TREATMENT
Therapy concept of the Földi Clinic for oedema conditions
The Földi Clinic is regarded as a European centre for lymphology and helps numerous patients from within Germany and abroad each year to alleviate their oedema complaints and associated comorbidities.
The therapeutic specialisation focuses on the treatment of the following conditions:
- Secondary lymphoedema
- Primary lymphoedema
- Phlebological oedema
- Multicausal, obesity-associated oedema
- Oedema conditions with chronic wounds
Focus areas
The focus of successful treatment is Complex decongestive physiotherapy (CDP). Using techniques from physiotherapeutic oedema therapy, such as compression bandaging, it is possible to reduce oedema.
The therapists at the Földi Clinic apply individually tailored, foam-padded compression bandages adapted to your oedema. Through these world-leading bandaging techniques, oedema fluid is displaced and hardened tissue is loosened.
In combination with movement, the venous and lymphatic muscle and joint pumps are activated and lymphatic return is improved. Using manual lymphatic drainage (MLD), especially hardened, fibrotic lymphoedema tissue can be loosened and oedema fluid mobilised. Depending on the oedema diagnosis and stage of lymphoedema, this massage technique is individually adjusted for you. Gentle, circular lymphatic drainage movements can stimulate lymphatic vessel activity. Stronger, deeper strokes loosen hardened tissue.
Associated conditions
Patients with lymphoedema often suffer recurrent infections due to a locally reduced immune defence. Erysipelas is a typical comorbidity of chronic lymphoedema. In addition to thorough education about this problem, skin care and skin treatment are important components of lymphoedema therapy. Learning treatment techniques and applying a self-bandage are also parts of the therapeutic measures during your rehabilitation stay.
Therapy
Successful treatment of oedema and accompanying conditions requires a holistic treatment approach. Orthopaedic, internal medicine, psychological or other diagnoses may require an adjustment of therapy priorities. After medical examination and diagnosis, the therapeutic measures will be tailored to your condition.
Components of the therapy may include:
- Manual lymphatic drainage (MLD)
- Skin care
- Compression therapy
- Exercise and movement therapy
- Physiotherapy
- Occupational therapy
- Psychological therapy
- Nutritional medicine
- Pain management
- Health education sessions and training
- Social counselling
Treatment for Lipalgia Syndrome
The lipalgia syndrome primarily affects women and is defined by the following two criteria:
- Disproportionate fatty tissue in the area of the legs (sometimes also the arms)
Plus
- Relevant pain/complaints in this fatty tissue.
A large proportion of patients with lipalgia syndrome also suffer from overweight or obesity, reduced physical fitness, psychological stress or psychiatric conditions such as depression, post-traumatic symptoms or eating disorders. Many affected individuals report problems with self-acceptance due to the prevailing slim beauty ideal.
Treatment of the lipalgia syndrome is therefore interdisciplinary and multimodal in a lipalgia syndrome programme developed specifically at the Földiklinik, which is oriented towards the latest scientific findings. The basis is the International Consensus on the Lipoedema Syndrome (2020) and the new S2k guideline for Lipoedema (Jan. 2024).
Important to know:
Contrary to earlier assumptions, the lipalgia syndrome is not an oedema disorder. The new S2k guideline for Lipoedema explicitly states: “Lipoedema is primarily neither an oedema disorder nor a condition with venous or lymphatic functional impairment.” (S2k guideline Lipoedema, p. 38). Therefore, pure lipalgia syndrome does not require decongestive therapy. The Földiklinik is the European Centre for Lymphology; diagnostics and treatment are always adapted to the latest scientific standards. For this reason, we no longer perform manual lymph drainage on women with a pure lipalgia syndrome.
