Email: enquiries@physiopod.co.uk
Follow:                  SEARCH

Clinical Case Report: Multimodal Therapy for Severe Head and Neck Lymphoedema and Fibrosis Driven by Deep Oscillation

Head and Neck Lymphoedema (HNL) with severe fibrosis affects up to 90% of those treated for Head and Neck Cancer (HNC). This report from Lila Hipwell-Larken BSc, details multimodal therapy, using Deep Oscillation Therapy (DOT) as a crucial adjunct for patient HMTTC. DOT drove rapid reduction in oedema, pain, and fibrosis, resulting in significant improvements in function and Quality of Life (QoL)

 

Lila top image

head with lymph vessels

Patient ID: HMTTC        
Deep Oscillation Treatment Duration/Frequency: Initial intensive phase (Once per week), progressing to maintenance phase (Once every 3 or 4 weeks)
Date of Assessment: 13th September 2025    

Introduction

Head and Neck Lymphoedema (HNL) is a common chronic sequela following HNC treatment, estimated to affect up to 90% of individuals [1, 2]. HNL frequently presents with fibrosis and scarring due to the effects of radiation and surgery, often resulting in complex complications that severely impact function and emotional well-being [2, 3]. This report details the successful management of patient HMTTC, utilising Deep Oscillation Therapy (DOT) as a crucial adjunct. This multimodal approach is necessary because the British Lymphology Society (BLS) Position Document (2024) confirms the evidence base for Manual Lymphatic Drainage (MLD) efficacy in HNL is limited in terms of abundance and quality and recommends MLD should not be used as a stand-alone treatment [4]. Early intervention with powerful adjunct therapies is vital for maximizing function and QoL for HNC survivors [3].

Case Presentation

Patient HMTTC commenced management in January 2025, several months post-surgery [5]. Initial physical presentation included severe bilateral neck swelling, a significantly swollen tongue, soreness, and bilateral pain in the mandible, making the jawline invisible [5]. Functional impairment was profound; the patient struggled to speak and swallow, leading to a weight loss exceeding four stone [5]

The therapist's observations emphasised the patient’s psychological state: the patient was "very bewildered, quiet with a sense of lostness," and initially presented as "broken, in physical strength and mind" [5]. This profound psychological distress, combined with functional issues like difficulty eating, aligns with findings that chronic HNL causes distress and anxiety [3, 6]. Lymphoedema often develops near surgical sites because lymphatic pathways do not reestablish themselves across scars [7].

Intervention

The multimodal treatment plan addressed both the fluid component and the severe tissue hardness:

  1. Photobiomodulation (PBM): This non-invasive tool was utilized prior to DOT, contributing to pain reduction, decreased congestion, and reduced oedema [8]. PBM is proposed in scientific literature to mitigate pro-inflammatory cytokines and encourage lymphangiogenesis [8]. PBM led to an overall improvement in symptoms, including loosening of phlegm [5, 8]
  2. Manual Lymphatic Drainage (MLD): MLD techniques were incorporated, including Fluoroscopy Guided MLD (FG-MLD) principles. FG-MLD is noted in literature as an alternative form of MLD that assists in the movement of interstitial fluid [9].
  3. Deep Oscillation Therapy (DOT): Applied gently via the therapist's gloves, [10, 13] DOT is a non-invasive treatment that generates deep resonance vibration through the entire depth of the tissue layers (skin, subcuateous fat, blood and lymph vessels, muscles, and connective tissue) to a depth of 8 cm [10, 23] The patient found DOT highly valuable because it was gentle and non-invasive, preferring it over the potential manipulation and heavy handedness they had been dreading [5, 10]. The patient was "particularly impressed" with DOT, noting only a slight vibration and buzzing in the ears [5].

