In my career as a lymphedema therapist, we have reversed our advice on exercise from 'reduce what you do' to 'do more, carefully but still more'. For many years we warned people away from experimental surgical options, but many are not experimental anymore. So is it time to reconsider our advice on compression too?
Compression therapies have been core to good lymphedema management for over 50 years and I really wish they were more accessible and acceptable for those who need it. So much lymphoedema can be prevented or significantly improved with appropriate compression therapy. But compression is not accessible to all, for myriad reasons.
In hard to compress areas like breast, face and abdomen, Lymph Taping has offered an effective option for many, but the evidence on whether lymph tapes are a viable alternative to arm compression is mixed. The most recent systematic review by Kasarawara et al (2018) concluded that
[kinesiology tape] was effective on postmastectomy lymphedema related to breast cancer; however, it is not more efficient than other treatments'.
And now there is another study to add to the discussion. Conducted in a hospital setting in Spain, the authors found that the tape intervention delivered greater change in relative arm volume* than custom made class II compression sleeves. After taping, relative volume reduced 5.7% vs 3.4% reduction with flat knit compression (P < 0.001). There were also superior benefits in ROM and taping was reported by participants as more comfortable than the garment. (Otero et al, 2019).
The reductions for both interventions were very small and may not be clinically relevant, but there are a few issues and things to keep in mind when interpreting these results. Firstly, it was a cross over design which means that all participants received both interventions, half had taping first and half had compression first with a 'wash out' period of 4 weeks before each intervention. The wash out was described as '...patients were instructed to comply with selfcare procedures for lymphedema (skin care and exercise)', but everyone was already using class II flat knit compression before entering the study, and we are not told if they continued to use these during the washout weeks. We can possibly assume they did as it would seem unethical to ask anyone affected by lymphoedema to stop performing self-management.
So the fact that flat knit, class II compression was one of the interventions makes me feel more like they compared taping to a new, custom made garment. And if they were in class II sleeves already, could either group be expected to make large volume reductions? It would have been good to have had the raw circumference data available too to help get a better idea of what the interventions actually achieved. And finally, as the authors identified, it would have been good to know if there were different results in arms at stage 2a and 2b lymphoedema. Also during taping there was weekly contact with the therapist but the therapist/client interaction is not considered or discussed.
This is possibly the first trial to use the taping pattern developed by our own Joyce Bosman (and colleagues).
Could the inclusion of the waving equidistant tapes over a large area of unaffected skin account for the better results observed during the taping weeks?
Neither group received MLD, so the MLD-like action of the tapes might account for the added volume reduction during the taped weeks.
So can we say that lymph taping can replace a sleeve now? Well this is lymphoedema, so of course it's not as simple as that. To apply this new information clinically we need to weigh up things like the ongoing cost, and an economic comparison in this study would have been informative. For the small advantage over the sleeve that was found, 20% of the participants reported skin peeling during the taping week whereas no adverse events were recorded with the sleeve. The authors themselves recommend only short term use of the tape due to the potential for skin complications.
In deciding what is appropriate for each client we must always factor in their uniques circumstance, and I believe in most cases we will continue to recommend flat knit compression as a mainstay of lymphedema self-maintenance. One of the best uses I see for the tape is to extend the benefits of the sleeve by adding those long waving tapes into the unaffected area. This introduces an element of continuous 'MLD-like' movement in the skin which should improve the effectiveness of the sleeve. I'd love to see a study measuring this vs the sleeve alone.
This most recent study adds to a growing body of evidence for lymph taping as a valuable adjunct in lymphoedema management. For an increasing number of people affected by lymphedema lymph taping is providing a much need option to nothing.
Lymph taping continues to develop in style and effectiveness and I'm sure the evidence for it use in lymphatic therapies will continue to grow.
If you haven't taken the course yet you can read more at www.movinglymph.com.au
* Relative volume change was calculated as ((Affected arm at time 2/Unaffected arm at time1)/(Unaffected arm at time 2/Affected arm at time1)) − 1).