TREATMENT
Therapy Concept of the Földi Clinic for Oedema Diseases
The Földiklinik is considered a European centre for lymphology and helps numerous patients from both domestic and international locations each year to alleviate their oedema complaints as well as associated accompanying diseases.
The therapy specialisation focuses on the treatment of the following conditions:
- Secondary lymphoedema
- Primary lymphoedema
- Phlebological oedema
- Multicausal, obesity-associated oedema
- Oedema diseases with chronic wounds
Focus Areas
The focus of successful treatment is Complex Physical Decongestion 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 Földiklinik apply individually tailored and fitted compression bandages padded with foam to suit the patient's 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 pump is activated, and lymphatic return flow is improved. The use of Manual Lymphatic Drainage can particularly loosen hardened, fibrotic lymphoedema tissue and mobilise oedema fluid. This massage technique is individually adapted based on the oedema diagnosis and lymphoedema stage. Gentle circular lymphatic drainage strokes can stimulate lymph vessel activity. Stronger, deeper strokes loosen hardened tissue.
Accompanying Diseases
Lymphoedema patients often suffer from recurrent infections due to locally reduced immune defence. Erysipelas is a typical accompanying disease of chronic lymphoedema. In addition to good training on this issue, skin care and skin recovery are important components of lymphoedema therapy. Furthermore, learning treatment techniques and applying self-bandaging are part of the therapeutic measures during your rehabilitation stay.
Therapy
The successful treatment of oedemas and accompanying diseases requires a holistic therapeutic approach. Orthopaedic, internal medicine, psychological or other diagnoses may necessitate adjustments in the therapeutic weighting. Following a 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
- Sports and movement therapy
- Physiotherapy
- Occupational therapy
- Psychological therapy
- Nutritional medicine
- Pain therapy
- Health lectures and training
- Social counselling
Therapy for Lipedema Syndrome
The Lipedema syndrome primarily affects women and is defined by the following criteria:
- Disproportionate fat tissue in the legs (sometimes also in the arms)
Plus
- Relevant pain/discomfort in this fat tissue.
A large number of patients with Lipedema syndrome also suffer from overweight or obesity, reduced physical fitness, psychological stress or mental disorders such as depression, post-traumatic symptoms, or eating disorders. Many affected individuals report issues with self-acceptance due to the prevalent slim beauty ideal.
Consequently, therapy for Lipedema syndrome is carried out in an interdisciplinary and multimodal manner in a specialised lipedema programme developed at the Földiklinik, which is based on the latest scientific findings. The foundation is the International Consensus on Lipedema Syndrome (2020) and the new S2k Guideline on Lipedema (Jan. 2024).
Important to know:
Contrary to previous assumptions, Lipedema syndrome is not an oedema disease. The new S2k Guideline on Lipedema explicitly states: "Lipedema is primarily neither an oedema disease nor a condition associated with venous or lymphatic dysfunction." (S2k Guideline on Lipedema, p. 38). Therefore, no decongestive therapy is needed for pure Lipedema syndrome. The Földiklinik is a European Centre for Lymphology; diagnostics and therapy are always adapted to the latest scientific standards. For this reason, we no longer perform Manual Lymphatic Drainage for women with pure Lipedema syndrome.
Modern interdisciplinary multimodal therapy for Lipedema syndrome
- Physiotherapy and exercise therapy with compression
- Psychosocial therapy
- Weight management
- Self-management
- Liposuction only in well-selected cases
The interdisciplinary multimodal Lipedema programme at the Földiklinik
- Bioimpedance measurement at the beginning and at the end to assess changes in fat tissue and muscle mass
- Fitness test at the beginning and at the end
- Individual training consultation for exercise with Lipedema syndrome
- Compression therapy for Lipedema syndrome
- Medical lecture on Lipedema syndrome
- Psychologically guided Lipedema group – an interactive workshop on psychological topics
- Nutrition group for Lipedema syndrome
- Exercise group for Lipedema syndrome
- Obesity counselling for women with Lipedema syndrome and severe obesity (BMI 40 kg/m2)
The Long Road to the Right Treatment
Many patients experience a long ordeal 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 used to treat lymphoedema. It is customised to the individual's skin and oedema situation, using gentle strokes to stimulate the transport of lymph fluid in the lymphatic vessels and mobilise oedema fluid in the tissues. Firm, hardened oedema tissue is treated with stronger, kneading massage techniques known as fibrotherapy.