Modern interdisciplinary multimodal therapy for lipalgia syndrome
- Physiotherapy and exercise therapy in compression
- Psychosocial therapy
- Weight management
- Self-management
- Liposuction only in carefully selected cases
The Földiklinik's interdisciplinary multimodal lipoedema programme
- Fitness test on admission and at discharge
- Individualised exercise counselling for training with lipalgia syndrome
- Compression therapy for lipalgia syndrome
- Medical lecture on lipalgia syndrome
- Psychologist-led lipalgia group – an interactive workshop on psychological topics
- Nutrition group for lipalgia syndrome
- Exercise group for lipalgia syndrome
- Obesity counselling for women with lipalgia syndrome and severe obesity (BMI 40 kg/m2)
Further information can be found here
The Long Road to the Right Treatment
Many patients experience a long journey of suffering before they arrive at the correct diagnosis and treatment at the Földiklinik, where they finally receive effective therapy.
Manual Lymphatic Drainage
Manual lymphatic drainage is a medical massage technique for the treatment of lymphoedema. Tailored to the patient's skin and oedema condition, gentle strokes stimulate the transport of lymphatic fluid in the lymphatic vessels and mobilise oedema fluid in the tissue. Firm, hardened oedema tissue is treated with firmer, kneading massage strokes, the so-called Fibrosetechnik.
Manual lymphatic drainage is applied daily depending on the severity of the condition and is part of a complex treatment concept — Complex Physical Decongestive Therapy (KPE).
Physiotherapy
Using various physiotherapeutic techniques, the aim is to specifically treat the human body's mobility in cases of functional impairments. The goal of the therapies is to achieve optimal mobility and pain relief, as well as to improve daily activities. Those diagnosed with limitations receive a physiotherapeutic examination and assessment.
Through a comprehensive targeted group offering, which is supplemented by individual treatments as needed, physiotherapy supports rehabilitation success.
The Compression Bandage
Bandaging is a crucial part of complex physical decongestion therapy. Typically, the application of the compression bandage occurs immediately after treatment with manual lymph drainage. You will receive individually tailored padding made of foam, combined with a compression bandage made of elastic compression bandages, which supports manual decongestion, loosens the oedema tissue, and enhances treatment success.
Compression Systems
The latest compression systems, such as the medically adaptive compression MAK or intermittent pneumatic compression therapy, are used as necessary. In addition to oedema reduction, the compression bandage also has a positive effect on venous return and alleviates pain associated with tissue discomfort in lipedema syndrome.
Personal Responsibility as the Key to Therapy Success
The long-term success of therapy largely depends on the discipline and accountability of the patients, who need to learn to integrate treatment into their daily lives.
Occupational Therapy
Occupational therapy is a versatile treatment approach aimed at helping individuals with physical, mental or emotional limitations to achieve greater independence in their daily lives. Through various therapeutic methods such as cognitive training, activities of daily living (ADL) training, joint protection advice, sensitivity training, and assistive device consultation, occupational therapists support their patients in improving their quality of life and managing everyday tasks more effectively.
Our Occupational Therapy Services for You
- Cognitive Training
- ADL Training
- Advice and Training on Joint Protection
- Sensitivity Training
- Assistive Device Consultation
Sports and Exercise Therapy
It is widely proven that sport and exercise positively affect health. Physical activity reduces a variety of health issues and promotes recovery.
Regular Exercise
Regular exercise protects against cardiovascular diseases and positively influences metabolism; a strong muscular corset stabilises the spine and joints. In relation to lymphoedema, the muscle and joint pumps are activated, thereby stimulating decongestion. Exercise helps maintain weight, avoid obesity, and reduce pain issues in lipedema. Last but not least, sport has a positive effect on mental health.
There are many arguments in favour of maintaining an active and lively lifestyle.
The Földiklinik offers a diverse and differentiated sports and exercise programme.
The focus of the sports and exercise therapy group offerings is to improve overall fitness. This increases performance and resilience for work and everyday life at home, enhancing overall well-being.
Courses with varying intensities are prescribed by the doctors according to your level of exertion. The range of exercise therapies is wide and includes gentle options such as Tai Chi, Qi Gong, Feldenkrais, and Yoga, as well as aerobic, dance, step-aerobics, walking, and playful forms of movement.
As a patient, you can discover and try out a variety of methods to find the right form of exercise that can then be integrated into your daily routine.
