4 common Leg Swelling Conditions (fluid retention) and Their Treatment

Interview with Dr Paul Bell of Osteopathic Centre.

1. Diabetes Swelling the Causes and Treatment

Coach Mike: let’s talk about diabetes and swelling/fluid retention in the legs related to diabetes and the treatment using natural remedies

Dr. Paul: Well, I mean, the big thing obviously, the big problem, if you like, with diabetes is the vascular damage that’s associated with the disease. The side effects of that can be swelling and it can be tissue damage as well, tissue necrosis or death of tissue.

We all see those horror cases with people having to have toes and fingers amputated. That’s a worst-case scenario and it’s quite uncommon but it can happen.
So, the big thing with diabetes is to promote tissue health and the best way to promote tissue health is to maintain the elasticity in the vascular system, in the blood vessels and in the venous vessels and the lymphatic vessels. And a really good way of doing that, actually, is by maintaining movement in the tissues and changing the pressure in the tissues, so you’re changing the pressure flow of the fluids.

From a manual therapy perspective we do that with manual therapy and we do that with massage and those type of approaches. But, if we’re talking about the products that Recovery Systems supply and obviously the intermittent compression is a great adjunct therapy, I think, for that because it can be used regularly and it’s real benefit is that because it’s intermittent compression it’s causing a change in the pressure in the vascular system which has been shown to improve the health of the actual blood vessels. So, it can reduce the risk of tissue damage, I would say.

Coach Mike: some of our products are very portable because we realize many patients need treatment more than one time a day so having something very portable is very convenient for them to take, including a battery version so that they’re able to seek treatment at any time and in any place as well.

Dr Paul: I think that’s a great thing to do. I think it’s a potentially very useful tool to improve tissue health.
As I said, the issue with diabetes obviously, as well as working with your specialist and your doctor and managing your blood sugar levels etcetera, and dealing with your physiology from a medical perspective, is thinking about tissue health and thinking about exercise and movement, thinking about maintaining as good a tissue health as possible, and I think intermittent compression, as I say, is a useful tool to use for that purpose

2. DVT Swelling, the Causes and Treatment

Coach Mike: Yeah, let’s lead in. DVT, leg swelling related to that and the condition of DVT and the different treatment modalities.

Dr. Paul: Well, I mean, let’s just talk a little bit about what DVT is. Most people have heard the term and it’s one of those things that I think creates a sense of fear when people hear about the term DVT, especially when it’s related to” I’ve just being on a flight and have I got a DVT?”
To be fair, one of the early symptoms of DVT can be swelling (fluid retention) in the legs, especially in the ankles and feet.

Having said that, if you get swelling in your ankles and feet after a flight, that’s also just a normal thing because you’ve been less mobile and the effects of altitude on the fluid systems in the body.
But one of the side effects can be DVT, but DVT generally caused by some type of coagulation in the vein, hence the deep-vein thrombosis in the deeper veins.
And that can be, a precursor to that could be injury, it could be trauma or it can be sort of a progressive vascular deterioration or damage. As an example, conditions like diabetes may be one of the risk factors for developing a DVT.

Dr. Paul: And that DVT then causes the blockage or a partial blockage in the vein and that affects how the fluid drains from the, I say ankles and feet because it’s much more common in the lower limb, it can happen in the upper limb but much less commonly.
And then what happens is there’s less capacity for the fluid to move from the lower limbs and it starts to accumulate and you get swelling in the lower limb. The big risk of DVT obviously is if the actual thrombosis separates from the venial wall then it can become an embolism and that’s usually when people have the more severe emergency episodes such as cardio-vascular problems or strokes.

Dr. Paul: So, I mean, the big thing with DVT is prevention. Obviously once you get a DVT there are ways of treating it. You can have specific medications. But if you can prevent that coagulation, prevent that formation of the thrombosis on the venal wall, then you’ve got a much better chance of not developing a DVT.
And ways of doing that, obviously, especially if we’re just talking about flying would be using compression or intermittent compression is even better because it encourages better venal return, venous return, to try and stop or should I say maintain the flow of the venous fluid to reduce the risk of it starting blockages in the veins, basically. I think intermittent compression is a great tool to use as a preventative measure to try stop that. You can also use massage and movement etcetera, which can be very effective.

Dr. Paul: But I think the benefit of having intermittent compression is that you can use it regularly and often without having to visit a clinic or a therapist.

Coach Mike: So, just a quick note on intermittent compression. As you see by the graphics on the screen, we’re squeezing from the foot to the thigh. We’re moving the excess fluid out.
So, not only the squeeze is important but also the release, because we’re returning fresh nutrients back to maintain good, healthy condition. With regards to DVT, we also developed within our products the ability to take them on an aero plane which you mentioned as being a problem area for DVT sufferers.

Dr. Paul: Yeah, I think that’s a great idea Michael, actually to be honest to have that facility because again, that’s prevention which is the more important thing, I reckon.

Coach Mike: Yeah. So, thanks Dr. Paul. This has been a quick talk on DVT, swelling related to DVT, the causes and the treatment modalities. Thank you.

