Complex Physical Therapy (CPT) is intended as a way to treat and minimise the symptoms of Lymphoedema – a fluid retention disease caused by a compromised lymphatic system. CPT was developed by Emil Vodder in the 1930s, and involves manual manipulation of the lymphatic ducts, compression bandaging, therapeutic exercise and skin care.
Lymphoedema is a condition of localised fluid retention, often in a limb, caused by failures in the lymphatic system. The lymphatic system is the body’s secondary circulatory system that drains and filters the fluid that collects around the cells in the body. The impairment of this system results in swelling, discomfort and loss of function. If Lymphoedema is untreated, it can can progress and be a potentially crippling illness. Edema fluid and protein collect around soft tissue and, without proper drainage, provide a site for possible bacterial infection. It can be caused by both congenital abnormalities, or trauma, such as axillary lymph node dissection during surgery.
Dr. Emil Vodder and his wife Dr. Estrid Vodder were the pioneers of treating Lymphoedema through a speciality medicine called ‘lymphology’. In 1932, they began work on studies of the lymph system, and developed movements intended to stimulate its function. In 1936, the pair introduced this treatment to Paris, and Emil continued work on it until his death in 1986.
Complex Physical Therapy Bandaging is a special wrapping technique designed to encourage lymphatic flow and soften swollen areas affected by Lymphoedema. The bandages themselves are low- or short-stretch, which means they are capable of providing higher tension around the muscles than the long-stretch bandages used to treat sprains. These short-stretch bandages wrap the affected area in several layers, and during exercise they provide increased resistance for the lymph vessels, which in turn promotes the break-down of fluid blockages. The bandages are not only able to reshape the limb, but can also cope with varying limb sizes, even from one area to another.
This treatment is also known as Manual Lymph Drainage, and is performed by Certified Lymphatic Therapists. It is a special form of massage designed to remove the build up of fluids and proteins around the tissue that is symptomatic of Lymphoedema. By opening the areas between affected and unaffected tissue, this treatment aims to create a pathway through which the excess fluid can drain to the rest of the body. The limb itself is massaged in strokes that correspond to the direction of lymphatic flow (toward the body) from the top and moving toward the hand or foot.
People who suffer from Lymphoedema are always at risk of infection of the affected areas, and therefore must always keep the site clean and the skin in the best health possible. Skin problems are known to cause further protein build-ups in the already blocked areas, which can overburden the lymphatic system and exacerbate complications involved in draining the areas. Patients are encouraged to keep the skin of the affected areas supple and moist, and treat any trauma (mosquito bites, sunburn, or abrasions) immediately. The limb should also be dried very carefully. Oil-based cleansers are recommended for cleaning the limbs, as they are less prone to drying the skin than normal soaps.
CTP has a range of exercises patients should perform with the limbs affected by Lymphoedema in order to promote circulation. They are recommended to be used in conjunction with compression bandaging, and should be performed once or twice a day. Many patients do the exercises in a pool, as it helps keep the tissue soft for the duration of the exercise. The exercises have been designed to empty central lymph reservoirs, promote lymphatic function, and mobilise swollen joints while strengthening the limbs.