Do your legs, arms, feet and hands often feel stiff?   Do they appear puffy/ swollen?  If so, it may be that you have impaired lymph flow, or lymphedema.  In this article, we’ll discuss the function of the lymphatic system, and what you can do if you have impaired lymph flow.

What are the parts of the lymphatic system?

The lymphatic system is a vital part of the body’s immune system and plays a crucial role in maintaining fluid balance, removing waste products, and fighting infections. It consists of a network of lymphatic vessels that run alongside veins and arteries and form connections at the arteriole/ venule level; lymph nodes, lymphoid organs (spleen, tonsils, thymus, appendix), and lymphatic fluid called lymph.  Unlike the circulatory system that has the heart to move blood through it, the lymph has no such organ.  Lymph fluid circulates slower than blood and is driven primarily via skeletal muscle contraction, the movements of breathing, and slight contraction of smooth muscle in vessel walls.

Here’s a simplified overview of how the lymphatic system works:

Lymphatic vessels: Lymphatic vessels are thin-walled, one-way channels (made possible by specialized valves that allow flow only in one direction) that carry lymph throughout the body. They are similar to blood vessels but have larger gaps between their cells, allowing fluids, waste products, and immune cells to enter (see diagram below):

Lymphatic vessels connect with arteries and veins to filter out excess fluids and waste

Interstitial fluid collection: Interstitial fluid is a clear fluid that surrounds the cells in body tissues. It is derived from blood plasma that leaks out of capillaries. The lymphatic vessels collect this excess fluid, along with proteins, cellular waste, and pathogens, preventing its accumulation and maintaining tissue fluid balance.  It’s important to note that heavy exercise, such as long distance running, increases the pressure in the circulatory system and also increases heart rate and vessel contraction/dilation movement, which can cause more fluids to build up in the interstitial space along with metabolic products of muscle cell metabolism; i.e. lactic acid and carbon dioxide.  So, the lymphatic system is very active during and following intense exercise.

Lymph transport: The lymphatic vessels carry the collected fluid, now called lymph, through a network of progressively larger vessels. Smooth muscle contractions in the vessel walls and one-way valves help propel lymph toward the chest where the filtered lymph fluid re-enters the circulatory system at the thoracic ducts.

Lymph nodes: Along the lymphatic vessels, there are small, bean-shaped structures called lymph nodes. Lymph nodes are highly concentrated with immune cells, such as lymphocytes and macrophages, which help filter and cleanse the lymph of pathogens, foreign substances, and damaged cells. Lymph nodes play a crucial role in immune response and can become swollen and tender when fighting infections.  They are more concentrated in the neck, axilla (armpit region), and inguinal (groin area) regions, although they are present throughout all parts of the body.  Lymph nodes are easily palpated through the skin as the lymph vessels are mostly just under the skin.

Lymphoid organs: In addition to lymph nodes, other lymphoid organs, such as the spleen, thymus, appendix and tonsils, are part of the lymphatic system. These organs house immune cells and contribute to the production and maturation of lymphocytes, which are key players in the immune response.

Lymphatic fluid return: Ultimately, the lymphatic vessels return the filtered lymph back into the bloodstream, near the heart, through the thoracic duct (left side of the body) and the right lymphatic duct (right side of the body). The lymph rejoins the blood circulation, and any remaining waste products are eliminated through the kidneys and other excretory organs.

The lymphatic system acts as a drainage and defense system, collecting excess fluid and waste, filtering it, and helping to mount immune responses against infections. By doing so, it helps maintain tissue health, fluid balance, and overall immune function in the body.

What happens if your lymph system is impaired?

Lymphatic insufficiency, also known as lymphedema, occurs when there is a disruption or impairment in the normal functioning of the lymphatic system. This condition can result in a buildup of lymphatic fluid in the affected area, leading to swelling, tissue damage, and increased susceptibility to infections.

Some common causes of lymphedema are:

Surgery: Lymphedema can occur as a complication of surgical procedures that involve the removal or damage to lymph nodes or lymphatic vessels. This is often seen in cancer surgeries, such as breast cancer or melanoma surgeries, where lymph nodes are removed or radiation therapy is administered to the lymphatic area.  Some destruction of adjacent lymph vessels occurs, and flow is impaired.

Radiation therapy: Radiation treatment for cancer can damage lymph nodes and lymphatic vessels, leading to lymphedema. The risk is higher when radiation is directed towards the lymphatic drainage pathways.

Infection: Certain infections can cause inflammation and damage to the lymphatic vessels, resulting in lymphedema. Examples include filariasis (a parasitic infection transmitted by mosquitoes), cellulitis (bacterial skin infection), and lymphangitis (inflammation of the lymphatic vessels).

