TREATMENT
Therapy Concept of the Földi Clinic for Oedema Disorders
The Földi Clinic is regarded as a European centre for lymphology and helps numerous patients from both domestic and international backgrounds each year to alleviate their oedema complaints as well as associated comorbidities.
The therapy specialisation focuses on the treatment of the following conditions:
- Secondary lymphoedema
- Primary lymphoedema
- Phlebological oedemas
- Multifactorial, obesity-associated oedemas
- Oedema disorders with chronic wounds
Focus Areas
The emphasis of successful treatment is on Complex Physical Decongestive Therapy (KPE). With the help of techniques from physiotherapeutic oedema therapy, such as compression bandaging, it is possible to reduce oedemas.
The therapists at the Földi Clinic apply individually tailored compression bandages, padded with foam, specifically designed for the patient’s oedema. These globally renowned bandaging techniques displace oedema fluid and loosen hardened tissue.
In combination with movement, the venous and lymphatic muscle and joint pump is activated, improving lymphatic return. Manual lymphatic drainage effectively loosens hardened, fibrotic lymphoedema tissue and mobilises oedema fluid. Depending on the diagnosis of the oedema and the stage of lymphoedema, this massage technique is individually adjusted for the patient. Gentle, circular lymphatic drainage techniques can stimulate lymphatic activity. Stronger, deeper techniques can loosen hardened tissue.
Comorbidities
Patients with lymphoedema often suffer from recurrent infections due to a locally reduced immune response. Erysipelas is a typical comorbidity of chronic lymphoedema. Besides comprehensive education on this issue, skin care and skin restoration are essential components of lymphoedema therapy. Additionally, learning treatment techniques and applying self-bandaging are parts of the therapeutic measures during your rehabilitation stay.
Therapy
The successful treatment of oedemas and associated diseases requires a holistic approach to therapy. Orthopaedic, internal, psychological, or other diagnoses may necessitate an adjustment of the therapy emphasis. Following medical examination and diagnosis, the therapeutic measures will be tailored to your condition.
Components of the therapy may include:
- Manual lymphatic drainage
- Skin care
- Compression therapy
- Sport and exercise therapy
- Physiotherapy
- Occupational therapy
- Psychological therapy
- Nutritional medicine
- Pain therapy
- Health lectures and training
- Social counselling
Therapy for Lipoedema Syndrome
The lipoedema syndrome primarily affects women and is defined by two criteria:
- Disproportionate fat tissue in the area of the legs (sometimes also the arms)
Plus
- Relevant pain/discomfort in this fat tissue.
A large number of patients with lipoedema syndrome also suffer from overweight or obesity, reduced physical fitness, psychological stress, or psychological disorders such as depression, post-traumatic symptoms, or eating disorders. Many individuals report issues with self-acceptance due to the commonly held slim beauty ideal.
The therapy for lipoedema syndrome is therefore interdisciplinary and multimodal, conducted within a lipoedema programme developed specifically at the Földiklinik, which is oriented towards the latest scientific findings. The foundation is the International Consensus on Lipoedema Syndrome (2020) and the new S2k guidelines on lipoedema (Jan. 2024).
Important to know:
Contrary to previous assumptions, lipoedema syndrome is not an oedema disease. The new S2k guidelines on lipoedema explicitly state: "Lipoedema is primarily neither an oedema disease nor a clinical picture with venous or lymphatic dysfunction." (S2k guidelines on lipoedema, p. 38). Therefore, no decongestive therapy is required for pure lipoedema syndrome. The Földiklinik is a European Centre for Lymphology; diagnostics and therapy are always adjusted to the latest scientific standards. For this reason, we no longer perform manual lymphatic drainage for women with pure lipoedema syndrome.
Modern interdisciplinary multimodal therapy for lipoedema syndrome
- Physiotherapy and exercise therapy with compression
- Psychosocial therapy
- Weight management
- Self-management
- Liposuction only in well-selected cases
The interdisciplinary multimodal lipoedema programme at Földiklinik
- Bioimpedance measurement at entry and upon completion to assess changes in fat tissue and muscle mass
- Fitness test at entry and upon completion
- Individual training advice for lipoedema syndrome
- Compression therapy for lipoedema syndrome
- Medical lecture on lipoedema syndrome
- Psychologically guided lipoedema group – an interactive workshop on psychological topics
- Nutrition group for lipoedema syndrome
- Exercise group for lipoedema syndrome
- Obesity counselling for women with lipoedema syndrome and severe obesity (BMI 40 kg/m2)
The Long Journey to the Right Treatment
Many patients endure a long journey of suffering before receiving 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 used to treat lymphoedema. Tailored to your skin and oedema situation, gentle strokes stimulate the transport of lymph fluid in the lymphatic vessels and mobilise oedema fluid in the tissue. Firm, hardened oedematous tissue is treated with firmer, kneading massage techniques, known as fibrolysis.
