Patient at Vodder School Austria
Before CDT treatment
After CDT Treatment

Doctors and Health Professionals

Chronic Oedema, Lymphatic Conditions and Lymphoedema are extremely misunderstood areas of diagnosis with water tablets and patients told `you have water retention`and there is no treatment! Continuous inflammatory conditions worsen and will deteriorate without treatment and then they become irreversible!


....early diagnosis and treatment with MLD (Manual Lymph Drainage) or CDT (Complete Decongestive Therapy) can prevent, reverse and alieviate symptoms and the need for further more expensive treatment and possible hospitalization.

Please listen to what these lymphatic doctors and some patients have to say:-

Then watch the videos below by Christine Moffatt wound care specialist. We treat and help patients at Feel Good Factor we have sucessfully treated, lymphoedema and venous ulcers - don`t your patients deserve another option?


Best Practice for the Management of Lymphoedema

Best Practice for the Management of Lymphoedema by

Professor Christine Moffatt PhD MA, RGN, DN

International Consensus

This 6 part in depth presentation by Christine gives a fantastic overview of essential information that all Practitioners should be aware of and gives a valuable insight into the misunderstood world of Lymphoedema

1. Intro

2. Statistics

3. Venous Ulcer Patient

4. Differential Diagnosis

5. Treatment Decisions

6. MLD

Medical Study in America


146 patients with unilateral extremity lymphoedema were treated with Complex Lymphoedema Therapy (CLT), also known as Complete Decongestive Therapy (CDT). Lymphoedema reductions after CLT averaged 67.7 % in the 112 patients with one affected arm, and 71.6 % in the 34 patients with one affected leg. At 5-year follow-up, the average reduction in-patients with one affected arm increased to 75%, and decreased to 62% in those with one affected leg.

Successful maintenance of initial lymphoedema reduction is dependent upon compliance with the daily home self-care program. This program includes individualized lymphoedema exercises which combine self manual lymphatic drainage, deep abdominal breathing, sequential isotonic/isometric exercises, instruction in risk reduction techniques/skincare to avoid infection in the affected limb, and 24 hour compression on the affected limb via compression garments/bandages.

Sufficient time is needed for patients to successfully learn how to apply all the components of the home program. Patients who were compliant showed significant increases in lymphoedema reduction, whereas non-complaint patients lost part of their initial reduction.

These results showed that reductions in lymphoedema achieved from a single course of CLT/CDT can be successfully maintained for 5 years without further treatment, provided the patient is taught a proper self-care program and is compliant with that program on a daily basis.

Full Comprehensive Lymphoedema Management Report

It is well known that lymphoedema, untreated, is a progressive, chronic, incurable disease. While the incidence of lymphoedema secondary to treatment for breast cancer is reported to average between 6-30% , the incidence of lymphoedema secondary to other cancer surgeries and treatments has not been well reported. In addition, primary lymphoedema (other than connatal which appears at birth) which develops in childhood, adolescence, or later life, is often misdiagnosed and under-treated.

Lacking accurate information about which individuals are at risk prevents proper screening and education in lymphoedema risk management strategies. Early diagnosis and intervention can minimize the lymphoedema progression from Stage 1, which is easily reversible, into Stage 2 and Stage 3.

Experts in the field of lymphology generally agree that the initial treatment for lymphoedema should be Complete Decongestive Therapy (CDT)/Complex Lymphoedema Therapy (CLT). Complete Decongestive Therapy (CDT)/Complex Lymphoedema Therapy (CLT) is a two-phase program. The first phase consists of meticulous skin care and treatment of any fungal infections/ulceration of the skin, manual lymphatic drainage, exercises that mimic the pattern of lymphatic drainage appropriate for the individual patient, and compression with multi-layered, short-stretch bandages. Phase 2 focuses on conserving and optimizing the reduction in lymphoedema achieved in phase 1. This is accomplished by patient compliance with a self-care program.

This program consists of the skin care regime adopted for that individual during Phase 1 and attention to risk reduction strategies for the involved limb(s). In addition, compression of the affected areas is achieved by means of low-stretch elastic compression stockings or sleeves (supplemented with nightly compression bandaging instead of stockings/sleeves if needed. Individuals must perform their lymphoedema exercise/self-lymphatic drainage program twice daily for optimal results.

The importance of regular follow-up visits for evaluation of the affected areas including girth/volume measurements, review/modification of self-care program, and fitting/modifying compression stockings/sleeves cannot be underestimated. Individuals with lymphoedema, like diabetes or any other chronic medical condition, deserve to have the appropriate skilled medical and psychological support provided to achieve continued success with their Phase 2 program. Additional intensive CDT/CLT treatment should not be routinely necessary. However, there are situations that exacerbate lymphoedema such as trauma, infection, surgery on or adjacent to, the involved areas. Additional treatment may be warranted if the individual is unable to reduce the exacerbation independently by following their Phase 2 program, supplemented by self-bandaging daily for a short period of time.

Complex Lymphoedema Therapy, as practiced today in the US, was principally introduced, applied, and refined in Germany by the Foldis in the 1980's . This technique, also called Combined Decongestive Physiotherapy (CDP) was modified and supplemented with specific physical therapy exercises by the Casley-Smiths in Australia. They called the technique Complex Physical Therapy (CPT) . Several other authors have reported varying results of CDT with average lymphoedema reductions ranging from 15% to 68.6%

Critics of CDT question whether individuals can continue to maintain their reductions with compliance with their Phase 2 home program without additional intensive Phase 1 type treatment. The goal of this study is to demonstrate that the excellent reductions in lymphoedema and fibrosclerotic changes achieved through a single course of CDT/CLT can be maintained over a 5 year period without further intensive treatment, provided that the individual's medical condition remains stable.

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