Absolutely, Julie — thanks for pointing that out! Here's an updated figure legend that reflects the broader therapeutic scope of the DEEP OSCILLATION® Personal Pro device: --- **Figure Legend:** *Facial Application of DEEP OSCILLATION® Therapy Using the Personal Pro Device* This image illustrates the application of DEEP OSCILLATION® therapy to the face and cervical region via vinyl gloves, allowing electrostatic impulses to be transmitted through the therapist’s hands for targeted tissue stimulation. The treatment supports a wide range of clinical indications including lymphoedema, lipoedema, post-operative recovery, pain management, fibrosis reduction, wound healing, and enhancement of physical performance and recovery. Shown on the right is the DEEP OSCILLATION® Personal Pro device by PHYSIOMED, designed for both clinical and personal use. It features pre-programmed protocols for specific conditions such as lymphoedema, alongside a customizable interface that enables users to freely program treatment parameters tailored to individual therapeutic needs. This integration of manual technique with advanced electrostatic therapy exemplifies the versatility and precision of DEEP OSCILLATION® in modern rehabilitation and wellness care

Figure 1 Facial Application of DEEP OSCILLATION® Therapy Using the Personal Pro Device

This image illustrates the application of DEEP OSCILLATION® therapy to the face and cervical region via vinyl gloves, allowing electrostatic impulses to be transmitted through the therapist’s hands for targeted tissue stimulation. The treatment supports a wide range of clinical indications including lymphoedema, lipoedema, post-operative recovery, pain management, fibrosis reduction, wound healing, and enhancement of physical performance and recovery.

Shown on the right is the DEEP OSCILLATION® Personal Pro device by PHYSIOMED, designed for both clinical and personal use. It features pre-programmed protocols for specific conditions such as lymphoedema, alongside a customizable interface that enables users to freely program treatment parameters tailored to individual therapeutic needs. This integration of manual technique with advanced electrostatic therapy exemplifies the versatility and precision of DEEP OSCILLATION® in modern rehabilitation and wellness care.

 

 

Outcomes and Results

before and after

 

Figure 2 Clinical outcomes following PBM and Deep Oscillation therapy for head and neck lymphoedema.

This figure presents pre- and post-treatment. The "Before" images (left) show visible signs of tissue swelling, skin laxity, and fluid retention beneath the chin and along the cervical region. The "After" images (right) demonstrate marked improvements, including reduced oedema, enhanced skin tone, and improved contour of the lower face and neck. These results highlight the synergistic effect of PBM and deep oscillation in promoting lymphatic drainage and tissue regeneration.

 

Practitioner Observations 

Deep Oscillation is demonstrated to be the distinguishing factor in achieving rapid and substantial clinical outcomes as reported in other therapist feedback [13, 14]. In this case report, after the very first session with Deep Oscillation, the therapist observed a significant positive outcome: the patient’s speech significantly improved, tongue size reduced, neck oedema and fibrosis had significantly reduced, and pain in the mandible had gone [5]. The oedema to the lower mandible greatly reduced, and the patient's jawline became visible again [5]. The patient felt much better, less congested, and was able to move more freely [5].

The formal assessment recorded Significant Improvement across crucial domains [5]:

  • Fibrosis and Scar Tissue Reduction: There was Significant softening of fibrotic tissue or scar tissue and a Significant reduction in contractures [5].
  • Functional Gains: Reduction in oedema and fibrosis facilitated better breathing, speech, and swallowing functions [5]
  • QoL Improvement: The patient achieved a Significant overall improvement in Quality of Life, with their overall wellbeing and mindset becoming uplifted [5].

The therapist noted that DOT made the relocation of lymph "Moderately simpler" compared to manual techniques alone [5]

 

DEEP OSCILLATION® Discussion: Mechanism, Effects, and Adherence

 

effects and depth of deep oscillation

Figure 3. Clinical Effects and Tissue Penetration of DEEP OSCILLATION® Therapy 

The left panel shows the clinically observed effects, including pain alleviation, suppression of inflammation, reduction of lymphoedema and oedema in lipoedema, fibrosis prevention, wound healing support, and enhanced physical recovery. Additional benefits include improved trophicity, increased range of motion, functional enhancement, and improved physical activity in patients with chronic obstructive pulmonary disease (COPD). The right panel presents a cross-sectional schematic of human tissue layers—skin, connective tissue, fat tissue, blood and lymph vessels and muscle—highlighting the therapy’s permeations depth of up to 8 cm. Concentric waveforms depict the oscillatory field reaching deep into the musculature, indicating the broad sphere of activity and therapeutic reach of the modality [10].