Primary lymphedema: In some cases, lymphedema can be present at birth or develop later in life due to congenital abnormalities or genetic factors that affect the development or function of the lymphatic system. This is known as primary lymphedema.

Secondary lymphedema: Secondary lymphedema occurs as a result of an acquired condition or event that damages the lymphatic system. Common causes include trauma, burns, severe obesity, chronic venous insufficiency, or surgical procedures unrelated to cancer.

Cancer: Lymphedema can also occur as a result of cancer itself. Tumors can obstruct or invade the lymphatic vessels, impairing lymphatic flow and causing fluid buildup.

It’s important to note that lymphedema can develop immediately after an event (e.g., surgery or radiation) or may manifest months or years later. The severity and progression of lymphedema can vary from person to person.

Here’s what happens in the body during lymphatic insufficiency:

1. Fluid buildup and swelling: The impaired drainage causes a buildup of lymphatic fluid in the affected area. Initially, this may lead to mild swelling, which tends to worsen over time if left untreated. The swelling is often persistent and may involve the limbs, most commonly the arms or legs. In some cases, lymphedema can affect other areas of the body, such as the face, neck, or genitals.
2. Tissue changes: Prolonged accumulation of lymphatic fluid results in changes to the affected tissues. The tissues become fibrotic and less elastic, causing them to harden and thicken.  Why this happens isn’t clear, but if interstitial fluid that needs to be moved out lingers around instead of being picked up by the lymph system, the waste products in it accumulate and the body responds by laying down fibrous tissue to consolidate it.  Over time, this can lead to skin changes, such as thickening, hardening, or a “woody” appearance. The skin may become more prone to infections, ulcers, and other complications.
3. Increased risk of infections: The stagnant lymphatic fluid creates an environment favorable for bacterial or fungal growth. The compromised lymphatic system also means that the body’s immune response is weakened in the affected area. As a result, individuals with lymphatic insufficiency are at a higher risk of developing recurrent infections, such as cellulitis, lymphangitis, or fungal infections.
4. Reduced transport of nutrients and waste removal: The impaired lymphatic flow hinders the transport of nutrients, oxygen, and waste products between the tissues and the bloodstream. This can lead to further tissue damage, impaired wound healing, and an increased risk of secondary complications.
5. Functional limitations: Lymphedema can cause functional limitations and affect the quality of life. The swelling and tissue changes can lead to discomfort, pain, heaviness, and difficulty moving the affected limb(s). The condition may impact daily activities, mobility, and emotional well-being.

How can leg compression boots help lymphedema?

Treatment for lymphatic insufficiency focuses on managing the symptoms, reducing swelling, preventing infections, and improving overall function. This may involve a combination of techniques, including compression therapy, manual lymphatic drainage massage, exercise, skin care, and sometimes surgery.  Take note; it is not a good idea to wear tight-fitting clothes as it may worsen the problem, so if you have lymphedema, make sure to wear loose clothing.

The legs are especially affected by lymphedema since they are furthest away from the heart and the fluids there have to work against gravity.  Many people with lymphedema are finding success using compression boots.  This popular therapy device contains individual air bladder sections, from the foot to the upper thigh, which are filled using a programmable air pump unit.  When maximally filled with air, the air bladder compresses that section of your leg.   You can control the sequence of filling of these bladders, and the pressure level.  The higher end models are capable of generating a strong compression while the cheaper versions do much lighter compression.

For example, the standard program compresses the feet first, then the lower calf, upper calf, and thigh, in that order.  It holds the pressure for a couple of seconds, then all the air is released, and the process is repeated. This repeated pattern of compression, from leg to thigh, pushes the lymph upwards towards the heart.

Compression boots for lymphatic insufficiency

You don’t have to suffer from lymphedema to benefit from compression boots.   They are great for post-exercise treatment, especially after a marathon or a long hike.  The compression waves not only help blood and lymph in your leg vessels to move towards the heart and thoracic ducts, they massage the leg muscles as well.  This may even reduce the onset of delayed onset muscle soreness (DOMS), the soreness that often comes a few hours after rigorous exercise involving the legs.

Bottom Line:  Compression boots are helpful in alleviating the symptoms of lymphatic insufficiency, and assisting circulation in your legs, post exercise.  They offer a relatively inexpensive form of palliative care, and are worth the investment.  Lymphatic insufficiency can cause long-term problems such as fibrosis, skin hardening and even toxicity if left unchecked, so it’s best to be active in managing the condition.