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Lymphoedema is a condition characterised by swelling, that can affect any body parts, due to the accumulation of lymph fluid. This can happen when the lymphatic system, which helps maintain fluid balance and supports the immune system, is not functioning properly.
There are a series of reasons why someone can develop Lymphoedema. This presentation could have a genetic component, where the lymphatic system didn’t form properly. That’s what we refer to as Primary Lymphoedema, a mono-lateral swelling (at the leg, most often) that start distal and moves proximally (it start lower and move up).
On the other hand, infections, surgeries, specifically cancer removal, and related radiotherapy can lead to the formation of Lymphoedema and in this case, we would call it a Secondary Lymphoedema compared to the primary one, the swelling would start proximal and move distally (start at upper move lower). That said, any oedema that lasts longer than 12 months can be classified as Lymphoedema.
To know more about how Giovanni can assist you with your Lymphoedema, book a 15 minutes free phone consultation.
The skin in a Lymphoedema has several distinguished characteristics, and based on the typology, primary or secondary, and the time passed since the initial swelling, they may vary case by case.
The skin would initially get rigid, and an accumulation of fibery tissue could occur between the skin and the muscle layer. Along with the rigidity of the skin, there are the dangers of abrasions, which, given the rich protein fluid sitting in the edema, could get easily infected.
When the presentation reaches more advanced stages, and this is again, a case-by-case presentation, we can observe Hyperkeratosis, Epidermal papillomatosis and hyperplasia or Telangiectasia. In some cases, before any hands-on therapy and or compression can be applied, antibiotic therapy has to be prioritised, especially if infections are already manifesting.
In order to differentiate the different presentations of a Lymphoedema, here is a simplification of the different stages:
Stage 0: No visible swelling, but abnormal lymphatic transport detected (e.g., via lymphoscintigraphy).
Stage 1: Early edema that improves with limb elevation.
Stage 2: Persistent pitting edema that does not resolve with elevation.
Stage 3: Fibroadipose tissue deposition and skin changes occur.
At Melbourne Massage and Treatment, in Fitzroy North, Giovanni would ensure the best of care for his patients by offering tailored treatment that best metch each individual Lymphodema presentation. Giovanni did his training with the Vodder Academy, the world leader institute for lymphatic drainage and CDT therapy.
Lymphoedema management can be divided into acute care and extended care.
For acute care, Giovanni refers to swelling reduction, which would be achieved initially by Manual Lymphatic Drainage (MLD) treatment and Combine Decongestive Therapy (CDT), movement therapy and breathing exercises.
MLD is a hands-on treatment that can boost the movement of fluid, and CDT is a bandaging technique that would ensure constant pressure in the limb/s affected. To obtain the quickest limb size reduction, a series of daily sessions would be needed. You will receive guidance about the treatment plan along your first face to face visit from a Certified Lymphoedema Therapist. In between the visits, you will be instructed by Giovanni on movement therapy and breathing exercises that you can do to keep improving the presentation on your own time.
Past the severe swelling, we step into extended care, which aims to minimize the risk of the return of swelling. Part of the extended care includes, still movement therapy, tailored diet, skincare, and garment wear with occasional MLD session and CDT bandaging. Along with those, Giovanni can keep assist you with MLD, CDT, movement therapy, garment wear recommendations, and skin care. Still, he will gladly refer you elsewhere for services that step out of his duties, such as diet advice.
When a lymphoedema is present, as already mentioned above, we have to be aware of the risk related to it, such as ulcers, infections, or underlying causes. The 15 min free phone call is an opportunity to start knowing how Giovanni, one of our experienced lymphoedema specialists can help you, based on your personal and close family medical history, and this time would allow you and Giovanni to understand if a referral from your GP or other practitioner is needed to proceed with the treatment, or if other interventions need to be prioritized before any Manual Lymphatic Drainage, or Bandaging are applicable.
The initial face-to-face consultation for Lymphodema treatment at Melbourne Massage and Treatment is 90 minutes.
