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The reference treatment

The reference treatment

Decongestive Lymphatic Therapy

(DLT)

Decongestive lymphatic therapy (DLT), also called Complete Decongestive Therapy (CDT), is the standard conservative treatment for lymphedema/chronic edema. It is an individualized treatment plan that may include compression bandaging or garments, skin care, therapeutic exercise, education, self-management strategies, and manual techniques such as manual lymph drainage when appropriate. Decongestive lymphatic therapy is delivered in two phases: the intensive decongestive phase and the maintenance phase. 

Therapists are specifically trained and certified to practice decongestive lymphatic therapy. Consult the LAQ Resource Guide to find a certified therapist near you.

Your therapist will assess the stage and severity of your lymphedema/chronic edema and take a medical history before proposing an individualized treatment plan. Learning to manage your lymphedema/chronic edema through ongoing self-care is essential to the success of your treatment. Your therapist will give you the training, tools, and resources to guide you.

The intensive decongestion phase includes:

Manual techniques

Manual techniques, which may include manual lymphatic drainage (MLD), are gentle, hands-on interventions used as part of a comprehensive lymphedema/chronic edema treatment plan. Rather than serving as a standalone treatment, these techniques are applied based on each individual’s needs to support tissue health, improve lymphatic flow, and address concerns such as tightness, discomfort, scar tissue, or fibrosis.

While MLD may help relieve symptoms and improve comfort and mobility, it is most effective when combined with other key components of care, including compression, exercise, skin care, and self-management strategies.

Compression bandages (multi-layers or adjustable systems)

Compression bandaging is a key component of lymphedema/chronic edema treatment and is used to help reduce and control swelling. It may involve multi-layer bandaging or adjustable compression systems (such as Velcro wraps), selected based on your individual needs, comfort, and stage of lymphedema/chronic edema.

These bandages provide consistent pressure to support lymphatic flow, prevent fluid buildup, and improve the effectiveness of muscle movement during daily activities. Compression bandaging is typically initiated and monitored by a trained healthcare professional to ensure proper application and effectiveness.

As part of your care, you and/or a caregiver may be taught how to safely apply compression to support your independence and ongoing self-management.

Therapeutic exercise

A lymphedema/chronic edema-trained therapist will guide you through individualized therapeutic exercises designed to support your overall function and well-being. These exercises help stimulate lymphatic flow, improve mobility, build strength, and enhance cardiovascular health.

Exercise is an important part of lymphedema management and is most effective when tailored to your needs and performed in combination with other treatments such as compression and self-management strategies.

Skin care

Skin care is an essential part of lymphedema/chronic edema management and plays a key role in preventing infections. Keeping the skin clean, well-hydrated, and protected helps maintain its integrity and reduces the risk of bacteria and fungi entering the body. 

Daily gentle cleansing and regular moisturizing are recommended, along with careful monitoring for any signs of irritation, injury, or infection. Your healthcare provider will guide you on the best skin care routine based on your individual needs. 

The maintenance phase

Once lymphedema/chronic edema has stabilized thanks to decongestive lymphatic therapy (2 weeks or more), your therapist will recommend the compression garment that’s right for you and help you make the transition to the maintenance phase and learning self-management skills.

The maintenance phase includes: wearing the compression garment(s), physical activity, skin care, weight control, and deep breathing combined with self-massage and/or professional manual lymphatic drainage.

 

Other treatments

Sequential pumps

Pneumatic pumps are sometimes used to treat lymphedema/chronic edema. However, they can cause swelling and hardening of the tissue above the treated area. Pumps are most effective when used in combination with DLT and under the supervision of a therapist.

Diuretics

Diuretics are not usually recommended for lymphedema/chronic edema, as they remove water and increase protein concentration, which can lead to tissue hardening and increased inflammation. However, you should continue to take this medication if it has been prescribed for another condition. Please discuss any questions you may have with your doctor.

Lymphatic surgery

It’s important to know that lymphatic surgery DOES NOT cure lymphedema. As Dr. Michel-Alain Danino, microsurgeon at CHUM, puts it: “After surgery, the patient must adapt to his or her new lymphedema.”

Read more

Chronicles and advice

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