0
Latent stage
No visible swelling
Lymph flow is already impaired, but there is no visible swelling yet. There may be a feeling of heaviness.
Lymphoedema · MLD/CDT · Tseri
Clinical Lymphatic Drainage (MLD) and Lymphoedema Treatment (CDT)
Specialised, evidence-based physiotherapy for lymphoedema and persistent swelling. Not a wellness massage: assessment, measurements and a programme based on international guidelines.
- Certified MLD/CDT (Vodder)
- GESY-registered clinic
- Strovolou 51, Tseri
01 · What it is
What lymphoedema and lymphatic drainage are
An arm, a leg or another part of the body that swells, feels heavy and does not settle with rest is not just a nuisance. It is a clinical problem that, without proper management, tends to get worse over time.
The lymphatic system is the “drainage network” of the body’s tissues: it collects the fluid that leaks out of the blood vessels, together with proteins, cell debris and immune cells, and returns it to the bloodstream. It has no “heart” of its own: lymph moves thanks to the rhythmic contractions of the lymph vessels, muscle contraction during movement and breathing, and it is filtered through the lymph nodes.
Lymphoedema develops when the lymphatic system can no longer clear the fluid from the tissues: when lymph vessels or nodes have been removed or damaged (for example by surgery or radiotherapy) or did not develop properly from birth. The trapped fluid is rich in protein and, over time, hardens the tissues (fibrosis) and increases fatty tissue, while the skin becomes more prone to infections (cellulitis, erysipelas). In the early stages, swelling is easier to reverse: that is why early assessment makes the difference.
Clinical lymphatic drainage (MLD) is not a massage
It is a specialised hands-on technique: gentle, rhythmic movements that stretch the skin with a specific direction, pressure and rhythm, following the anatomy of the lymph vessels. The central areas (neck, trunk, healthy lymph nodes) are prepared first to “open the way” for the fluid, and lymph is then directed through alternative pathways towards healthy lymphatic areas. The pressure is deliberately light: the initial lymph vessels lie just under the skin, and vigorous massage can even damage them.
02 · The treatment
The components of Complete Decongestive Therapy (CDT)
Complete Decongestive Therapy (CDT) is the internationally established conservative treatment for lymphoedema. Lymphatic drainage is one of its core components, not the only one.
Lymphatic drainage (MLD)
Moving lymph with specialised techniques, which relieves pain and tissue tightness. It is especially valuable where compression is difficult: the chest, trunk, head and neck.
Component 1Multi-layer bandaging
Short-stretch bandages over protective and padding layers. Low pressure at rest, high pressure during movement: it holds the gains of each session and softens hardened tissue. Applied only by a trained therapist.
The cornerstoneCompression garments
For the maintenance phase. We choose the type (circular or flat knit, ready-made or made to measure) and measure at the right time, once the volume has stabilised, working with your doctor on the prescription.
Maintenance phaseDecongestive exercises
In the intensive phase they are done with the bandages on, so that every muscle contraction acts as a pump for the lymph. Properly supervised exercise is safe and beneficial for people with lymphoedema.
The muscle pumpSkin and nail care
A limb with lymphoedema defends itself less well against germs: a scratch, an insect bite or a burn can lead to infection. Daily hygiene, moisturising and protection from injury, sun and insect bites.
Preventing infectionSelf-care training
Self-drainage (self-MLD), self-bandaging where appropriate, an exercise plan and warning signs. The result lasts only when you know what to do every day.
Independence03 · Clinical or cosmetic?
Clinical lymphatic drainage or cosmetic massage?
Both have their place. But when swelling is a medical problem, it needs clinical treatment.
✓ Clinical MLD / CDT
- Who: a registered physiotherapist specialised in lymphoedema.
- Purpose: treating abnormal swelling and preventing it from getting worse.
- Before starting: history, clinical examination, measurements, staging and a check for contraindications.
- Content: MLD, compression, exercise, skin care and education.
- Progress: recorded measurements in every phase.
Cosmetic lymphatic massage
- Who: a beauty or wellness professional.
- Purpose: relaxation, wellbeing, a cosmetic result.
- Before starting: usually no clinical assessment.
- Content: massage.
- Progress: how it feels.
04 · Assessment
Assessment and staging
We always start with a full assessment: history (surgery, cancer treatment, medication, other conditions, previous infections), clinical examination (skin and tissues, pitting oedema, Stemmer sign, fibrosis, scars), measurements, and a safety check in cooperation with your doctor. Swelling is staged according to the International Society of Lymphology (ISL).
