Swelling in the arms or legs is often a problem for people who have impaired mobility. This might occur with paralysis, multiple sclerosis, Parkinson’s disease, or after a stroke. Pumping of muscles is an important factor in the body’s process of continually returning fluids to the blood circulatory system. In the absence of this important muscle pumping, swelling, or “edema” may form.
In the medical community this type of swelling is termed “dependent edema”. If a body part is lower than the heart, it is said to be in a position dependent to the heart. In a dependent position, gravity contributes to fluid accumulation in areas of the body farthest from the heart (arms and legs). The effects of gravity combined with lack of muscle pumping is what causes dependent edema.
At first the swelling completely goes away with elevation. For example, in the morning when a person rises from bed their arms and legs have been at the same level as their heart. So, when they get up in the morning there is no swelling. But as the day goes by, the effects of gravity and lack of muscle pumping cause the fluid to reaccumulate and swelling occurs. Sitting in a chair for many hours and bending at the hips also contribute by impeding the flow of fluids.
In the blood circulatory system, arteries carry fluid away from the heart. Fluid is always leaving the arteries to bring oxygen, nutrients and other vital substances into the body tissues. Most of that fluid returns to the blood stream through the veins. The fluid not taken up by the veins is picked up by lymphatic vessels and filtered in lymph nodes. Veins and lymphatic vessels have muscles in their walls to move fluid, but also rely on movement of the body to function.
If the swelling no longer goes away with elevation, such as when a person arises from bed in the morning, it indicates that lymphatic transport is overwhelmed by the amount of fluid in the soft tissues. When this occurs, the body’s immune system is greatly impaired because cellular debris, bacteria, viruses, toxins, and other molecules are not being effectively filtered out by the blood and lymph circulatory systems. This makes a person more prone to infections such as cellulitis or fungal, and wounds are slower to heal.
Swelling may become so extreme that it is difficult to find shoes and clothing that fit over the swollen areas. It may also further impair one’s functional mobility. The swelling may also become achy or painful.
Occupational & physical therapists with special training in lymphedema treatment may treat dependent edema. Treatment components normally include special bandaging techniques, compression garments, and manual lymph drainage (MLD). MLD is a skin touch technique performed to direct fluid toward lymph nodes. Bandages are typically applied at night, and compression garments worn during the day. Often compression garments are custom made to ensure a comfortable, proper fit. Compression garments fit better and are more comfortable once the swelling has been reduced with bandaging and MLD.
Lymphedema therapists may teach their patients or their patient’s caregivers how to apply bandages and compression garments, and perform simple. MLD for home management of swelling. Sometimes non-elastic binders may be used instead of bandaging if this facilitates independence in home management by the patient or their caregiver.
For more information regarding lymphedema therapy for dependent edema, please call Patti Jo Erickson at the Fairview-University Medical Center Lymphedema Treament Center: 612-273-5377.