Adie Mackenzie, one of our Clinical Advisors, outlines why an increase in the number of massage therapists could help better serve the lymphedema patient population.

Lymphedema and other lymphatic dysfunctions are significant challenges to an individual’s quality of life, involving a propensity toward swelling of a limb or other body part. This can be due to damage of the lymphatic system occurring during the patient’s life or malformation that is present from birth.  In either case, the condition is lifelong and the treatment, Complete Decongestive Therapy (CDT), is the same, and is best started as soon as the condition or the risk is identified.

CDT can be provided by a Certified Lymphedema Therapist (CLT) who is a specially trained individual with some other health care training, licensure and/or certification. Specialties that can qualify to treat lymphatic dysfunctions include Doctors of Medicine and Osteopathy, Nurses, Physical and Occupational Therapists and their Assistants, Certified Athletic Trainers and Licensed Massage Therapists. All of these professionals are vital to providing appropriate care to this very underserved patient population.

There are, however, multiple barriers to adequate access of providers with these specialized skills, and we will go on to discuss those at greater length. In this article, I attempt, as both a Lymphedema Patient and a Massage Therapist CLT (MT-CLT), to make a case for increasing the number of qualified providers and in particular for recognition of the important role that MT-CLT can play as we attempt to assure that every patient has access to appropriate care in a timely fashion.

Lack of Education in Lymphedema Care
Some important issues must be considered in addition to discussing the number of qualified therapists. First is the fact that most medical professionals are not well trained in the structure and function of the lymphatic system. In medical school, doctors have reported that they were given anywhere from 3 hours to 3 days-worth of education in this realm.

Although the lymphatic system has not been traditionally thought of as a “formal” part of the immune system, it plays a critical role to immunity1, and therefore these limitations in medical education pose a serious impediment to assuring the proper diagnosis and care of numerous conditions. In the Oncology setting, physicians are more likely to be aware that their patients are at risk for lymphedema, and they more readily provide education and referral for appropriate care. However, in many other areas, patients may seek evaluation from a parade of providers before receiving an accurate diagnosis.

This educational shortfall is being directly addressed by many professional groups including the American Vein and Lymphatic Society, (formerly the American College of Phlebology). Although the situation is improving, the development of increased awareness will take time to reach the point that these patients are likely to be given a correct and helpful diagnosis when they first seek it.

The limited availability of therapists who are trained and certified to treat lymphatic dysfunction is another concern. While there is no specific statistic on the number of these professionals, the wait lists that most clinics and private practitioners report is suggestive of a great need for additional providers to be trained and to gain experience.

The Importance of Massage Therapy
Although massage therapists often have fewer hours of overall training than other allied professionals, they are a natural group of providers to be considered by lymphedema patients and medical professionals as part of the lymphedema care management team. Massage therapists, especially those with in an interest in oncology care, have often taken advanced training in Manual Lymphatic Drainage techniques. These therapists are devoted to the well-being of their clients and motivated to provide a health care intervention, such as CDT, that is physically, mentally and financially challenging. These practitioners should not be seen as lesser providers for patient referral.

As we have identified the need to increase the number of providers capable of and qualified to apply interventions for patients in need of lymphedema care, below is a list of reasons that CLT massage therapists should, in my opinion, be among the referral options considered by physicians and clinics seeking partnership in the wider community. With the aforementioned limitation in providers and extended wait times to begin therapy at many medical clinics, a MT-CLT may be the most available therapist to initiate care.

  1. CDT should be started as soon as lymphatic dysfunction is identified.
  2. Massage therapists rarely bill insurance. This means that they may have more time for the hands-on components of CDT, as the rigors of compliance with insurance rules is lessened. That does not mean that the MT-CLT is less able to meet the needs of the patient, only that they are less constrained by the rules that may be present in an out-patient rehabilitation clinic or a hospital-based environment.
  3. Health insurance may have a limitation on therapy visits or a significant co-pay, a high co-insurance amount or a very high deductible. Some patients may not be insured at all. These situations may make the MT-CLT the most affordable provider available.
  4. Patients may be challenged or unable to leave their homes. There are few home-health agencies offering CDT and the MT-CLT is often able to travel to the client’s home or preferred location.
  5. Patients may have completed CDT in the medical setting and may benefit from long-term maintenance interventions. A monthly visit with a MT-CLT can allow for this type of relationship in a potentially less medical setting.
  6. Many patients with lymphedema are cancer survivors and the clinical environment, another medical setting, may be triggering and emotionally challenging. A massage “studio” or the patient’s own home may be a much more emotionally supportive environment.
  7. Patients with lymphedema may be working professionals and find it difficult to commit to attending the lymphedema clinic during business hours. The flexibility of scheduling that most massage therapist may offer can be a boon to obtaining treatment.
  8. The MT-CLT may be the most experienced local professional to offer care to those with lymphatic dysfunction.
  9. A MT- CLT can safely treat other conditions and offer general massage that will not cause exacerbation of a patient’s current lymphedema symptoms.
  10. The MT-CLT may have additional health care degrees and/or certifications. This is not true in every case, but a health care professional may choose to function under their massage licensure to support home visits, or for various other reasons.

Additional Considerations
It is incumbent on the patient to inquire about the therapist’s experience, licensures and certifications. Some therapists will refer to themselves as “certified” after a short weekend course and are not actually qualified to treat lymphatic dysfunction with CDT. We can discuss this at greater length in another article, but a quick word to patients: Be sure to double check that your therapist has training from a reputable training program in not just treating lymphedema, but in CDT, a 135-hour training program.

It is also reasonable to consider a massage therapist who is certified in Manual Lymphatic Drainage (MLD), a 45-hour program, especially in the absence of a local MT-CLT. These therapists are qualified to provide interventions that are safe. Such interventions that will not cause lymphedema exacerbations and which may reduce fibrosis, minimize pain, and other complaints, while supporting lymphatic flow. These therapists are not, however, trained to provide all of the aspects of care for patients with lymphatic dysfunction. We will discuss the importance of these providers at greater length in a future article and/or presentation when we discuss the needs of Lipedema patients as well as other appropriate applications of MLD.

Contemplating the life-long needs of the lymphedema patient to experience decongestive care is critical. We must consider all options and all providers available to address these needs and the very unique circumstances of the individual. To overlook the role of the MT-CLT in the management of lymphedema intensifies the challenge all of us face in making sure that these patients receive the most timely and appropriate care for their particular situations.

Stay tuned for more related topics in future blog posts. In the meantime, you can learn more about Adie Mackenzie and her role with the AIROS Medical team.

Adie Mackenzie
Adie Mackenzie

Adie MacKenzie is a national board-certified health and wellness coach and a Certified Lymphedema Therapist. She has over 40 years of experience in manual therapy, including medical massage and physical therapy. She currently treats lymphedema patients and people with chronic pain and chronic illnesses as part of her private practice and during clinical hours at an integrative health facility in Nashville, Tennessee.

Massage TherapyAdrien MackenzieLymphedema CareMLD