Manual lymphatic drainage is applied daily depending on the severity of the condition and is part of a complex treatment concept known as complex physical decongestive therapy.
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 lipodema syndrome, a multimodal therapy concept has been developed, where lymphological decongestion and substantial weight reduction go hand in hand. The therapy programme is conducted and evaluated under the supervision of an internist by a qualified and interdisciplinary team of therapists.
Therapist Team
- Internists, diabetologists, nutrition specialists, general practitioners
- Psychological psychotherapist and graduate psychologist
- Physiotherapists and lymph therapists with additional qualification in obesity sports
- Sports educators with additional qualification in obesity sports
- Dietitians/diabetes assistants DDG, physiotherapists and lymph therapists with additional qualification in obesity sports
- Dietary-trained chef
- Experienced nursing team in dealing with obese patients
- Collaboration with a – certified – centre for obesity surgical procedures
- Collaboration with a university centre for plastic surgical procedures.
Therapy Goals
- Reduction of obesity-associated lymphoedema or lipodema syndrome
- Weight reduction
- Improvement of mental and physical health status, particularly the cardiovascular risk profile
- Drafting a concrete action plan for the post-hospitalisation period
- Improvement of quality of life
- Work capability or reintegration into professional life.
The Treatment of Chronic Wounds
Lymphoedemas are often associated with chronic wounds and wound healing disorders due to various underlying conditions. A focus of therapy at the Foeldiklinik is on modern phase-appropriate wound management with certified and annually trained wound managers 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
The treatment of chronic wounds is only successful if, alongside local wound treatment, the diagnosis and therapy of the underlying condition are considered within an interdisciplinary approach. Another pillar of therapy is optimal decongestion therapy, as well as the possibility of surgical wound debridement and the final defect closure through skin transplantation, which can be performed by our partner at the University Hospital Freiburg.
Wound Spectrum
- Venous ulcers in phlebolymphoedema (CVI – chronic venous insufficiency, PTS – post-thrombotic syndrome, PAD – peripheral arterial occlusive disease)
- Diabetes mellitus/Diabetic foot syndrome
- Pressure ulcer care and prevention
- Burn wounds
Wound Healing Disorders
- Chronic and iatrogenic wound healing disorders following surgical treatment or radiation of a cancer (possibly with secondary lymphoedema)
- Wound healing disorder due to maceration, mycosis, erysipelas, abscess, necrotising fasciitis in chronic lymphoedema Stage III
- Post-traumatic wound healing disorder
Palliative wound situation
Admission is through a rehabilitation or AHB application.
Before the inpatient admission, the following must be available to the patient management:
- Current bacteriological results including MRSA and MRGN
- Relevant findings and medical reports, wound documentation, image documentation, wound measurements
- Information on underlying conditions - multimorbidity, mobility, care requirements, necessity of a hospital bed
- Review of findings by a specialist
- Depending on the level of treatment and care required, a special fee must be requested from the payers
Treatment of Internal Accompanying Conditions
Following the medical admission examination, known accompanying conditions that can adversely affect the lymphoedema are closely monitored and treated.
Particularly patients with multi-causally induced lymphoedemas require specialist internal therapy that also addresses conditions exacerbating the oedema. Naturally, we provide all forms of medication administration.
Furthermore, additional examinations are conducted if there are indications of such conditions. In cooperation with oncological centres, we also continue ongoing chemotherapy treatments.
Interdisciplinary Diagnostics and Treatment of Accompanying Conditions
- Lymphology (ICG fluorescence scintigraphy)
- Vascular Diagnostics (LRR, Doppler, FKDS)
- Diabetology
- Internal Medicine
- Bariatrics (Consultation on obesity surgery)
- Gynaecology, Endocrinology
- Nutrition Consultation
- Psychotherapy
Nursing Pain Management
“Do not let your pain turn you into someone you do not want to be”
In nursing pain therapy, you will experience and learn about the various methods through which you can achieve pain relief or counteract pain.
Non-pharmaceutical applications will be used, such as rhythmic massages according to Wegmann & Hauschka, hot and cold treatments, aromatherapy, and the use of pain drawing cards. Equally important is the consultation for better management of your analgesics.