I
Early stage
Goes down when the limb is raised
Swelling that subsides when the limb is elevated.
II
Established stage
Does not go down when raised
Swelling persists despite elevation, and the tissues start to harden.
III
Advanced stage
Marked swelling
Pronounced swelling, hardened tissue and skin changes.
Progress in numbers
Circumference measurements at fixed points on both limbs, with the volume calculated (truncated cone method), before, during and after treatment.
Staging according to the 2023 Consensus Document of the International Society of Lymphology (ISL).
05 · When it helps
When it is indicated
CDT is used for lymphoedema of any cause and, suitably adapted, for other chronic or post-operative swelling. In every case, a medical diagnosis comes first.
Secondary lymphoedema
The most common form. It appears after breast cancer surgery with removal of armpit lymph nodes, removal of lymph nodes in the groin or pelvis, radiotherapy or head and neck cancer treatment, or after serious injury and repeated infections. It can appear months or even years later.
Most commonPrimary lymphoedema
Caused by the lymphatic system not developing properly from birth. It can show at birth, in adolescence or later, most often in the legs. The aim is long-term control of the swelling, with the emphasis on self-care.
Present from birthPost-operative and post-traumatic swelling
After plastic surgery (e.g. liposuction, tummy tuck), always following your surgeon’s protocol, after joint replacement or fractures, and in sports injuries with persistent swelling. Here MLD is complementary: it does not replace therapeutic exercise.
ComplementaryLipoedema
A chronic condition of fatty tissue, mainly in women, with disproportionate fat on the legs, pain on pressure and easy bruising. Conservative treatment does not “dissolve” the fat: it targets pain, heaviness and fatigue. MLD helps most when swelling is also present.
Pain and heavinessChronic venous insufficiency
When the veins do not return blood efficiently, the lymphatic system becomes overloaded. Compression is the basis of management, with MLD and calf-pump exercise as complements. A vascular assessment comes first.
After vascular assessmentMonitoring for high-risk patients
Before or right after breast surgery with lymph node removal: baseline measurements of both arms, check-ups usually every three months in the first year, and treatment at the first measurable increase, when lymphoedema is easier to manage.
Early detectionWhen treatment is not given, or needs medical approval first
- Acute skin infection (e.g. erysipelas or cellulitis), especially with fever.
- Recent or suspected deep vein thrombosis.
- Uncontrolled heart failure.
- Severe peripheral arterial disease (for compression).
- Active cancer: treatment is tailored in agreement with your oncologist.
- Sudden swelling with pain, redness, warmth or fever needs urgent medical assessment, not physiotherapy.
06 · The phases
The two phases of treatment
Lymphoedema treatment runs in two phases, each with its own goal.
01
Usually a few weeks
Intensive (decongestive) phase
Frequent, ideally daily, sessions: MLD, bandages left on until the next session, exercise and skin care. The goal is maximum volume reduction and softer tissue, until the volume stabilises.
02
Long term
Maintenance phase
Compression garment, self-care, exercise, periodic re-assessments and measurements, with infrequent visits. The goal is to keep and improve the result.
Realistic expectations
Lymphoedema is usually a chronic condition. With the right treatment and self-care, the volume can be reduced significantly and kept under control.
We adjust the frequency and length of sessions to the stage, the cause and your daily life.
07 · Why us
Why choose AlexPhysio
At AlexPhysio, swelling treatment follows the same standards as all our clinical work: evidence, safety, measurement.
Certified MLD/CDT therapist
Lymphatic drainage and bandaging are carried out by a clinic physiotherapist who is a certified MLD/CDT therapist in the Dr. Vodder method: 4 levels of training (Basic, Therapy I, II and III, 20 days) and a final certification exam (Epimorfosis, under the auspices of O.Ed.E.M.A. Academy).
Vodder method · CertifiedEvidence-based practice
Our protocols are based on the guidelines of the International Society of Lymphology (ISL). We tell you honestly what each treatment can achieve, and what it cannot.
ISLMeasurable results
We measure before, during and after treatment. You see your progress in numbers.
MeasurementsA strictly clinical setting
Registered physiotherapists, a contraindication check before every start, and cooperation with your doctor.
SafetyEverything under one roof
Assessment, MLD, bandaging, garments, exercise and education. After breast surgery, we combine lymphoedema treatment with restoring shoulder mobility, another of our specialist areas.
