On September 25 and 26, Valencia, Spain, hosted the European Congress of Lymphology. This event brought together the international scientific community—including physiotherapists, vascular and plastic surgeons, and other healthcare professionals—to discuss the latest advances and challenges in the treatment of lymphatic disorders.
As a physiotherapist specialising in this field, I would like to share the main developments, emerging assessment technologies, and reflections on the current state of lymphatic rehabilitation in Portugal.
Understanding Lymphedema and Lipedema
Dermatofunctional and oncological physiotherapy focuses on complex conditions such as lymphedema, a chronic, progressive, and currently incurable condition that may be congenital (primary), trauma-related, or associated with cancer treatment.
Another condition that received significant attention at the congress was lipedema, an increasingly recognised disorder with a substantial impact on the lymphatic system.
In both cases, early physiotherapy intervention is essential. As these are chronic and progressive conditions, our role focuses on managing symptoms, slowing disease progression, and educating patients in self-management strategies.
A Revolution in Assessment: Greater Technology and Precision
Fortunately, scientific research has increasingly focused on developing more effective and validated assessment methods.
The congress highlighted how the future of diagnosis and assessment will increasingly rely on advanced technologies within physiotherapy practice, particularly:
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Bioelectrical Impedance Analysis (BIA): Enables a detailed assessment of body composition and fluid distribution.
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LymphScanner: An important tool for the early detection of localised changes in tissue fluid levels.
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Ultrasound Imaging: Used to assess skin and tissue quality and integrity, as well as to monitor dermal changes.
Treatment: Between the Gold Standard and Surgical Innovation
Regarding conservative treatment, Portugal remains fully aligned with international clinical guidelines.
Complete Decongestive Therapy (CDT), encompassing all its core components, continues to be the first-line approach and the gold standard in lymphatic rehabilitation.
At the same time, significant advances are being made in surgical approaches within vascular and plastic surgery, particularly through Lymphovenous Anastomosis (LVA) and, more recently, BioBridge techniques.
The Challenge of Pre- and Postoperative Protocols
These surgical advances present a new challenge for physiotherapy: Which rehabilitation protocols should we follow?
Current scientific literature remains limited and lacks consensus regarding postoperative management, with approaches ranging from no immediate intervention to early physiotherapy.
However, there is strong consensus regarding preoperative care: Complete Decongestive Therapy plays a fundamental role in preparing tissues for surgery.
The Reality in Portugal: Clinical Excellence vs. Delayed Diagnosis
I return from Valencia with one clear conviction: physiotherapists who pursue this specialisation in Portugal have access to excellent education and training.
We are keeping pace with international best practices. Nevertheless, two major challenges remain in our country:
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Delayed diagnosis within the medical community.
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The need for earlier and more efficient referral of patients to appropriately specialised physiotherapists.
The Key Takeaway from the Congress
The future of lymphatic healthcare can be summarised in three fundamental pillars:
Assess accurately, identify patients at risk, and prioritise prevention before the condition becomes permanently established.
Jessica Margarido
Physiotherapist specialising in oncology and lymphatic disorders
