This blog will explore infrared saunas and lymphedema, but keep in mind, it not replace the experience and recommendations of your health care professional.
What is Lymphedema?
Lymphedema is a swelling condition in which lymphatic fluid builds up in the body. Lymphatic fluid is a protein rich fluid that the lymphatic system, should return to the blood, but when it pools in one place, it creates swelling and inflammation. This inflammation leads a build-up of fibrotic tissue and a thickening of the skin.
Lymphedema is both chronic and progressive and the progressive element comes from the inflammation and fibrosis, so finding a treatment that can halt or reverse this will help a lot of people. This is where infrared therapy could potentially help.
When people ask me about infrared saunas, I think they are picturing a full body sauna – like a Finnish sauna, but with the addition of the red lights, or some might think of the single seat capsule devices, in the body is within the capsule, but the head remains out. While these infrared saunas are more accessible to people outside of a research setting, sadly these types have not been studied for lymphedema.
Instead, all the research that I could find on infrared sauna and lymphedema used a device made at the Jiao Tong University affiliated with the Ninth People’s Hospital in Shanghai. This device generates infrared radiation with 6.0 and 14.0 micromolar wavelength using a ring of eight far infrared quartz lamps, surrounded by a stainless steel casing (Li, 2017 and 2018). This is not a full body device, as only the lymphedema limb, either the arm or leg is inside the device.
During treatments, only the affected limb is in the device which is set to maintain 42C during the treatments aimed to achieve skin temperature of 39.5 +/- 0.5C. While, it’s exciting to read what was done in these treatments and the positive results…because the device is so different from a full body infrared sauna that you might find at your local health club, I think it isn’t wise to extrapolate the results. But, I’m sharing to help generate interest in this topic, some discussion and potentially some research if the medical community is as intrigued by this as I am.
All of the research on the subject of infrared saunas for lymphedema that I could find is published by Dr K Li, MD, from Shanghai, China. I’ll share three of the studies with you below, but first, let’s answer some questions.
What is Far-Infrared Light?
Infrared rays can be; near infrared/short wave and far infrared/long wavelength. The far infrared region of the light spectrum lies beyond the red end of the visible range. Among the different light rays, the far infrared rays are the most beneficial for living beings. Far infrared rays are able to penetrate the skin layers and resonate with water and organic molecules of our body.
What is an Infrared Sauna?
This is a sauna that uses light, specifically red light from the far end of the light spectrum to generate heat. In contrast, a Swedish sauna uses heat to warm the air which warms you up as you sit in there, while an infrared sauna, heats your body directly, as the red light can penetrate your skin.
You would still experience similar feelings of a traditional sauna, ie. sweating, increased heart rate, but this will happen at a lower air temperature in an infrared sauna. The potential health benefits of infrared saunas, have been examined for people with a variety of health conditions such as high blood pressure, heart failure, diabetes, and arthritis. I won’t get into those results in this blog though, as I want to focus on lymphedema.
Far Infrared Sauna vs Finnish Sauna
With a Finnish sauna, dry air heated to 150-195F (80-100C) within a wooden structure with wood benches with 10-20% humidity usually for 5 to 20 minutes with cooling off periods in between. In contrast, far infrared saunas, heats your body through infrared light.
The infrared sauna does not heat up to the same temperature and can be more comfortable for people. The temperature inside an infrared sauna is typically 110-135F (43-57C). Infrared saunas tend to be more comfortable for people who can’t tolerate the higher temperature of a Finnish sauna. Let’s look at three studies on people with lymphedema using far-infrared therapy.
Study #1. Far-infrared Therapy on Leg Lymphedema, 2017
In this study, 64 women who had been treated for gynecological cancer (31% cervical, 8% ovarian and 61% endometrial cancer) with stage II to II lymphedema in one leg for at least one year were included.
In addition, the women had an outbreak of dermatolymphangioadenitis at least once in the previous year. Dermatolymphangioadenitis (dermato-lymphangio-adenitis) – is inflammation and infection of the skin over the lymphedema tissue. The symptoms are pain, red rash (erythema), red streaks that align with the superficial lymphatics, lymph node swelling, and fever.
Treatment
The women received five treatments per week for four weeks, for a total of 20 sessions. The leg was kept in the far-infrared machine pictured above for two hours at a time at a temperature of 107.6F (42C).
The women were followed for one year after treatment to assess the number of episodes of dermatolymphangioadenitis they experienced, so that this could be compared to the number before treatment.
Results
Dermatolymphangioadenitis Frequency
Before treatment, the mean frequency was three times per year. After infrared treatment, the mean frequency reduced to less than once per year. Seventy eight percent of the women did not have any Dermatolymphangioadenitis at all in the year after treatment.