 

Comparative Mechanisms of DEEP OSCILLATION® Therapy vs. Conventional Electrotherapy This figure contrasts the physiological targets and mechanisms of DEEP OSCILLATION® therapy with those of conventional electrotherapy. The left panel displays microscopic tissue images illustrating the action of DEEP OSCILLATION®, which primarily intervenes in the connective tissue matrix. This modality employs low-frequency electrostatic impulses to generate deep, pulsating oscillations within the tissue, facilitating cellular mobilization, extracellular matrix modulation, and enhanced lymphatic flow. The right panel presents tissue samples affected by conventional electrotherapy, which acts predominantly on the neuromuscular system. This approach stimulates nerve and muscle fibers to elicit motor responses, improve circulation, and modulate pain through neural pathways. Together, the visual and textual elements underscore the distinct therapeutic pathways of each modality—connective tissue modulation versus neuromuscular activation—highlighting DEEP OSCILLATION® as a unique intervention for tissue-level rehabilitation and recovery.

Figure 4. Comparative Mechanisms of DEEP OSCILLATION® Therapy vs. Conventional Electrotherapy

Image contrasts the physiological targets and mechanisms of DEEP OSCILLATION® therapy with those of conventional electrotherapy. The left panel displays microscopic tissue images illustrating the action of DEEP OSCILLATION®, which primarily intervenes in the connective tissue matrix. This modality employs low-frequency electrostatic impulses to generate deep, pulsating oscillations within the tissue, facilitating cellular mobilisation, extracellular matrix modulation, and enhanced lymphatic flow.

The right panel presents tissue samples affected by conventional electrotherapy, which acts predominantly on the neuromuscular system. This approach stimulates nerve and muscle fibers to elicit motor responses, improve circulation, and modulate pain through neural pathways.

Together, the visual and textual elements underscore the distinct therapeutic pathways of each modality—connective tissue modulation versus neuromuscular activation—highlighting DEEP OSCILLATION® as a unique intervention for tissue-level rehabilitation and recovery.

 

Ultrasound Evidence of Oedema Reduction Following HIVAMAT® 200 Treatment with Manual Lymphatic Drainage High-definition ultrasound scans illustrating the impact of a 20-minute session using the HIVAMAT® 200 device in combination with manual lymphatic drainage on lower-limb oedema in patients with lymphoedema and lipoedema. The left image ("Before 20 minutes of treatment") shows a predominance of red pixels, indicating fluid accumulation and tissue oedema. The right image ("After 20 minutes of treatment") reveals a marked reduction in red pixels and an increase in blue pixels, signifying decreased oedema and improved tissue fluid balance. These visual changes suggest the efficacy of DEEP OSCILLATION® therapy in promoting lymphatic flow and reducing interstitial fluid retention. Adapted from Teo et al., Journal of Lymphoedema, 2016, Vol 11, No 1.

Figure 5. High Definition Ultrasound Evidence of Oedema Reduction Following HIVAMAT® 200 Treatment with Manual Lymphatic Drainage

High-definition ultrasound scans illustrating the impact of a 20-minute session using the HIVAMAT® 200 device in combination with manual lymphatic drainage on lower-limb oedema. The left image ("Before 20 minutes of treatment") shows a predominance of red pixels, indicating fluid accumulation and tissue oedema. The right image ("After 20 minutes of treatment") reveals a marked reduction in red pixels and an increase in blue pixels, signifying decreased oedema and improved tissue fluid balance. These visual changes suggest the efficacy of DEEP OSCILLATION® therapy in promoting lymphatic flow and reducing interstitial fluid retention. Adapted from Teo et al., Journal of Lymphoedema, 2016, Vol 11, No 1. [23]

 

Ultrasound Visualization of Lymphatic Fluid Reduction Following DEEP OSCILLATION® Therapy Side-by-side ultrasound scans from The European Journal of Lymphology and Related Problems, Vol. 16, No. 48 (2006), demonstrate the therapeutic impact of a single DEEP OSCILLATION® session using the HIVAMAT® device on a limb affected by lymphedema. Photo 1 (left) shows the pre-treatment ecographic window with prominent lymphatic lakes, indicating significant fluid accumulation. Photo 2 (right) captures the same anatomical region post-treatment, revealing a marked reduction in lymphatic fluid and increased tissue compactness. These images provide visual evidence of the efficacy of DEEP OSCILLATION® in mobilizing lymphatic congestion and promoting structural normalization of affected tissues. Adapted from Gasbarro et al., EJLRP 16:48.

