This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

Biology of Lymphedema

Objective: The purpose of this study was to investigate the acute effects of manual lymphatic drainage (MLD) on pain threshold and pain tolerance of different body parts. Methods and Results: Thirt...

Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts

Background: Lymphedema arises due to a malfunction of the lymphatic system, leading to extensive tissue swelling. Complete decongestive therapy (CDT), which is a physical therapy lasting for 3 weeks and includes manual lymphatic drainages (MLD), leads to fluid mobilization and increases in plasma volume. Here, we investigated hemodynamic responses induced by these fluid shifts due to CDT and MLD. Methods: Hemodynamic parameters were assessed continuously during a sit-to-stand test (5 min baseline, 5 min of standing, and 5 min of recovery). This intervention was repeated on days 1, 2, 7, 14, and 21 of CDT, before and after MLD. Volume regulatory hormones were assessed in plasma samples. Results: A total number of 13 patients took part in this investigation. Resting diastolic blood pressure significantly decreased over three weeks of CDT (p = 0.048). No changes in baseline values were shown due to MLD. However, MLD led to a significant decrease in heart rate during orthostatic loading over all epochs on therapy day 14, as well as day 21. Volume regulatory hormones did not show changes over lymphedema therapy. Conclusion: We did not observe any signs of orthostatic hypotension at rest, as well as during to CDT, indicating that lymphedema patients do not display an elevated risk of orthostatic intolerance. Although baseline hemodynamics were not affected, MLD has shown to have potential beneficial effects on hemodynamic responses to a sit-to-stand test in patients undergoing lymphedema therapy.

https://www.mdpi.com/2079-7737/10/7/642/pdf

Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy.

Introduction. Varicose veins disease of the lower extremities is often accompanied by edema, which persists even after the elimination of the causes of venous insufficiency. Clinically, the etiopathogenesis of edema in such patients is not always possible to differentiate. Objective. To determine the role of the lower limb lymphatic vasculature stucture variants in the development of chronic venous edema in patients with varicose veins disease. Materials and methods. A retrospective analysis of the results of X-ray contrast lymphography and radionuclide lymphoscintigraphy of 257 patients with different stages of chronic venous insufficiency (CVI). Results. Pathognomonic patterns of the lymphatic vasculature structure at various stages of lymphedema in patients with C3-C5 CVI were discovered. We found that the increasing number of cases of persistent oedema could be associated with the lower limb lymphatic vasculature hypoplasia and higher classes of CVI: 43.95 % among the patients with C4 CVI and 88 % with C5 CVI. The majority (94,1 %) of patients with C3 CVI with a normal-like lymphatic system presented with transitory oedema. With CVI C5, the capacity of the groin lymph nodes was impaired in 64 %. In C4 CVI, weak contrasting was observed in 45.1 %. With C3 – in 35.1 % of cases. Conclusions. The progressing degree of chronic venous oedema could be associated with the lymphatic vasculature hypoplasia and the malfunction of the groin lymph nodes.

The role of the anatomical structure of the lymphatic system of lower limbs in the development of chronic venous edema in varicose veins disease

/pdf/the-effect-of-craniofacial-manual-lymphatic-drainage-after-pj55i75k.pdf

The Effect of Craniofacial Manual Lymphatic Drainage after Moderate Traumatic Brain Injury

Background: The purpose of this study was to investigate acute cardiovascular responses to manual lymphatic drainage (MLD) on different parts of the body. Materials and Methods: Thirty hea...

Acute Cardiovascular Responses to the Application of Manual Lymphatic Drainage in Different Body Regions.

Background: Lymphedema is a chronic and progressive disease whose diagnosis involves determination of clinical and demographic characteristics. The aim of this retrospective study was to analyze th...

Clinical Characteristics of and Services Provided for Patients with Lymphedema Referred to a Physiotherapy Program During the Years 2009 Through 2019.

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Acute Cardiovascular Responses to the Application of Manual Lymphatic Drainage in Different Body Regions.

Clinical Characteristics of and Services Provided for Patients with Lymphedema Referred to a Physiotherapy Program During the Years 2009 Through 2019.