Sports and Movement Programme
Functional Full-Body Training
A mix of cardio training and workouts
Back and Posture Training for Work and Everyday Life
With many tips for daily life, as good posture helps to prevent back pain
Relaxing with Breath
Deep breathing not only promotes lymph flow but also aids in detoxification, relaxation, and better coping with daily life
Mobilisation While Sitting
Movement is also possible while sitting, helping to become stronger and more mobile.
Balance, Coordination Training and Fall Prevention in Small and Large Groups
Avoiding falls is an important goal to prevent serious injuries and long periods of immobility.
Fascia Training in a Group
Stretching, loosening, releasing adhesions. Fascia training promotes both mobility and stability.
Fascia Self-Treatment in Small Groups
In a small group, there can be individual work to soften the tissue.
Pelvic Floor Exercises
The pelvic floor supports our posture. The focus is on improved awareness of the pelvic floor
Tai Chi, Qi Gong
These Eastern movement methods help to relax, improve posture, and enhance mobility
Yoga
The meditation method with versatile stretching and strengthening poses helps you to relax better and improves the mobility and stability of the whole body.
Zumba, Dance, Step
Moving to music is easier! In addition to the cardiovascular system, coordination is also trained
Arm Group
The arm group is specifically tailored to patients with arm lymphoedema after breast cancer.
Less Pain through Gentle Movement
Gentle movement is a key to managing pain better.
Walking with Qi Gong
Walking adapted to your physical fitness level, with or without walking poles in the beautiful Black Forest landscape. Walking with varying intensities
Equipment Therapy Area
Alongside our diverse sports therapy group offerings, you will find optimal opportunities on the large equipment therapy area to improve your mobility and fitness. You have access to a Milon strength and endurance circuit, cable machines, treadmills, exercise bikes, NuStep machines, and Motomed ergometers. You will receive an individual introduction for health-oriented training on the equipment.
Obesity Therapy
For morbidly obese patients (BMI > 40 kg/m²) with lymphoedema or lipalgia syndrome, a multimodal treatment concept has been developed in which lymphatic decongestion and substantial weight reduction go hand in hand. The treatment programme is carried out and evaluated under the supervision of an internist by a qualified, interdisciplinary therapeutic team.
Therapeutic team
- Internists, diabetologists, specialists in nutritional medicine, general practitioners
- Psychological psychotherapist and qualified psychologist
- Physiotherapists and lymph therapists with an additional qualification in exercise for obesity (Adipositassport)
- Sports educators with an additional qualification in exercise for obesity (Adipositassport)
- Dietitian/diabetes assistant (DDG); physiotherapists and lymph therapists with an additional qualification in exercise for obesity (Adipositassport)
- Cook trained in dietetics
- Nursing team experienced in caring for obese patients
- Cooperation with a certified centre for bariatric (obesity) surgical procedures
- Cooperation with a university centre for plastic surgery procedures.
Treatment goals
- Reduction of obesity-associated lymphoedema or lipalgia syndrome
- Weight reduction
- Improvement of psychological and physical health, in particular the cardiovascular risk profile
- Development of a concrete action plan for the post-discharge period
- Improvement of quality of life
- Capacity to work or reintegration into working life.
Treatment of chronic wounds
Lymphoedemas are often associated with chronic wounds and impaired wound healing due to various underlying conditions. One therapeutic focus of the Földiklinik is modern, phase-appropriate wound management with certified wound managers who receive annual training, in accordance with the criteria and standards of national and international professional societies (DGfW:
German Society for Wound Healing, ICW
Initiative Chronic Wound, EWMA
Interdisciplinary concept
Treatment of chronic wounds is only successful when, alongside local wound care, diagnosis and treatment of the underlying disease are considered within an interdisciplinary concept. Another pillar of therapy is optimal decongestive therapy as well as the option of surgical wound debridement and final defect closure by skin grafting, which can be provided by our cooperation partner, the University Medical Center Freiburg.
Wound spectrum
- Leg ulcer (ulcus cruris) in phlebolymphoedema (CVI – chronic venous insufficiency, PTS – post-thrombotic syndrome, PAD – peripheral arterial occlusive disease)
- Diabetes mellitus/diabetic foot syndrome
- Pressure ulcer care and pressure ulcer prevention
- Burn wounds
Wound healing disorders
- Chronic and iatrogenic impaired wound healing following surgical treatment or radiotherapy for cancer (possibly with secondary lymphoedema)
- Impaired wound healing due to maceration, mycosis, erysipelas, abscess, necrotising fasciitis in chronic lymphoedema stage III
- Post-traumatic impaired wound healing
- Palliative wound situations
Admission is via a rehabilitation or AHB application.