Figure 6. Ultrasound Visualisation of Lymphatic Fluid Reduction Following DEEP OSCILLATION® Therapy

Side-by-side ultrasound scans from The European Journal of Lymphology and Related Problems, Vol. 16, No. 48 (2006), demonstrate the therapeutic impact of a single DEEP OSCILLATION® session using the HIVAMAT® device on a limb affected by lymphedema. Photo 1 (left) shows the pre-treatment ecographic window with prominent lymphatic lakes, indicating significant fluid accumulation. Photo 2 (right) captures the same anatomical region post-treatment, revealing a marked reduction in lymphatic fluid and increased tissue compactness. These images provide visual evidence of the efficacy of DEEP OSCILLATION® in mobilising lymphatic congestion and promoting structural normalization of affected tissues. Adapted from Gasbarro et al., EJLRP 16:48. [24]

 

The Mechanism of Deep Oscillation and HNL: DOT's unique mechanism lies in its action within the interstitial space of the connective tissue [10]. The intermittent electrostatic field creates a pumping action, facilitating the movement of excess biological matter and protein solids toward the lymphatic system for removal [10, 15]. This mobilisation is critical, as HNL is characterised by the accumulation of stagnant, protein-rich lymph fluid. This action promotes tissue relaxation, moderate vasoconstriction, and favouring oedema reabsorption [10, 16].

Impact on Oedema, Fibrosis, Scar Tissue, and Pain: DOT's effects are clinically effective in reabsorbing oedema and providing analgesic effects [17]. DOT’s anti-fibrous effects achieve the crucial softening of fibrotic tissue and scars, which increases flexibility and mobility, often yielding results that are palpably evident to practitioners [13, 16]. This anti-fibrotic action is especially beneficial in HNL, making DOT "particularly useful in areas harder to massage, such as the head and neck" [10, 12].

Functional Recovery (Speech and Swallowing) and Wellbeing: The reduction in oedema and fibrosis around the airway and oral structures resulting from DOT improves breathing, speech, and swallowing functions [5]. The reduction in discomfort and pain, and enhanced mobility significantly boost emotional well-being [3, 5]

Tissue Quality and Cellulitis Risk: DOT improves circulation and the quality of tissue. The enhanced skin health and resilience observed by therapists reduces the risk of ulceration, infections, and cellulitis [17]. By mobilising debris and proteins in the interstitial fluid, DOT directly lowers the risk of cellulitis formation [12].

DOT and the Glasgow Benefit Inventory (GBI) [9]: The profound physical benefits align with validated outcomes measured by the Glasgow Benefit Inventory (GBI). Studies evaluating HNL treatment found that the average total QoL improvement score was +7.2, with the physical benefit subscale showing the greatest average improvement at +13.1 [9]. DOT contributes substantially to these measurable physical benefits by promoting tissue relaxation and reducing fibrosis.

Adherence and Self-Management: The rapid positive results gained from DOT are crucial for promoting long-term patient adherence [6]. Patients, highly motivated by the efficacy, often choose to buy a personal unit for self-management [18], noting that using the clinic machine means "nothing at all compares", which makes the investment necessary to achieve control over the chronic condition. Patient Corinne described the therapy as a "real game changer" for targeting fibrosis and restoring movement [18]. Other patients, such as Amanda Winter, noted the immediate functional improvement and were straight away advised of the DOT machine's benefits [20]. The patient HMTTC is also looking for regular treatment as it is highly effective at managing pain, discomfort, tongue swelling, congestion in mouth and throat and general oedema [5].

Patient Acknowledgment

We specifically acknowledge the HNC patients, including Corinne and David McConnachie, who have taken the time to share their deeply personal experiences. Their feedback is fundamental in highlighting the physical and psychological benefits of DOT and confirming the need for independent self-management tools to control this chronic condition. 

Practitioner and Educator Acknowledgement

We acknowledge the expert clinical contributions of specialist practitioners and educators, recognising their valuable years of work.

