Physiotherapy and Lymphoedema

Physiotherapy

​It’s normal to have some physical limitations during cancer treatment and for several weeks after surgery. Side effects from head and neck cancer treatment can lead to nerve injuries, neck and shoulder pain, lymphoedema, and deconditioning.

For many people these issues may persist beyond cancer treatment, and impact on ability to return to work and other activities.

A whole range of head and neck cancer survivors see a physiotherapist, from those who have had neck dissection surgery that may have nerve-related shoulder dysfunction, to those who have received chemo-radiation therapy with head and neck lymphoedema.

Physiotherapy can help with neck tightness, shoulder pain, head and neck lymphoedema, and reduced body strength and fitness.

The earlier you seek a referral to see a physiotherapist if you notice any of these problems, the greater the chance of improvement and recovery.

An Overview to Lymphoedema

Causes of Lymphoedema?

• The lymphatic system is made up of lymph nodes and lymphatic vessels 

• • Lymph nodes are little ‘filters’ located throughout our body. They help the body filter out things like germs and infections.  

• • Lymphatic vessels drain fluid out of the tissue, pass the fluid through the lymph nodes, and return the fluid to the blood stream. 

• Lymphoedema happens when the lymphatic system is not working properly, causing fluid to build up in the area. This may happen because: 

• • lymph nodes were removed during surgery  

• • lymph nodes were damaged during radiotherapy 

• • cancer has caused a blockage in the lymphatic system of the neck. 

• Lymphoedema is more likely to occur in people who have had: 

• • both surgery and radiotherapy 
  • both sides of the neck treated. 

• Your surgeon and/or radiation oncologist may recommend specific techniques that are less damaging to the lymphatic system. These include:  

• • a sentinel node biopsy that removes a small number of lymph nodes 

• • radiotherapy techniques that limit the dose given to the lymph nodes. 

Managing Lymphoedema

• While lymphoedema can be a long-term (chronic) condition for some people, treatment for lymphoedema aims to: 

• • reduce the swelling and prevent it from getting worse 

• • reduce the symptoms associated with lymphoedema such as discomfort, tightness, stiffness and difficulty swallowing 

• Treatment for lymphoedema may be provided by:  

• • an occupational therapist, physiotherapist, massage therapist, speech therapist or nurse with specialist training in lymphoedema. 

• There are two phases to lymphoedema treatment: 

• • Phase I is an intensive phase, where you receive frequent treatment, education, and support from a lymphoedema practitioner 

• • Phase II is a maintenance phase where you apply self-management strategies as part of your daily routine.   

• Treatment for head and neck lymphoedema may include: 

• • Manual lymphatic drainage – is a specialised type of massage designed to move fluid from swollen areas towards areas that are draining normally.  

• • Exercise – including head and neck movement and stretches can help reduce the severity of lymphoedema by promoting lymph flow. Targeted shoulder and whole body rehabilitation may also be needed after head and neck cancer surgery. Speak to your cancer care team for more information.   

• • Compression devices - compression bandages and garments may be used in the head and neck region to help soften and reduce swelling. 

• • Lymphatic taping – is used to move fluid from swollen areas towards areas that are draining normally.  

• • Skin care – is important to keep your skin in good condition and prevent infection. Some helpful tips include: 

• • • Keep your skin clean by using a soap-free cleanser 

• • • Moisturise your skin every day by applying a moisturiser 

• • • protect your skin from cuts and damage from the sun immediately clean any scratches, grazes or cuts and cover the area with a dry dressing and monitor closely for signs of infection

• • • See a doctor as soon as possible if any signs of an infection appear, such as redness or inflammation. 

• Posture - simple changes to your standing posture and sleeping position can help your natural lymphatic drainage to be more effective.   
  
  
• Laser photobiomodulation - involves the use of specialised laser devices that can improve lymphatic flow and soften firm tissues. Your lymphoedema practitioner will determine if this is a suitable treatment for you.
  
  
• Negative pressure therapy - involves the application of a device which applies negative pressure (a ‘sucking’ force) to your tissues to move lymphatic fluid.  

The Cancer Care Team

• Always tell your doctor if you notice new swelling in your face or neck. They can arrange for you to have tests to find out the cause if this is not expected.
  
  
• Your doctor may recommend seeing a lymphoedema practitioner for treatment (who may be an occupational therapist, physiotherapist, massage therapist, speech therapist or nurse) or other healthcare professional to support you during your treatment journey. 

• You can find more information and resources from the Australian Lymphology Association website: https://www.lymphoedema.org.au/ or from the Cancer Council Understanding Lymphoedema website:  Understanding Lymphoedema 

Questions to ask you Cancer Care Team

• Who should I speak to if I have concerns about my lymphoedema?  

• What treatment do you recommend for lymphoedema?  

• Can you refer me to a health professional who would be able to help me with lymphoedema? 

• Is a compression garment appropriate for me?  

• How much will lymphoedema treatment cost?  

• What type of moisturiser should I use?  

• What types of exercises can I do?  

• Are there any techniques I can use at home to help my lymphoedema?  

• How might my work be affected?  

• How might my lifestyle be affected?  
  
• Can I talk to someone about how I am feeling? 

More Information

• Australasian Lymphology Association
• Return to activity following a neck dissection
  Hunter Cancer Research Alliance