Edema treatment focuses on correcting the cause of the fluid accumulation. Edema is a symptom of an underlying health condition; therefore, it is important to seek medical advice on the cause first.

Various factors can contribute to the development of swelling in the legs and arms. When it occurs, it can range from mild to severe. While edema can impact function and mobility, the vast majority of edema is treatable with conservative approaches.  In this article we will discuss different symptoms and causes of edema, classifications, as well as edema management, including physiotherapy and massage therapy.

Table of Contents:

What is Edema?

Edema is the swelling of limbs as a result of fluid build-up, most often affecting the arms and legs. Individual with edema can experience reduced mobility, difficulty fitting into shoes or clothing, and skin changes like pitting or discoloration.

Edema is something that can affect anyone but most often occurs in those who are pregnant and those 65 and older. It is important to manage edema as it can impact one’s ability to carry out daily tasks.

Edema Symptoms

Symptoms of edema typically include:

  • the skin of the swollen area looked stretched and/or shiny, at times the area can also feel warm.
  • when you press the swollen area, it leaves a dent
  • discomfort when wearing clothes and jewelry
  • feeling of fullness or heaviness in the swollen area
  • difficulties walking or moving the affected joints
  • sensation of pain in the surrounding area

Four Grades of Edema

One of the ways edema is diagnosed is through a physical exam where there is gentle pressure put over the swollen area. If there is edema, an indentation in the skin will be seen. A medical doctor can determine the cause of the swelling and may run other tests such as blood tests, electrocardiogram to help finalize the diagnosis.

Edema is graded on four levels. The edema grading scale is based on how quickly the dimple goes back to normal (rebounds) after a pitting test.[i]

Grade 1: immediate rebound with 2mm pit

Grade 2: less than 15s rebound with 3-4mm pit.

Grade 3: rebound greater than 15s but less than 60s with 5-6mm pit.

Grade 4: rebound between 2-3mins with an 8mm pit. 

Causes of Edema

There are various factors that can contribute to the development of swelling in the legs and arms. It is important to identify the cause of the fluid buildup to help guide the treatment approach.

Some common causes include:[i][ii]

  • Gravity: when spending time sitting or standing in one place for a long time, gravity will naturally pull the fluid downwards, often resulting in swelling in the arms, legs, and feet. Sometimes individuals experience this after sitting on a long flight, for example.
  • Underlying health conditions: conditions such as heart failure, lung, liver and kidney diseases often result in edema
    • Congestive heart failure can lead to edema as the heart is not able to pump the blood around the body. Due to the increased pressure in the veins, the fluid seeps out to the surrounding tissues.
    • Kidney disease often means the kidneys are not removing enough sodium and water from the body. This results in an increase in pressure in the blood vessels and results in edema.
  • Medication side effects: some medications such as blood pressure or pain management medications have edema as a side effect.
  • Diet: a diet high in sodium (salt) can sometimes cause buildup of fluid.
  • Pregnancy: as the uterus puts pressure on the blood vessels and on the lower part of the body, it can result in swelling in the legs.
  • A chronic condition such as lymphedema: This is often a result of damage to the lymphatic system. In many cases this occurs after cancer treatment where the lymph nodes have been removed.
  • Paralysis: Conditions such as stroke, spinal cord injury or brain injury often result in partial paralysis in one part of the body. Paralyzed muscles are not contracting and are often in a “low” position (such as when someone is sitting in a wheelchair). As a result, the fluid pools in the legs or arms and cannot get pumped back to the heart.

Edema Treatment Approaches

Often times, mild cases of edema go away on their own. If the edema is not going away on its own, it is important to seek out medical advice to first determine its cause. Edema is a symptom of an underlying health condition and requires regular management by a healthcare provider.

Edema treatment focuses on correcting the cause of the fluid accumulation and can include the following one or several of the following management approaches.

Medical Management

If there is an underlying health condition causing the edema, your healthcare provider will likely recommend lifestyle changes to help reduce it. This can include mobility and recommendations for diet changes. Your family doctor may prescribe you medication in order to treat the underlying condition, such as the case with kidney disease.

Massage Therapy

Massage therapy is very beneficial to individuals struggling with edema; massage and other manual therapy techniques are effective in improving overall lymphatic circulation, reducing fluid buildup in concerned areas, reducing pain, and promoting relaxation of musculature and the parasympathetic nervous system.

Massage therapists treating edema employ techniques that facilitate drainage of the lymphatic system. They will incorporate passive range of motion techniques to joints and musculature to aid in circulation. In addition, they can utilize contrast hydrotherapy or cool hydrotherapy applications to reduce localized swelling. It is not recommended to use heat applications to problem areas as they have the potential to worsen symptoms.


The underlying cause of the edema will guide your physiotherapist’s treatment. Your physiotherapist will first ask you about your medical history to rule out heart disease, liver disease and kidney disease.

It is important to know that some treatments may be contraindicated if this is the main cause of the edema or may require medical management prior to beginning physiotherapy. In some cases your physiotherapist may refer you to your family doctor for further testing prior to beginning physiotherapy.

The goal of physiotherapy with edema management often includes reducing and preventing an increase in the edema, reducing the “tight” feeling, improving the range of motion in the joint affected to help improve your function and ability to do day-to-day tasks and prevent skin problems.

Treatment approaches to address these often include education, manual therapy, mechanical therapy, exercise and bandaging to aid in management.

  1. Education: This will include how to incorporate movement throughout the day if one of the causes of the edema is sitting or standing for a long period of time. Education can also include general recommendations on diet and exercise to help prevent long-term complications.
  2. Positioning recommendations: Your physiotherapist will make positioning recommendations. This includes on how to elevate the swollen limb. Your therapist will also make positioning recommendation to protect the area from unnecessary pressure, extreme temperatures, and potential injuries. The skin over the swollen area becomes thin overtime; this means that cuts and scrapes take longer to heal and are more likely to get infected. Therefore, it is important to prevent skin damage if you have edema.
  3. Exercise: Your therapist may prescribe exercises (known as “muscle pump” exercises) to perform to help move the fluid away from the affected area in order to reduce the swelling. Using the muscles of the affected area can help move the excess fluid in the joint back towards the heart. If mobility is limited, such in the case of those with neurological injuries, passive range of movement exercises may be beneficial in helping reduce the swelling.
  4. Mechanical therapy: A recommendation of compression socks, sleeves or stockings can be made as well in order to help reduce the swelling. Taping the area can also be effective as it provides compression.
  5. Manual therapy: For those with lymphedema, manual therapy can be used to help move the fluid away from the affected area. Some physiotherapists have specific training in managing lymphedema which includes manual lymphatic drainage to help reduce the area of swelling. The message can help push the fluid back to the heart, away from the swollen area of the body. Your physiotherapist may also provide education on how to bandage the area. [iii]
  6. Contrast baths: This involves alternating the limb between a bucket of colder water and warmer water (often 2 minutes at a time) which can be effective in reducing swelling in a limb. The contrast between the hold and cold temperatures causes the blood vessels to dilate and constrict causing a “muscle pump” effect. [iv]


There are several reasons that lead to build up of edema in the body and treatment goals can vary. Massage therapy and physiotherapy can help treat the pain and decreased function of individuals with edema and can significantly improve mobility and independence.

Contact us at the clinic to ask how our therapists can help you!

Written by

Sandra Al Ali
Sandra Al AliRegistered Physiotherapist
Sandra Al Ali is passionate about working collaboratively with patients to help them return to doing the things they love. She takes an active and evidence-approach to treatment and tailors her approach based on the individual.



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