Let's Talk About Swelling....Glycocalyx?
By: Teresa Iattoni MSPT, CLT, CES
March is lymphedema month, you might ask how does that impact me? Most people will experience swelling during their life, whether it is a result of an injury like an ankle sprain or a result of a chronic condition like lymphedema. Swelling in the medical world is commonly referred to as edema. It may be caused from a specific event or have multiple causes. If you have swelling, you should discuss that with your medical provider. Swelling can develop due to the following: 1) as a side effect of your medication, 2) as a symptom of a cardiac/lung/kidney condition, 3) because of diabetes mellitus, 4) secondary to a protein deficiency, 5) in the presence of venous insufficiency/varicose veins, or 6) from an infection (Stout et al., 2012). Physical and occupational therapists commonly see swelling related to inflammation from an injury or surgery, which leads to increased pain, decreased muscle activation, abnormal movement, and impaired healing. In many cases, physical and occupational therapists can help by providing education for appropriate exercises and special treatments for swelling.
What is Glycocalyx? First, you should understand the basics of the circulatory system. The heart pumps the blood out into the arteries. The arteries are linked via small blood vessels (capillaries) to the veins. The veins take the blood back up to the heart. If our circulation was that simple it would be easy, but our bodies are extremely complex. The third part of the circulatory system is the lymphatic system. The lymphatic system follows the path of the veins and eventually brings fluid back to the large vein (superior vena cava). The lymphatic system’s job is to fight infection by filtering fluid at each lymph node, to maintain the balance of fluid throughout the body, and helps process dietary fat (Lee, Rockson, & Bergan, 2018). The glycocalyx is a protein tunnel in the capillaries that allows fluid and protein from the blood to go into the tissue spaces in our body (Hansen et al., 2015). The glycocalyx tunnel functions as a one-way road, so what goes out cannot normally come back in. The lymphatic system has the job of clearing the extra fluid and waste materials from the tissue space (Levick & Michel, 2010).
How does that relate to my swelling? Your swelling is best managed by addressing the cause of the swelling and encouraging fluid return thru the lymphatic system. In cases where the lymphatic system is not working appropriately, lymphedema can occur. Lymphedema is a high protein swelling. It commonly appears in arms or legs but can develop in any body part. Lymphedema left untreated can lead to chronic large body parts, pain, limited motion, repeated infections, and to permanent thickening of tissue (Lymphedema Framework, 2006). Advanced Physical Therapy & Sports Medicine has specialty trained physical and occupational therapists, who can provide treatment for your swelling and lymphedema, through the application of manual lymphatic drainage, compression garments, exercises, skin care, kinesiotape and pumps.
Hansen, K.C., D’Alessandro, A., Clement, C.C., & Santambrogio, L. (2015). Lymph formation, composition and circulation: a proteomics perspective. International Immunology, 27(5), 219-227.
Lee, B-B, Rockson, S.G., & Bergan, J. (Eds.). (2018). Lymphedema: a concise compendium of theory and practice (2nd ed.). Switzerland: Springer
Levick, J.R., & Michel, C.C. (2010). Microvascular fluid exchange and the revised Starling principle. British Journal of Anaesthesia, 108(2), 198-210.
Lymphedema Framework. (2006). Best practice for the management of lymphoedema. International Consensus. London: MEP Ltd.
Stout, N, Partsch, H, Szolnoky, G, …et al. (2012). Chronic edema of the lower extremities: International consensus recommendations for compression therapy clinical research trials. International Angiology, 31(4), 316-329.