The aim is to empower/support you as a whole, enabling you to cope better with your pain situation. In our interdisciplinary pain team, your personal pain situation will be considered in regular internal meetings, and an individual pain therapy will be created, tailored to your specific needs.
Nursing Guideline of the Földiklinik
We strive to support our patients in planning and organizing their daily routine, take on advisory functions, and maintain constant contact with all departments.
Our nursing concept forms the professional foundation of our nursing activities, adapting in a practice-oriented way to our clinic's mission statement and nursing mission statement.
For us, nursing is a holistic, activating form of care that encompasses the patient in their entirety and provides supportive accompaniment in their recovery process.
The highest goal of our care is to maintain, restore, or improve the quality of life of our patients.
We strive to integrate each patient's individual needs into their care and place these at the center of our actions. We always try to address and respect cultural and religious needs.
We strive to enhance the physical and emotional well-being of our patients and promote their resources.
Psychology
Our three experienced qualified psychologists will support you with psychological issues or problems - even beyond your underlying condition of lymphoedema or lipedema syndrome - through specialised group and individual offerings.
We provide therapeutic support
- Individualised to suit you
- In line with the latest psychotherapy research
- Resource and solution-oriented
Our group offerings for you
Psychological training sessions
- Stress management
- Lipedema group – interactive workshop
- Mindfulness and mindful eating
- Practice group for mindful breakfast
- Lecture on chronic pain
- Autogenic training
As part of the medically and occupationally oriented rehabilitation (MBOR):
- MBOR stress management in working life
- MBOR communication and conflicts at the workplace
Psychological one-on-one consultations – our methods
- Systemic therapy – resource and solution-oriented
- Cognitive behavioural therapy
- Hypnotherapy
- Psycho-oncology
- Trauma therapy EMDR
- Process and embodiment-focused psychology PEP®
according to Dr. M. Bohne - Mindfulness-based approaches
We are here for you with individual psychological consultations regarding:
- Issues related to coping with illness
- Depression
- Anxiety or panic disorders
- Post-traumatic symptoms
- Eating disorders such as binge eating
- Chronic pain syndromes
- Crises
- Problems or conflicts in work life
- Grief
- Preparation for bariatric surgery within the obesity programme
- Psychological burdens you are suffering from
If needed, we are happy to support you in psychological one-on-one consultations, family consultations, couples, or family talks. The prescription takes place during the medical intake conversation or via your supervising ward doctor.
Nutritional Therapy
Through nutrition, we provide our bodies with energy (carbohydrates, proteins, fats) and essential nutrients, vitamins, minerals, and secondary plant substances. With a healthy diet, we lay the groundwork to prevent nutrition-related diseases or to treat existing conditions.
The nutritional concept in our clinic consists of a holistic approach:
The focus is on a healthy, balanced diet consisting of a varied, diverse, colourful, and fibre-rich selection of foods. According to current research, this should be based on the Mediterranean diet and predominantly plant-based. The food selection should, as far as possible, consist of regional and seasonal foods in the spirit of sustainability.
- Mindful, enjoyable eating
- Physical activity
Our advisory services:
Individual counselling:
Individually tailored based on the dietary protocol completed at home, e.g., for obesity, hypercholesterolemia, food intolerances, diabetes mellitus, etc.
Group training sessions:
- Seminar on healthy eating
- Interactive workshop on inflammatory diseases
- Cooking classes
- Shopping training
Social Counseling
Our social counseling service informs and advises patients and their relatives on social, personal, professional, financial and social law issues - comprehensively and holistically. With competence and empathy.
Self-help potentials and personal resources
The aim of the counseling is to reduce or alleviate the psychosocial burdens caused by the lymphatic system disease by activating self-help potentials and unlocking personal resources as well as those from the social environment.
The willingness to empathise with the situation of patients and their relatives is the foundation for good counseling. Specifically, it involves developing coping strategies and solutions together with the patients.
Organisation & Coordination
In implementation, the organisation of health and social follow-up care as well as the coordination of care services is paramount. During the hospital stay, the tailored follow-up care is initiated and coordinated in collaboration with the patient, their social environment, and the post-hospital services and facilities.
Service Spectrum of Social Counseling
- Lecture "The Social Network"
- MBOR: Rehabilitation clients with BBPL
- Monthly additional offer of self-help FR "Lymphoedema & Lipoedema Syndrome"
- Information event
- Degree of disability+
- Rehabilitation sports
- Individual counseling
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.