This appointment would give you and Giovanni the opportunity to revise your personal and close family medical history to evaluate in more detail the treatment plan needed to proceed with the Lymphoedema management.
Once the revised medical history is completed, objective measurement follows to draw a baseline for your presentation.
Then it is time to pass to hands-on treatment with Manual Lymphatic Drainage, where needed and possible mobilization, to improve joint mobility, which is essential to keep you mobile and functioning.
At Melbourne Massage and Treatment, you can get a private health insurance rebate for Remedial Massage and Myotherapy, which would also cover your Lymphoedema Therapy. The rebate percentage may vary based on your contract with your private health insurance. If your’re looking for a Lymphoedema Specialist in Melbourne, Giovanni offers expert care tailored to your conditon. He also offers services as an unregistered NDSI provider, so you can claim Giovanni’s services if you are on an NDSI plan.
To overcome the lymphoedema presentation, it is essential to stimulate that part of the lymphatic system that is still intact and operative. Indeed, Lymphoedema is a condition that is present due to a failure of the lymphatic system.
Therefore, the first step in Lymphoedema therapy is a detailed Clinical History:
In case of an initial consultation, measurements of the limb would be taken.
After a detailed clinical history, we can recommend Lymphoedema management with MLD and CDT.
These guides are designed as an educational aid based on experience, with no evidence in the literature.
Once you submit the answer, you will receive a copy of the questionnaire within 24 hours for your records.
If you have any questions, please get in touch with Giovanni now.
Giovanni is the best of the best! I’ve had training in the lymphoedema field myself, it’s very technical and really an emerging field.
Because of this, there aren’t many knowledgeable practitioners. I’ve tried quite a few.
Apart from being knowledgeable in Lymphoedema, he has a great skill set in lipoedema, another field that isn’t well understood and has a terrible impact on patients' lives.
I wholeheartedly recommend him!
Thanks, Giovanni, for your knowledge, your incredible support of your patients, and the passion you have for helping people out.
Giovanni is the best of the best! I’ve had training in the lymphoedema field myself, it’s very technical and really an emerging field.
Because of this, there aren’t many knowledgeable practitioners. I’ve tried quite a few.
Apart from being knowledgeable in Lymphoedema, he has a great skill set in lipoedema, another field that isn’t well understood and has a terrible impact on patients' lives.
I wholeheartedly recommend him!
Thanks, Giovanni, for your knowledge, your incredible support of your patients, and the passion you have for helping people out.
Giovanni’s experience with lymphatic drainage started back in November 2021, when he completed a certificate in Applied MLD, which is a Vodder Academy certification, where he learned to work with patients presenting with an intact lymphatic system.
In October 2024, after completing the BCHs in Clinical Myotherapy, he undertook Certificate IV with the Vodder Academy for Lymphoedema and Lipoedema Management. During this course, Giovanni learned how to work with patients with a damaged lymphatic system, providing MLD and CDT therapy.
Noticeable puffiness in the arms, legs, or other affected areas. This swelling may cause clothing, shoes, or jewellery to feel tighter than usual.
A persistent sensation of heaviness or tightness in the affected limb, which can be uncomfortable and restrictive.
General discomfort or aching in the swollen area, which may worsen with prolonged use or at the end of the day.
Difficulty moving the affected limb fully, leading to limitations in daily activities.
The skin over the swollen area may feel tight, and in some cases, may become thicker or develop a leathery texture.
Pressing on the swollen area may leave an indentation, indicating fluid accumulation.
The affected area may be more susceptible to infections, such as cellulitis, due to impaired lymphatic drainage.
It’s important to note that these symptoms can vary in intensity and may develop gradually. Early detection and intervention are key to managing lymphoedema effectively.
If you notice any of these signs, consult a healthcare professional for assessment and to discuss appropriate management strategies.