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
Various physiotherapeutic techniques are used to specifically treat the mobility of the human body when there are functional impairments. The aim of the therapies is to achieve optimal mobility and pain relief, as well as to enhance daily activities. For diagnosed limitations, a physiotherapeutic examination and assessment is provided.
Through a comprehensive targeted group offering, which is supplemented by individual treatments as necessary, physiotherapy supports rehabilitation success.
The Compression Bandage
Bandaging is an essential part of Complex Physical Decongestive Therapy. Typically, the application of the compression bandage occurs immediately after treatment with Manual Lymphatic Drainage. You will receive custom padding with foam, combined with a compression bandage made of elastic compression bandages, which supports manual decongestion, loosens the oedema tissue, and enhances the treatment outcome.
Compression Systems
The latest compression systems, such as the medically adaptive compression system MAK or intermittent pneumatic compression therapy, are used as needed. In addition to reducing oedema, the compression bandage also positively impacts venous return and alleviates tissue pain in cases of lipœdema syndrome.
Self-Responsibility as the Key to Therapy Success
The long-term success of therapy largely depends on the patients' own discipline and sense of responsibility, who must learn to integrate the treatment into their everyday life.
Occupational Therapy
Occupational therapy is a versatile treatment approach aimed at helping individuals with physical, mental, or emotional limitations 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 counselling, 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
- Joint Protection Advice and Training
- Sensitivity Training
- Assistive Device Counselling
Sports and Exercise Therapy
It is well established: Sport and exercise have a positive impact on health. Physical activity reduces a multitude 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 encouraging decongestion. Exercise helps maintain weight, prevent obesity, and reduce pain issues in lipöedema. Last but not least, sport has a positive effect on mental health.
There are many compelling reasons to maintain an active and dynamic lifestyle.
Földi Clinic offers a diverse and tailored sports and exercise programme.
The main focus of the sports and exercise therapy group offerings is to improve general fitness. This enhances performance and resilience for both work and daily life at home, improving overall well-being.
The courses, with varying intensities, are prescribed by the doctors according to your level of exertion. The range of exercise therapies is vast, from gentle options such as Tai Chi, Qi Gong, Feldenkrais, and Yoga, to Aerobics, Dance, Step Aerobics, Walking, and playful movement forms.
As a patient, you can explore a variety of methods to find the movement style that suits you, which can then be incorporated into your daily life.
Sports and Exercise Programme
Functional Full-Body Training
A mix of cardio training and workouts
Back and Posture Training for Workplace and Daily Life
With many tips for daily life, as good posture helps to avoid back pain
Relax with Breath
Deep breathing not only promotes lymph flow, but also aids detoxification, relaxation, and better coping with daily life
Sitting Mobilisation
Even while sitting, movement is possible 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 prolonged periods of immobility.
Fascial Training in Groups
Stretching, loosening, releasing adhesions. Fascial training promotes both mobility and stability.
Fascia Self-Treatment in Small Groups
In small groups, individuals can specifically work on softening the tissue.
Pelvic Floor Gymnastics
The pelvic floor is essential for our posture. The focus is on improving 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 postures helps you relax better and improves the body's overall mobility and stability.
Zumba, Dance, Step
Moving to music feels better! In addition to cardiovascular fitness, coordination is also trained
Arm Group
The arm group is specifically tailored for patients with arm lymphedema after breast cancer.
Less Pain Through Gentle Movement
Gentle movement is a key to better managing pain.
Walking with Qi Gong
Walking adapted to your physical performance level, with or without walking sticks, in beautiful Black Forest landscapes. Walking with varying intensity levels
Equipment Therapy Area
Alongside our diverse therapeutic group offerings, you will find optimal opportunities to improve your mobility and fitness in the large equipment therapy area. You have access to a Milon strength and endurance circuit, cable machines, treadmills, exercise bikes, NuStep devices, and Motomed ergometers. You will receive an individual introduction for health-oriented training on the equipment.