  • Emma Holly, a leading global educator on scar therapy, is acknowledged for her significant endorsement, describing DOT as an "invaluable tool" for gentle, effective, and transformative healing, noting it works through the skin without pressure.
  • Monica Conway detailed how DOT effectively enhances conventional MLD methods, resulting in rapid outcomes, particularly when managing post-radiation fibrosis.
  • Catherine Groom, working in an NHS clinic, noted that DOT significantly enhances MLD, improving outcomes and helping to address challenges like excess swelling, fibrosis, pain, and taut scars.
  • Siobhàn Casey confirmed that DOT delivers substantial and clinically meaningful improvements across structural, functional, and psychosocial domains.
  • Christine Talbot is recognised for demonstrating DOT's immediate impact on a severe HNL patient and detailing how DOT aids circulation by softening consolidation at deeper levels and relieving pain and stiffness.
  • Paola Yañez Chandia for showcasing DOT's ability to address chronic and debilitating symptoms severely impacting daily living.

Thank you to  Lila Hipwell-Larken BSc for submission of this case report.

References

  1. Survey: UK Treatments and Experiences with Head and Neck Lymphoedema (HNL). https://www.physiopod.co.uk/new-survey-hnl.shtml
  2. Rajaram R., Lee J., Lok E., Ng S., and Yamamoto T. (2025). The Management of Head and Neck Lymphoedema: A 2025 Systematic Review. Head & Neck, 47(10): 2897–2910. doi: 10.1002/hed.28265 http://onlinelibrary.wiley.com/doi/abs/10.1002/hed.28265
  3. Starmer H. M., Cherry M. G., Patterson J., Fleming J., Young B. (2023). Head and neck lymphedema and quality of life: the patient perspective. Support Care Cancer, 31:696. doi: 10.1007/s00520-023-08150-2 https://link.springer.com/article/10.1007/s00520-023-08150-2
  4. British Lymphology Society (BLS). (2024). Manual Lymphatic Drainage Position Document. https://www.thebls.com/documents-library
  5. Completed Case Report Questionnaire - Patient ID- HMTTC, Date of Assessment- 13th September 2025, Therapist Name- Lila Hipwell-Larkin. https://www.physiopod.co.uk/case-report-hnl-hipkin-larkin-2025.shtml
  6. Mullan, L. J., Blackburn, N. E., Gracey, J., et al. (2025). Patients understanding, perceptions and experiences... Supportive Care in Cancer, 33(7). doi: 10.1007/s00520-025-09668-3 https://link.springer.com/article/10.1007/s00520-025-09668-3
  7. Warren A. G., Slavin S. A. (2007). Scar lymphedema: fact or fiction? Ann Plast Surg, 59(1): 41-5. doi: 10.1097/01.sap.0000258449.23979.3f https://journals.lww.com/annalsplasticsurgery/Abstract/2007/07000/Scar_Lymphedema__Fact_or_Fiction_.9.aspx
  8. Deng J., Lukens J. N., Swisher?McClure S., et al. (2021). Photobiomodulation Therapy in Head and Neck Cancer?Related Lymphedema: A Pilot Feasibility Study. Integrative Cancer Therapies, 20. doi: 10.1177/15347354211037938 https://journals.sagepub.com/doi/full/10.1177/15347354211037938
  9. Halliday E., Gittins J., & Ahsan S.F. (2020). Using the Glasgow Benefit Inventory questionnaire to quantify the health benefits... Applied Cancer Research, 40, 9. doi: 10.1186/s41241-020-00093-y https://appliedcr.biomedcentral.com/articles/10.1186/s41241-020-00093-y
  10. MLDUK The Journal Autumn 2015: (Jens Reinhold mechanism, 8cm depth, anti-fibrotic effects, useful in hard-to-massage areas). https://www.physiopod.co.uk/assets/images2017/2017-MLD-6pp-web.pdf
  11. Lisa Capitelli: DEEP OSCILLATION® Brings Rapid Head and Neck Lymphoedema Improvements, Often After Just One Session. https://www.physiopod.co.uk/lisa-capitelli-impressed-by-results-of-deep-oscillation-in-head-and-neck-lymphoedema.shtml