Before inpatient admission, the patient administration must have the following on file:
- Current bacteriology report including MRSA and MRGN
- Relevant findings and medical reports, wound documentation, photographic documentation, wound measurements
- Information on underlying conditions – multimorbidity, mobility, care needs, necessity of a medical/nursing bed
- Specialist review of findings
- Depending on the treatment and care required, an additional fee must be requested from the payers
Treatment of internal comorbidities
After the medical admission examination, known comorbidities that can worsen the lymphoedema are closely monitored and treated.
In particular, patients with lymphoedema of multifactorial origin require specialist internal medicine care that also manages conditions that aggravate oedema. Of course, we administer medications in all forms.
Further investigations are carried out where there are indications of such conditions. In cooperation with oncology centres, we also continue ongoing chemotherapy.
Interdisciplinary diagnosis and treatment of comorbidities
- Lymphology (ICG fluorescence scintigraphy)
- Vascular diagnostics (LRR, Doppler, FKDS)
- Diabetology
- Internal medicine
- Bariatric medicine (advice on bariatric surgery)
- Gynaecology, Endocrinology
- Nutritional counselling
- Psychotherapy
Nursing Pain Management
"Don't let your pain make you into someone you don't want to be"
In nursing pain therapy you will experience and learn which applications can provide pain relief or help counteract pain.
Non-pharmacological applications are used, such as rhythmic rubs according to Wegmann & Hauschka, heat–cold applications, aroma care, and the use of pain-drawing (dolography) cards. Equally important is counselling for better handling of your analgesics.
The aim is to strengthen and support you as a whole so that you can better manage your pain. In our interdisciplinary pain team, your personal pain situation is reviewed in regular internal meetings and an individual pain therapy, tailored entirely to your needs, is developed.
Nursing Guideline of the Földiklinik
We aim to support our patients in planning and organising their daily routines, taking on advisory roles and maintaining constant contact with all specialist departments.
Nursing means to us that we carry it out in a qualified, responsible manner and according to the latest scientific findings in nursing. The patient is at the centre of this. Relatives and significant others are involved upon request to promote and support the healing process.
Our care concept is the professional basis of nursing activities, which is action-oriented and aligns with our hospital's mission statement as well as the nursing guiding principles.
For us, care is holistic and activating care that addresses the individual in their entirety and supports them in their recovery process.
The highest goal of our care is to maintain, restore or improve the quality of life of our patients.
We aim to integrate the individual needs of each patient into our care and place them at the centre of our actions. We always strive to address and respect cultural and religious needs.
We strive to enhance the physical and mental well-being of our patients and promote their resources.
Psychology
Our three experienced psychologists will support you with psychological questions or problems - also beyond your underlying condition of lymphoedema or lipoedema syndrome - in specialised group and individual programmes.
We provide therapeutic support
- Individually tailored to you
- Based on the latest psychotherapy research
- Resource- and solution-oriented
Our group programmes for you
Psychological courses
- Stress management
- Lipalgia group - interactive workshop
- Mindfulness and mindful eating
- Practice group: Mindful breakfast
- Lecture: Chronic pain
- Autogenic training
As part of medically and vocationally oriented rehabilitation (MBOR):
- MBOR: Stress management in working life
- MBOR: Communication and conflicts in the workplace
Individual psychological sessions – our methods
- Systemic therapy – resource- and solution-oriented
- Cognitive behavioural therapy (CBT)
- Hypnotherapy
- Psycho-oncology
- Trauma therapy (EMDR)
- Process- and embodiment-focused psychology PEP®
nach Dr. M. Bohne - Mindfulness-based approaches
We are available through individual psychological sessions for:
- Difficulties coping with illness
- Depression
- Anxiety or panic disorders
- Post-traumatic symptoms
- Eating disorders, e.g. binge eating
- Chronic pain syndromes
- Crisis situations
- Problems or conflicts in working life
- Grief
- Preparation for bariatric surgery as part of the obesity programme
- Psychological distress you are experiencing
If required, we are happy to support you in individual psychological sessions, sessions with relatives, couple or family sessions. Referrals are arranged as part of the medical admission interview or via your attending physician.