Lymphedema Symptoms
Lymphedema symptoms of tightness, heaviness, pain, hardness, soreness, discomfort, heat, fullness, tingling, limb weakness and numbness were all significantly improved after the infrared treatment.
Quality of Life
Quality of Life scores increased significantly. The tool used to measure this was the Functional Assessment of Cancer Therapy- General (FACT-G), which is a 27 item questionnaire completed by the patient to identify four aspects of well-being including physical, social, emotional and functional.
Laboratory Testing
Of the original 64 patients, eleven (17%) were randomly selected to have blood and lymphedema fluid samples taken. The levels of interleukin-1beta were significantly increased after infrared therapy. Why would this be? One explanation is that, the rise in temperature in the lymph improved the body’s nonspecific immune response, and allowed the previously static lymph to move which allowed the immune cells to be reintroduced to the area.
In contrast, other interleukin levels, specifically IL-2, IL-10, IL-18 were decreased. None of the other blood or lymph samples were changed with the treatment. Interleukin-10 (IL-10) is considered an anti-inflammatory cytokine and is secreted by many cells. The fact that it reduces after infrared therapy may be an indication that there is a lower demand for anti-inflammatory cytokines. While the explanations to make sense of the findings are just theory at this point, overall, the authors described the laboratory findings as an improvement in immune dysfunction.
Bottom Line on Study #1
The 64 women with lymphedema secondary to gynecological cancers improved their lymphedema symptoms, frequency of skin infections, and quality of life. Changes in blood and lymph inflammatory markers could be interpreted as representing improvements in immune dysfunction.
Study #2. Effects of Infrared Sauna on Lymphedema Fluid, Fat, Protein and Hyaluronan, 2017
In this study, 32 people with stage II and III lymphedema and repeated episodes of cellulitis were given infrared treatment. Of these 32, 11 had arm lymphedema and 21 had leg lymphedema. They were treated with far infrared radiation by having the limb encased in the far-infrared capsule pictured above for 2 hours a day at 42C (107.6F) for four weeks – a total of 20 treatments.
Results
Extracellular Fluid Weight and Circumference Measurements
The far infrared radiation treatment reduced the weight of the fluid in the lymphedema limb. It also reduced the circumference measurements of the limb.
Skin Thickness
The far-infrared radiation treatment reduced the thickness of the skin and subcutaneous tissue.
Fluid, Fat, Protein and Hyaluronan
The far-infrared treatments reduced the amounts of fluid, fat, protein and hyaluronan in the lymphedema limb. Hyaluronan or hyaluronic acid is one of the major components of the interstitial tissue. Along with fluid, fat and protein these are the major constituents of lymph.
Bottom Line on Study #2
Thirty two men and women with arm and leg lymphedema reduced the weight of their lymphedema fluid, reduced their circumference measurements, skin and subcutaneous skin thickness after 20 treatments of far infrared therapy. The quantities of the the major constituents of lymph; fluid, fat, protein and hyualuronan all reduced.
Study #3. Far-Infrared Therapy and Fibrotic Lymphedema, 2018
In this study, 64 patients with stage II and III lymphedema with fibrotic tissue were recruited (li, 2018). Eighteen had arm lymphedema and 26 had leg lymphedema. They had lymphedema from a variety of causes, including: breast cancer (25%), cervical cancer (19%), primary lymphedema (16%), ovarian cancer (13%), infection (9%), uterine cancer (6%), venous insufficiency (3%), Hodgkin’s lymphoma (3%), trauma (3%), and other (3%).
They completed 20 sessions of far infrared radiation thermotherapy for two hours at a time. The sessions took place every day Monday to Friday for four weeks. The temperature inside the machine was 42C.
Results
Skin elasticity and Fibrous Banding
The skin elasticity improved significantly with the far infrared treatment. Fibrous banding as visualized via ultrasound– substantially reduced.
Inflammation
Inflammation levels in lymphedema fluid (IL-18 and TGF-beta1) reduced. What is TGF-beta1? TGF-beta1 is a cytokine (an inflammatory messenger) that is influential in fibrosis development. It is present in higher numbers in people with chronic lymphedema and fibrosis. The serum cytokine concentrations had no change in values.
Bottom Line on Study #3
Sixty four people with fibrotic lymphedema in their arm or leg completed 20 sessions of two hours each of infrared treatment. The skin elasticity improved as did the fibrotic banding visible on ultrasound. There was a reduction of inflammation, as measured by IL-18 and TGF-beta1.
Study #4 Gynecological Cancer and Far-infrared Sauna
I’ve found another abstract with several authors, including the same author of the studies above, but so far, have not been able to get my hands on the full study (Xia, 2022). Once I get it, I can update this blog post.