  12. Deep Oscillation Enhancing NHS Patient Outcomes in Head and Neck Lymphoedema Care - By Catherine Groom, Specialist Lymphoedema Practitioner. https://www.physiopod.co.uk/deep-oscillation-enhancing-nhs-patient-outcomes-in-head-and-neck-lymphoedema-care.shtml
  13. Impact of Deep Oscillation Therapy on Head & Neck Lymphoedema By Siobhàn Casey, MLD DLT Practitioner. https://www.physiopod.co.uk/impact-of-deep-oscillation-therapy-on-head-and-neck-lymphoedema-by-s-casey.shtml
  14. Addressing Head and Neck Cancer Complications with Integrated Therapies By Monica Conway. https://www.physiopod.co.uk/addressing-head-and-neck-cancer-complications-with-integrated-therapies-by-monica-conway.shtml
  15. Case Study: Use of Deep Oscillation in Secondary Lymphoedema of the Head and Neck By Christine Talbot SRN Lymphoedema Practitioner https://www.physiopod.co.uk/case-study-use-of-deep-oscillation-in-secondary-lymphoedema-of-the-head-and-neck.shtml
  16. Emma Holly of Restore Scar Therapy Recommends DEEP OSCILLATION® Therapy. https://www.physiopod.co.uk/emma-holly-of-restore-scar-therapy-endorses-deep-oscillation-therapy.shtml
  17. Head and Neck Lymphoedema and DEEP OSCILLATION® by David McConnachie (Patient Feedback). https://www.physiopod.co.uk/david-mcconnachie-head-and-neck-lymphoedema-and-deep-oscillation.shtml
  18. Living with Lymphoedema - My Story by Corinne (Patient Feedback). https://www.physiopod.co.uk/living-with-lymphoedema-my-story-by-corinne.shtml
  19. Excerpts from "Regrets in Life? Just The One - Delaying The Purchase of a Deep Oscillation Personal Unit for Lymphoedema Management". https://www.physiopod.co.uk/deep-oscillation-head-and-neck-lymphoedema.shtml
  20. Head and Neck Lymphoedema - Self Management with Deep Oscillation Personal (Amanda Winter). https://www.physiopod.co.uk/head-and-neck-lymphoedema-self-management-with-deep-oscillation-personal.shtml
  21. Feedback: Head and Neck Lymphoedema and Deep Oscillation Treatment in Clinic and at Home (Patient & Practitioner Feedback). https://www.physiopod.co.uk/head-and-neck-lymphoedema-and-deep-oscillation-treatment.shtml
  22. Case Study: Deep Oscillation for Post-Surgical Oedema and Pain Relief | Lic. Paola Yañez Chandia, Physiotherapist, Argentina. https://www.physiopod.co.uk/case-study-deep-oscillation-for-post-surgical-oedema-and-pain-relief.shtml
  23. Hernández Tápanes S. et al (2009): Value of deep oscillation therapy in the healing of AB burns, Cuban Journal of Physical Medicine &Rehabilitation RNPS 2244- FOLIO 148- ISSN 2078-7162 Rev Cub MFR v.2 n.1 City of La Havana Jan-June 2010.
  24. Teo I., Coulborn A., Munnock DA (2016): Use of the HIVAMAT® 200 with manual lymphatic drainage in the management of lower limb lymphoedema and lipoedema. Journal of Lymphoedema 11 (1), 49-53.
  25. Gasbarro V., Bartoletti R., Tsolaki E., Sileno S., Agnati M., Conti M., Bertaccini C. (2006): Role of Hivamat® (deep oscillation) in the treatment of the lymphedema of the limbs. EYPP 16 (48), 13-15.

 

Disclaimer: The clinical content presented in this report is derived solely from the provided source materials (published studies, organisational documents, and clinical/patient records). However, the compilation, structuring, and formatting of this specific case report document were executed by an Artificial Intelligence (AI) model based on explicit instructions.

Citation For Web Article/Case Report:

Lila Hipwell-Larkin (Therapist). (2025). Clinical Case Report: Multimodal Therapy for Severe Head and Neck Lymphoedema and Fibrosis Driven by Deep Oscillation. PhysioPod UK Ltd. Assessment Date: 13th September 2025. Retrieved from https://www.physiopod.co.uk/case-report-hnl-hipkin-larkin-2025.shtml