Complete careYour independence is the goal
We give you the tools to keep the result in daily life, with our support at periodic check-ups. What counts is your quality of life in the long run.
Self-care08 · GESY
Lymphatic drainage with GESY
We are a GESY-registered clinic. With a referral from your doctor, physiotherapy is covered. Cover depends on the diagnosis on your referral and on the sessions you have already used this year.
12sessions
Sessions a year
For adults, GESY covers up to 12 physiotherapy sessions a year. Sessions you have already had this year for another problem count too.
45minutes
Minutes each
Each GESY physiotherapy session lasts 45 minutes.
€10per session
Co-payment
What you pay for each GESY session.
What this means for your treatment
The intensive phase needs frequent, ideally daily, sessions, and the maintenance phase needs periodic check-ups. So GESY sessions may not cover the whole programme.
A written plan before we start
After the assessment you get a written plan with the estimated number of sessions, what GESY covers and the cost of anything extra. No surprises.
09 · FAQ
What our patients ask
Do I need a referral from a doctor?
Treating lymphoedema or other abnormal swelling needs a medical diagnosis, so that other causes can be ruled out. If you already have a diagnosis, bring it with you; if not, we will guide you.
Who carries out the treatment?
A clinic physiotherapist who is a certified MLD/CDT therapist in the Dr. Vodder method. She has completed all 4 levels of training (Basic, Therapy I, II and III, 20 days in total) and the final certification exam, under the auspices of O.Ed.E.M.A. Academy.
Is treatment covered by GESY?
Yes, with a referral. For adults, GESY covers up to 12 physiotherapy sessions of 45 minutes a year, with a €10 co-payment per session. Cover depends on the diagnosis on your referral and on the sessions you have already used this year. Before we start, we tell you clearly what is covered and what it costs.
How many sessions will I need?
It depends on the stage and cause of the swelling. The intensive phase needs frequent sessions until the volume stabilises, followed by occasional check-ups. After the assessment you will have a written plan with the estimated number of sessions and the cost.
Does lymphatic drainage hurt?
No. MLD is gentle and most patients find it relaxing. Bandaging applies noticeable pressure but should not hurt; if it does, it is adjusted straight away.
Can I have treatment if I have or had cancer?
Yes. CDT is routinely used for patients after cancer treatment. If the disease is active, treatment is tailored in agreement with your oncologist.
Can lymphoedema be cured for good?
Lymphoedema is usually a chronic condition. With the right treatment and self-care, the volume can be reduced significantly and kept under control. Surgical options exist for selected patients; if you may be a candidate, we will refer you to a specialist surgeon.
How often should a compression garment be replaced?
With daily wear and washing, a garment gradually loses its elasticity and usually needs replacing about every six months. You need at least two: one to wear and one to wash. We check the fit at every re-assessment.
What is the difference between clinical lymphatic drainage and cosmetic lymphatic massage?
Clinical MLD is carried out by a registered physiotherapist, after an assessment and measurements, to treat abnormal swelling, as part of a programme with compression and exercise. Cosmetic lymphatic massage aims at relaxation and wellbeing. Both have their place, but when swelling is a medical problem it needs clinical treatment.
Book an assessment
Start with a full assessment
The first step is a full assessment. You will leave knowing the stage of your swelling, what can realistically be achieved and the proposed plan.
For doctors
We accept referrals and update the referring doctor in writing on the assessment and the patient’s progress, at alexphysioltd@gmail.com.
After breast surgery
We combine lymphoedema treatment with restoring shoulder mobility.
GESY-registered
Up to 12 sessions of 45 minutes a year with a referral, and a written plan for anything extra.
Team of 8 physiotherapists in Tseri
Strovolou 51, close to Lakatamia, Strovolos, Dali and Latsia.
AlexPhysio
Phone96 666 081
WhatsAppSend a message
ParkingGround floor, street-level entrance. Parking around the clinic, underground or at ParkinTown (give reception your registration number).
HoursMon, Thu: 09:15–19:15
Tue: 09:15–18:30
Wed: 09:00–18:30
Fri: 09:15–17:00
Tue: 09:15–18:30
Wed: 09:00–18:30
Fri: 09:15–17:00
Reviews★ 5.0 on Google
Bring to your assessment
- Medical reports (surgery, histology, imaging) and your list of medicines
- Your referral, if you have one
- Any compression garments you already use