlled cross over study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. European Journal of Cancer Care 11 (4).
• Eliska.O, Eliskova.M.1995. Are peripheral lymphatics damaged by high-pressure massage. Lymphology, 28.
• Singh, S and Ernst, E. 2008.Trick or treatment. Alternative Medicine on Trial. Bantam Press. London.
• HMSO 2008. Report form DoH Steering Group on Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and other Traditional medicine systems practised in the UK.
• Wilks. J. 2004. Understanding Bowen Technique. First Stone Publications. England
• Cohen. D. 1995 An Introduction to Craniosacral Therapy. North Atlantic Books, California.
• Mehta.N.1999 Indian Head Massage. Discover the power of touch. Harper Collins. London
• Jarmey.C. Tindall.J. 1991 Acupressure for common ailments. GAIA  BOOKS. LONDON.
• Wright. J. 2003 Reflexology and acupressure. Octopus. London.

Websites

www.fih.org.uk