1 – Combined Physical Therapy (CPT). This method generally consists of a two-stage treatment program: the first phase involves skin care, manual lymphatic drainage, a series of physical exercises, and elastocompression normally applied with multi-layer bandages. The second phase, which must be started as soon as phase 1 is completed with the aim of maintaining and optimizing the results obtained in phase 1, includes skin care, low-grade elastic compression garment (stocking or sleeve), exercises for the functional recovery of the limb and repeated sessions of manual lymphatic drainage, according to the individual cases. Essential conditions for the success of the combined physical protocol are the availability of medical personnel (clinical lymphologists), nursing, and physiotherapists adequately trained on this therapeutic method. Elastic compression, if not properly applied, can be useless and even harmful. For long-term care, it is essential that adequate elastocompressive garments are prescribed (if necessary, also “made to measure” forms) for the maintenance of the results obtained after CPT.
2 – Mechanical lymphatic drainage with intermittent and / or peristaltic-sequential pressure. Mechanical lymphatic drainage usually consists of a program of compressive therapy at low pressures, with multi-layer elastic bandages, and the subsequent application of a compression garment (stocking, sleeve, or pantyhose). Intermittent negative pressure therapy (VACUMED) can be advantageous at the end of the initial treatment cycle with a duration of 1-2 weeks
3 – Manual lymph drainage. It is mostly performed according to the classical methods of the German and Belgian schools. Depending on the case, the different manual lymphatic drainage techniques can be combined. It should not be practiced excessively vigorously in order to avoid possible damage to the lymphatic-lymph node structures.
Specific lymphatic drainage equipment (LPG System) can also be used.