Notes prepared by Nerida Smith who attended Michael Mason’s presentation at LAV Awareness Seminar March 2003.

Michael is a physiotherapist whose main interest was sports physiotherapy until 1987 when he established Adelaide Lymphoedema Clinic in S.A.  His interest in lymphoedema developed after he acquired a paper written by the Foeldis regarding their treatment for lymphoedema in Germany known as Complex Physical Therapy.

Prior to that he was at a loss on how to help people with the condition.

People were often told “It's only a swelling, don’t worry”

Michael considers C.P.T to be the best non-invasive treatment for lymphoedema available and he encourages people to “Live positively with lymphoedema.”

He went on to explain that the lymphatic system makes up part of our immune system and is a transport system for the lymph fluid which exits the blood stream to nourish the tissues and gather up the waste products from this process.

The body has 4 lymphatic territories separated by boundaries or watersheds. 2upper and 2 lower.  It is possible for a quadrant to be swollen without the corresponding limb.

There are surface lymphatics and deep lymphatics which follow in close proximity to the blood vessels and nerves. The surface lymphatics are important in the treating of lymphoedema and the reason why the lymphatic massage pressure is as the stroking of a cat.

Swelling occurs when the lymphatic system is impaired.  e.g. lymphoedema may develop in the arm because the capacity in comparison to normal is greatly reduced because of lymph node removal.  Infection will cause increased load and cause stagnation of the fluid because of the reduced capacity.

Lymphoedema is classified into 2 types – Primary and Secondary.

Primary also known as Milroys, Lymphoedema Praecox and Lymphoedema Tarda.  All of these are a congenital condition classified according to the age of onset. This often requires yearly treatment.

Secondary following surgery for cancer, radiotherapy, trauma, insect bite.

Venous Oedema responds to CPT. This swelling is charecterised by pigmentation on the lower limb.

Studies have shown that overweight or obese people are twice as likely to develop lymphoedema and they only respond half as well to treatment.

Lipodema is caused by an excessive deposition of fat cells – a pathological condition where the feet are not affected.  CPT only helps to some degree but liposuction is helpful.

Diagnosis of lymphoedema is mostly by clinical evidence and lymphocintoscans, which enables the tracing of the lymph flow in the limb.

Treatment  - many methods have been used  - surgery, drugs, hydrotherapy, compression pumps, laser and complex physical therapy.

Note: For lymphoedema the use of diuretics is not recommended they remove the water and concentrate the fluid causing the problem to worsen over time.

·         Laser softens the fibrous tissue.

·         Michael has developed a method called TMER (a routine combing massage and exercise) designed to stimulate deep drainage.  These are available for each affected limb or limbs.

·         Bandaging with low compression bandages over stockingette and polyester padding

·         Exercise - hydrotherapy, swimming, walking.

Self management tips.

Avoid overloading the lymphatics neither underload or overload the lymphatics.

1.       Avoid excessive heat and sunburn

2.       Practice good skin hygiene.

3.       Exercise regularly

4.       Wear a garment

5.       Eat sensibly

6.       Listen to your body

7.       Schedule periodic reviews

8.       Self massage

9.       Compliance with therapists treatment prescription.