Lymph fluid doesn’t have a pump like blood does. Instead, it relies on the movement of muscles and breathing to help it circulate. Exercise supports this movement, encouraging lymph drainage and reducing stagnation. Lymphoedema specialists often recommend targeted physical activity as part of an individual’s care plan to promote circulation and support long-term management. It also strengthens the surrounding muscles, supports joint mobility, and can improve overall well-being.
The best exercises for lymphoedema are low-impact and promote muscle contraction without overloading the limb. These include:
Diaphragmatic breathing encourages lymph flow from the abdomen and chest.
Improve mobility and relieve tightness, especially after surgery or radiation.
When introduced progressively, resistance exercises help tone muscles and support the lymphatic system.
Walking, cycling, and swimming are all effective in boosting circulation and lymph flow.
The gentle pressure of water can support the limb and promote lymph movement, making pool-based exercise an excellent choice.
Engaging in regular, controlled exercise not only helps with lymph fluid management but also reduces the risk of complications, supports mental health, and fosters independence in daily activities. At Melbourne Massage Treatment, we believe exercise is most effective when guided by a certified lymphoedema therapist and combined with other evidence-based therapies. When integrated with treatments like manual lymphatic drainage, compression therapy, and proper skin care, exercise becomes an essential pillar of holistic lymphoedema care.
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Lymphoedema can be caused by a genetic presentation (Primary Lymphoedema), where a person was born with a weak or not intact lymphatic system, or due to external causes (Secondary Lymphoedema), such as cancer surgery, severe skin infections, and severe physical accidents, which may damage the lymphatic system's functionality.
Due to other health factors, the life expectancy of someone with Lymphoedema can vary. Lymphoedema, on its own, if managed and kept under control, is not a cause of premature death. On the other hand, if left untreated, it can cause other conditions, such as severe infections, that can lead to severe illness and deteriorate an individual's health condition until death.
No, Lymphoedema is a chronic condition that cannot be reversed so far. It can be managed quite well if taken in its early stage and kept under control, but it cannot be completely reversed. Part of the management process can involve MLD and CDT therapy, but in some cases, also surgery.
Lymphoedema in its initial phase, if not coexisting with other conditions (such as Lipedema, skin infections, or others) is not a painful presentation. What you may experience in its initial phase is swelling, a feeling of heaviness in the limb and skin stretch. Some of the symptoms also include a change in temperature or sensation on the limb and lack of mobility of the joint/s affected.
Lymphoma and Lymphoedema are two separate conditions that can trigger the other. Specifically, Lymphoma is a cancer that affects the white cells of your immune system, called Lymphocytes, and if the cancer spreads too much, it can block the Lymphatic System. When the lymphatic system is blocked or damaged, Secondary Lymphoedema can develop.
Lymphoedema is diagnosed via an analysis of your clinical history and by excluding other conditions or factors that can lead to swelling of your limbs, such as DVT, varicose veins, or side effects from medications. A swelling that lasts for more than 12 months and has no other determined causations is considered Lymphoedema.
In a Lymphoedema clinic, we use tests like the Stemmer's sign and Pitting test as part of the diagnosis. The Stemmer sign consists of trying to pick the skin between the finger of the toes insertion. A positive test consists of the inability to grab the skin between the fingers of the therapist due to the patient skin being puffy and stretched out. The pitting test, as the name suggests, is about pressing on the affected area with the thumb, holding the pressure for about 60 seconds and seeing if an indentation is left behind. A positive test is due to an indentation left behind, with the skin taking minutes to recoil to the original status. Changes in the colour of the test site are also part of the evaluation.
A lymphoedema presentation is better addressed as soon as possible to avoid complications and side effects. At Melbourne Massage and Treatment we opt for Manual Lymphatic Drainage (MLD) and Combine Decongestive Therapy (CDT) as Lymphoedema treatment options. MLD is a gentle non invasive manual technique that aim to boost your lymphatic system, and CDT is the application of bandaging to the limb to compress the affected area and keep stimulating the flow of lymphatic liquid away from the limb. Other treatment options include laser therapy if there is a need to break down fibrosis.