Obesity Therapy
A multimodal therapy concept has been developed for morbidly obese patients (BMI > 40 kg/m²) with lymphoedema or liposuction syndrome, where lymphological decongestion and substantial weight reduction go hand in hand. The therapy programme is conducted and evaluated under the supervision of internists by a qualified and interdisciplinary team of therapists.
Therapeutic Team
- Internists, diabetologists, nutritional specialists, general practitioners
- Psychological psychotherapist and diploma psychologist
- Physiotherapists and lymph therapists with additional qualification in obesity sports
- Sports educators with additional qualification in obesity sports
- Dietitians/Diabetes assistants with DDG certification, physiotherapists, and lymph therapists with additional qualification in obesity sports
- Dietetically trained cook
- Nursing team experienced in dealing with obese patients
- Cooperation with a certified centre for obesity surgical procedures
- Cooperation with a university centre for plastic surgical procedures.
Therapeutic Goals
- Reduction of obesity-associated lymphoedema or liposuction syndrome
- Weight reduction
- Improvement of mental and physical health, particularly cardiovascular risk profile
- Designing a concrete action plan for post-stationary time
- Improvement of quality of life
- Workability or reintegration into professional life.
The Treatment of Chronic Wounds
Lymphoedema is often associated with various underlying conditions that lead to chronic wounds and impaired wound healing. 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 for Chronic Wounds, 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 consists of optimal decongestion therapy as well as the possibility of surgical wound cleansing and the final closure of defects through skin transplantation, which can be managed by our partner, the University Hospital Freiburg.
Wound Spectrum
- Leg ulcers due to phlebolymphoedema (CVI – chronic venous insufficiency, PTS – post-thrombotic syndrome, peripheral arterial occlusive disease)
- Diabetes mellitus/diabetic foot syndrome
- Decubitus care and decubitus prophylaxis
- Burn wounds
Wound Healing Disorders
- Chronic and iatrogenic wound healing disorders following surgical treatment or radiation for 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 rehab or AHB application.
Before hospital admission, the following must be submitted to the patient administration:
- Current bacteriology report including MRSA and MRGN
- Relevant findings and medical reports, wound documentation, imaging documentation, wound measurement
- Information on underlying conditions - multimorbidity, mobility, care requirements, necessity of a hospital bed
- Review of findings by a specialist
- Depending on the treatment and care requirements, a special fee must be applied for with the cost bearers
Treatment of Internist Comorbidities
Following the medical admission examination, known comorbidities that may adversely affect the lymphoedema are closely monitored and treated.
In particular, patients with multiple aetiological lymphoedema require specialist internal medicine therapy, which also treats oedema-aggravating conditions. Of course, we administer all forms of medication.
Furthermore, additional investigations are undertaken if there are indications of such conditions. In cooperation with oncology centres, we also continue ongoing chemotherapy.
Interdisciplinary Diagnostics and Treatment of Comorbidities
- Lymphology (ICG fluorescence lymphography)
- Vascular diagnostics (LRR, Doppler, FKDS)
- Diabetology
- Internal Medicine
- Bariatrics (consultation for obesity surgery)
- Gynaecology, Endocrinology
- Dietary advice
- Psychotherapy
Nursing Pain Management
„Do not let your pain make you someone you do not want to be“
In nursing pain therapy, you will experience and learn which treatments can provide pain relief or counteract your discomfort.
Non-pharmacological treatments will be used, such as rhythmic massage according to Wegmann & Hauschka, heat-cold applications, aromatherapy, and the use of pain assessment charts. Equally important is the advice for better management of your analgesics.
The goal is that you are strengthened / supported in your entirety to achieve better management of your pain situation. In our interdisciplinary pain team, your personal pain situation is addressed in regular internal meetings, and an individual pain therapy tailored to your needs is created.
Nursing Philosophy 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 diploma psychologists are here to support you with psychological questions or issues - even beyond your underlying condition of lymphoedema or lipedema syndrome - in specialised group and individual offerings.