Nutritional therapy
Through diet we provide our body with energy (carbohydrates, protein, fats) and important nutrients, vitamins, minerals and secondary plant compounds. With a healthy diet we set the course to prevent diet-related diseases or to treat existing conditions.
The nutritional concept at our clinic is based on a holistic approach:
The focus is on a healthy, balanced diet consisting of a varied, diverse, colourful, fibre-rich selection of foods. According to current evidence, this should be modelled on the Mediterranean diet and be predominantly plant-based. The food selection should, as far as possible, be made up of regional and seasonal foods in the interests of sustainability.
- Mindful, enjoyable eating
- Physical activity
Our counselling services:
Individual counselling:
Individual, based on the dietary record already completed at home, e.g. for obesity, hypercholesterolaemia, food intolerances, diabetes mellitus, etc.
Group sessions:
- Seminar on healthy eating
- Interactive workshop on inflammatory diseases
- Teaching kitchen events
- Grocery shopping workshops
Die Lehrküche der Földiklinik
Social counselling
Our social counselling informs and advises patients and their relatives on social, personal, occupational, financial and social-law issues - comprehensively and holistically. With competence and empathy.
Self-help potential and personal resources
The aim of the counselling is to reduce or alleviate the psychosocial burdens caused by disease of the lymphatic system by activating self-help potential and accessing personal resources and those of the social environment.
The willingness to empathise with the situation of patients and their carers is the basis for good counselling. Specifically, this involves developing coping strategies and problem solutions together with the patients.
Organisation & coordination
Implementation focuses on organising ongoing health and social care and on coordinating care services. During the hospital stay, appropriate follow-up care is initiated and coordinated in cooperation with the patient, their social environment and post-discharge services and institutions.
Social counselling services
- Lecture "The Social Safety Net"
- MBOR: rehabilitation patients with BBPL
- Monthly additional service offered by the FR self-help group "Lymph Self-Help"
- Information events
- Degree of disability+
- Rehabilitation sport
- Individual counselling
MBOR
MBOR stands for Medically Vocational Rehabilitation Measures.
Patients participating in this programme have a specific occupational issue that is identified through a screening questionnaire.
This is expressed in:
- problematic social medical developments, such as long or frequent periods of incapacity for work or unemployment due to health-related limitations
- negative occupational prognosis (also concerns about not being able to meet the demands of the workplace)
- occupational changes that are deemed necessary from a social medical perspective
- a high occupational burden, possibly also a health limitation due to work activities
Individual Consultations and Group Work
Interdisciplinary collaboration in the fields of medicine, psychology, physiotherapy, occupational therapy, nutrition, and social counselling provides affected patients with a specific occupational issue with comprehensive support through individual consultations and group work by:
- occupation-related diagnostics (matching skills, individual therapy goals)
- psychosocial work,
- occupation-related settings
- and workplace training.
This means that during the course of the rehabilitation stay with us, both health and the occupational situation or career perspectives are prioritized.
Personal Responsibility and Independence
The goal and also the mandate of the cost bearer of the pension insurance is to maintain, improve, or restore employability and to enable participation in social life while considering personal responsibility and independence. The transfer of the experiences gained into everyday life after rehabilitation is particularly important to us.
The rehabilitation measure is therefore primarily seen in the context of the occupational problem as a turning point for future health and professional prospects!
Help for Self-Help
The chronic condition 'lymphoedema' poses a significant psychological challenge for patients. Support and encouragement, particularly from the social environment, are of great importance. Education and training are essential, as patients must cope with their chronic condition 365 days a year.
In medical lectures and compression bandage courses, you will learn self-treatment and discover everything important regarding daily life with lymphoedema. Parents of affected children can learn how to treat their child through individual training provided by our therapists.