How Does Infrared Sauna Help Lymphedema?
The infrared capsule used in this research generates far-infrared light which produces three things: 1) radiation, 2) resonance (vibration) and 3) heat within the body.
The human body has a high water content – about 55-60% for female and male adults. As the far infrared rays come in contact with the body water, it heats it up, which increases the tissue temperature. The body’s response to this is the dilate the blood and lymph vessels. This increases the circulation of blood and lymph. There also appear to be anti-fibrotic effects as the fibrotic tissue softens with the far infrared radiation. In addition, the heat caused both the blood and lymphatic vessels to expand and this improves the flow which improves the microcirculation and increases immune system activation.
The increase in local immune cells leads to increased cytokine production. The increase in activated macrophages (big eater cells) phagocytize (eat up) and hydrolyze excess proteins present in the lymphedema tissue, which reduces the pressure. The oscillation results in the breakdown of large molecules of protein that are present the the lymph.
Lymphedema Management
These researchers of these studies point out that, as helpful as the far-infrared treatments were, patients who don’t follow this up with compression therapy, could have their fibrosis return.
If you need to find a certified lymphedema therapist, then check out this list of resources to help you find on in your area.
If you would like to read about other forms of heat treatment for lymphedema check out my blog on Heat Therapy for Lymphedema.
If you would like to watch a recorded webinar on low level laser – which also uses the far infrared spectrum to treat lymphedema, check out this webinar on low level laser with Ann Angel, the maker of the only FDA approved laser to treat lymphedema.
Want to find out about other complementary therapies for lymphedema? Watch my webinar series.
Is Infrared Sauna Safe for Lymphedema?
The current position paper on Risk Reduction from the National Lymphedema Network states “avoid exposure to extreme heat and cold”. This was last updated in 2012 and the organization has plans to update all of their position papers (NLN, 2012). There were no side-effects or adverse reactions reported in these publications, which is great news for people looking to help reduce lymphedema swelling and fibrosis.
Is Infrared Sauna Good for Lymphedema?
I enjoy learning about new things and what could be on the horizon to help treat lymphedema and I generally find that leaves me feeling very optimistic about future treatments. While heat is often something that people with lymphedema fear, this research breaks that taboo by applying heat in a controlled environment to produce positive results.
What does this mean for you if you have lymphedema now? Unfortunately, the heat that was applied in this research was such a specialized and controlled experiment, it would be difficult to predict what the outcome would be by going to a far-infrared sauna.
One of the biggest differences being that, far-infrared saunas that are available to consumers include either the entire body or the body without the head. Will this have the same positive impact as exposing the limb only? We don’t know. Also, this treatment was intense – two hours per day for 5 days a week for four weeks. Could less far-infrared light produce positive results and if so, what amount would do that? Unfortunately, we don’t know that either.
When I checked clinicaltrials.gov there are not any studies registered at the moment using far-infrared light for lymphedema. But if you want to check for updates yourself, go to ClinicalTrials.gov
Should you use far infrared sauna with your lymphedema?
Discuss it with your lymphedema therapist, share the experiences you’ve had with heat exposure with your lymphedema to date and you can share this blog with your health care professional if they want convenient access to the research that’s been published so far.
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References on “Is Infrared Sauna Good for Lymphedema?”
Li K, Zhang Z, Liu NF, et al. Far-infrared radiation thermotherapy improves tissue fibrosis in chronic extremity lymphedema. Lymphat Res Biol. 2018;16(3):248–257. doi: 10.1089/lrb.2016.0057.
Li K, Liu NF, Zhang YX. Therapeutic effects of far-infrared ray in treating chronic lower extremity lymphedema with dermatolymphangioadenitis. J Shanghai Jiaotong Univ (Med Sci). 2018;38(9):1059–1065.
Li, K., Zhang, Z., Liu, N. F., Feng, S. Q., Tong, Y., Zhang, J. F., Constantinides, J., Lazzeri, D., Grassetti, L., Nicoli, F., & Zhang, Y. X. (2017). Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis. Lasers in medical science, 32(3), 485–494. https://doi.org/10.1007/s10103-016-2135-0
Xia, L., Cui, C., Nicoli, F., Al-Mousawi, A., Campisi, C. C., Lazzeri, D., Liu, N. F., Xie, B., Li, K., & Zhang, Y. (2022). Far Infrared Radiation Therapy for Gynecological Cancer-Related Lymphedema Is an Effective and Oncologically Safe Treatment: A Randomized-Controlled Trial. Lymphatic research and biology, 20(2), 164–174. https://doi.org/10.1089/lrb.2019.0061