We provide therapeutic support
- Tailored individually to you
- Keeping up with the latest psychotherapy research
- Resource and solution-oriented
Our group offerings for you
Psychological Training
- 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 vocational rehabilitation (MBOR):
- MBOR stress management in the workplace
- MBOR communication and conflicts at work
Psychological individual 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 psychological individual consultations for:
- Issues with managing illness
- Depression
- Anxiety or panic disorders
- Post-traumatic symptoms
- Eating disorders such as binge eating
- Chronic pain syndromes
- Critical situations
- Issues or conflicts in work life
- Grief
- Preparation for bariatric surgery as part of the obesity programme
- Psychological burdens that you are suffering from
If needed, we are happy to accompany you in psychological individual consultations, family member consultations, couples or family discussions. The prescription is made during the medical intake consultation or via your attending ward doctor.
Nutritional Therapy
Through nutrition, we provide our body with energy (carbohydrates, proteins, fats) and essential nutrients, vitamins, minerals, and secondary plant compounds. With a healthy diet, we set the course to prevent nutrition-related diseases or to treat existing ones.
The nutritional concept in our clinic follows 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 studies, this should be aligned with the Mediterranean diet and primarily plant-based. The choice of food should, as far as possible, consist of regional and seasonal products in the interest of sustainability.
- Mindful, pleasurable eating
- Exercise
Our consultation services:
Individual consultation:
Individually tailored based on the nutritional diary completed at home, e.g. for obesity, hypercholesterolaemia, food intolerances, diabetes mellitus, etc.
Group training sessions:
- Seminar on healthy nutrition
- Interactive workshop on inflammatory diseases
- Cooking demonstrations
- Shopping training
Social Support
Our social support service provides information and advice to 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 counselling is to reduce or alleviate the psychosocial burdens caused by the lymphatic system disease by activating self-help potentials and tapping into personal and social resources.
The willingness to empathise with the situation of the patients and their caregivers is the foundation for good counselling. Specifically, this involves developing coping strategies and solutions together with the patients.
Organisation & Coordination
In implementation, the organisation of ongoing health and social care and the coordination of services take centre stage. During the hospital stay, the appropriate follow-up care is initiated and coordinated in cooperation with the patient, their social environment, and post-hospital services and facilities.
Service Spectrum of Social Support
- Lecture "The Social Network"
- MBOR: Rehabilitation patients with BBPL
- Monthly additional self-help offer for "Lymphoedema & Lipoedema Syndrome"
- Information event
- Degree of disability
- Rehabilitation sports
- Individual counselling
MBOR
MBOR stands for medically vocationally oriented rehabilitation measures.
Patients participating in this programme have a specific professional issue, which is identified through a screening questionnaire.
It manifests in:
- problematic social medical developments, such as prolonged or frequent sick leave or unemployment due to health limitations
- negative professional prognosis (including concern about not being able to meet the demands of the workplace)
- professional changes deemed necessary from a social medical perspective
- a high professional burden, possibly also due to health limitations resulting from professional activities
Individual consultations and group work
Interdisciplinary professionals in the fields of medicine, psychology, physiotherapy, occupational therapy, nutrition, and social counselling will provide holistic support to affected patients with a specific professional issue through the methodology of individual consultations and group work by:
- profession-related diagnostics (alignment of skills, individual therapy goals)
- psychosocial work,
- the professional setting
- and workplace training.
This means that during the course of rehabilitation with us, both health and the professional situation or professional prospects are at the forefront.
Personal responsibility and independence
The aim and mandate of the funding body 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 thus primarily a way of shaping the further health and professional future in the context of the professional issue!
Help for Self-Help
The chronic condition "lymphoedema" poses a significant psychological challenge for patients. Support and encouragement, especially from their social environment, are of great importance. Awareness and education are crucial, as patients must cope with their chronic condition 365 days a year.
In medical lectures and compression bandage courses, you will learn self-treatment techniques and gain all the essential information regarding daily life with lymphoedema. Parents of affected children can learn how to care for their child through individual training provided by our therapists.