3. Lymphedema Swelling Causes and Treatment

Coach Mike: Swelling related to lymphedema, the cause of it and the treatment modalities.

Dr. Paul: Okay. Well, I mean, there are a number of causes for lymphedema. Obviously, it can happen post-surgery, there are some people who have metabolic disorders that can cause lymphedema, it can be present post-cancer especially if you’ve had sort of the lymph glands removed, that can cause lymphedema, and it can also just be caused by progressive degeneration of the lymphatic system.
So damage to the lymphatic system which is the body’s natural drainage system, if you like. And the side-effects of that normally is swelling. It’s something you’ll see quite common post-breast cancer surgery when people have the lymph nodes removed from their armpit, from their axillar, and that affects how the fluid drainage from the arm and they’ll often have persistent lymphedema in the upper limb ongoing.
The same can happen in the lower limb as well. So that’s the main reasons why lymphedema occurs.

Coach Mike: Okay. So, let’s talk about treatment modalities.

Dr. Paul: From a true perspective, as manual therapists we approach the problem from a lymphatic perspective. So we look at how people breathe, their diaphragmatic tension.
We look at the drainage channels through the open chest, from the arm and through the pelvis from the lower limb. We look at tissue health and joint movement and muscle contraction, basically.
So it’s a combination of manual therapy and exercise and lymphatic massage obviously can be very effective which is, obviously if we’re talking about the Recovery Systems that sell the intermittent compression can be, I think, a reasonable replacement for massage.
Especially for lymphedema, because this is an on-going condition that needs recurring treatment, often daily and I think something like intermittent compression can provide that sort of ease of use on a daily.

Coach Mike: Cool. Let’s talk about frequency of use, because I’m sure there’s no hard and fast rule of thumb. Would that be correct?

Dr. Paul: Yeah. I mean, from a research perspective it’s one of those things that hasn’t been investigated enough and there isn’t enough evidence for, but generally with lymphedema everything you can do to help a lymphatic system cope with the problem is going to be beneficial.
So that means recurring treatments. Intermittent compression you could probably do it at least a couple of times a day would be beneficial. That should be then coincided with movement and other types of movement therapy to try and health the body’s lymphatic system cope better and drain better.
But I would say probably the big benefit of intermittent compression compared to perhaps going to see a lymphatic massage therapist is the ease of use. You can use it two to three times a day without any real inconvenience.

4. Pregnancy Swelling Causes and Treatment

Coach Mike: Let’s start the ball rolling with pregnancy swelling related conditions and their treatment.

Dr. Paul: Okay. So, I mean, let’s just talk a little bit about why we get swelling when we’re pregnant, I suppose. Perhaps it’s a subject I’ll never be an expert on as a man.

Dr. Paul: But from a physiological perspective, you have to look at why women get swelling. The proper term if you like is edema, which edema describes excess fluid in the tissues. It’s a physiological reaction to being pregnant so it’s a normal and natural thing that happens actually.

There’s a number of reasons why it happens. Hormones have an effect, that’s one of the reasons, and the body is trying to create a state where the body can accommodate the growing child in the womb, the growing baby. Secondly, you do have changes specifically in the venous flow and the lymphatic flow and the lymphatics are our drainage systems.
The lymphatics remove all the excess fluids from the extremities of our body, from our legs and arms, move them back to our central core of the body to be reintegrated back into the vascular system, into the blood really.
What happens is during the pregnancy with these changes in posture and the space-occupying effects of the baby is that the lymphatic system is compromised slightly. So it’s not as effective and it’s not difficult for the drainage system to work and the fluids to move back to the center of the body, basically. So that’s generally why edema happens during pregnancy.

So, if we look at it from an osteopathic perspective, what we are trying to do is improve lymphatic drainage really. To do that there are certain areas in the body, especially around the pelvis and the pectoral region, the chest, and the diaphragm that we can treat to reduce tension and hopefully allow the drainage system to function more efficiently.

So that’s where we’re coming from, manual therapy perspective. To supplement that, I’m a big believer in massage. I think massage can be very effective. I think that’s one of the benefits so the compression systems such as Recovery Systems that you sell, is that is can replace hands-on massage to some degree because firstly, it’s easier to do.
You can do it at home, you don’t have to go out to a clinic, which is very relevant in present times. Secondly, you can use it more. So, you can have, if you’d like, the equivalent of a massage in the legs without having to go and see a therapist.
So, it can be a good adjunct, I think, to the types of intervention, along with movement and exercise which I think is really important during the pregnancy, if it’s safe to do so.

Coach Mike: So, for our listeners, let’s just take a moment to describe what intermittent compression looks like. Essentially, it’s squeezing from the foot to the thigh and moving the excess fluid up into the lymphatic area where the extraction takes place.

So, quite some relief from a swelling point of view and, as you quite rightly pointed out, it’s a very convenient mode of treatment that can be done at home and that can be done multiple times a day. So, there’s a little snapshot on pregnancy related swelling conditions, the cause and the treatment. So, thank you Dr. Paul.