Tag Archives: lymph nodes

Tmj and MLD

TMJ or Temporomandibular joint is bilaterally located on the side of the human head. TMJ and Movement Upper Compartment Protrusion Retrusion Lower Compartment Lower the Jaw Raise the Jaw Lateral Deviation Said so: the opening is the combination of Protrusion plus Lowering the Jaw closing the mouth is Retrusion plus Raising the Jaw. TMJ and Pain When TMJ is in pain, we can find it hard to talk, eat and sometimes even rest, as the pain can be pretty strong. Moving forward, not everyone knows that deep under TMJ we have what we call Parotid Gland. The Parotid Gland is a salivary gland, and if gets infected, it can swallow up and be quite painful. What can happen at the Parotid Gland is an accumulation of calcium in its duct, and saliva can’t be expelled. Even though viruses or bacteria can also be responsible for TMJ infection. What also most people are not aware of is that in the Parotid Gland, there are lymph nodes. TMJ and MLD. The fact that the gland can be swollen is an indication that fluid is stuck in it. MLD, thanks to the boosting of the lymphatic system, which is responsible for reducing swelling in the body, can be the perfect technique to reduce the swelling and so restore the functionality of TMJ. If this post talks to you, book your next massage session by clicking here. The Parotid Gland lymph nodes unload their Lymph Obligatory Load into the cervical nodes. So as per usual, at the start of the MLD treatment, we will work along the upper neck, medial neck and then the terminal (just between the clavicle and the upper trap). In addition, what makes a difference with MLD is that is a pain-free technique. That would allow the client suffering from TMJ pain to receive a treatment that would not aggravate the pain feeling and would end up giving a deep relaxation too. Other work techniques can be used, such as Myotherapy and Remedial Massage trigger point, or dry needling for Myotherapy treatment. The Remedial Massage TMJ treatment is a valuable technique but would not resolve the problem at the root cause. In conclusion, MLD is probably the best manual, not invasive treatment that can be done for TMJ. Talk to your dentist about this option, and if they are not aware of what MLD is, don’t be surprised, it is, yes an excellent technique, but it is still not well known by many practitioners, dentist included.      

Range of Motion

Range of Motion Cervical Lateral Felxion

Range of Motion is the movement of a joint within a 3-dimensional space. For each joint, we expect a minimum and a maximum degree of movement. When to use a range of motion evaluation. Before performing a Myotherapy, Remedial Massage, or a Thai massage session, we check for a Range of Motion, also know as ROM. Checking for ROM is to establish the functionality of the joint and the muscles that surround it. For example, when a client walks in complaining of cervical pain, the first thing we look in too after the postural assessment is the ROM. A postural assessment is an evaluation of the skeletal structure. After that, we ask the client to do specific movements with their head. Like, Rotation side to side, flexion, extension, and lateral flexion. Indeed, these are the basic range of motion for the cervical area. What this range of motion can tell us? Well, depending on the essential mobility of the person, we expect a minimum and maximum range. Let’s say that the client has average mobility; we expect the range of motion of their cervical to be: Flexion (able to flex the head forward and leave a gap of 3cm between the chin and the sternum) Extension, we look in too 70° of movement Lateral Rotation we look in too 80° of rotation (the chin is nearly in line with the shoulder) Lateral Flexion we look in too 45°. If this post talks to you, book your next massage session by clicking here. Are the range of motion movements the same for everyone? A person with a hypermobile joint range may have a 10° about less ROM than this. Indeed, a person that has a hypermobile joint range can reach 10° furthermore. That’s why every person needs his evaluation. Moving forward, if the range of motion is limited, it could be a muscle tightness or a joint mobilization issue. The best approach for improving joint mobilisation is the Myotherapy treatment or Thai Massage.  Both techniques relieve muscle tension and improve muscle tone and joint mobility. The release of tension from the muscle would improve the ROM. On the other hand, when we ask a client to do a ROM, we don’t look only for the length of movement. Quality of movement. For the quality of movement, we refer to how smooth the movement is. Is the client trying to compensate for the cervical rotation by flexing the head? Is the client compensating for the flexion by shrugging the shoulder? Indeed, the movement of a joint is the key to understanding what muscle is responsible for the pain, discomfort or limited ROM. Once we individualise the key muscle/s, we can address the issue. Different types of ROM. In conclusion, the ROM can be active, passive and resisted. The client itself does active ROM. Passive are ROM done by the therapist with no assistance in controlling the movement by the client. Reisted is ROM active done by the client, with a resistance force applied by the therapist again the client’s movement. Each of this ROM can tell us something different about the joint. Active is about muscle lengthening. Passive is about joint mobility (ligament and tendon) Resisted is about the strength of the muscle. We can’t use the Resisted if Active or Passive reproduces pain. That would not be safe. Regarding the Resisted ROM, the resistance is applied in 3 different levels. When the pain gets reproduced, we stop the test. Occasionally, an orthopaedic test can be performed too. Orthopaedic tests are specific tests to evaluate in specific the muscle involved in the limited ROM.  

Pain and MLD

MLD on Lower Leg

MLD and Pain. As previously mentioned, MLD is a massage technique pain-free. This is one of the reasons that makes it so special. It doesn’t matter where the technique is applied, the touch has to be so light, that the patient doesn’t have to feel any pain. And believe it or not, MLD can be applied right after surgery, when you get sunburn or right after physical trauma. Indeed, what MLD does is prevent the body to feel the pain. So, in order to explain this, I may use the mosquito bite example. When a mosquito bites us, after several minutes we start to feel itchy. In fact, the first auto-reaction is to start stretching the body. What does the scratching do? Firstly, by scratching, we stimulate the mechanoreceptors of the skin. The mechanoreceptors, send a signal to the spine (to CNS) that inhibit the pain receptors, which are constantly stimulated from the mosquito bite. Indeed, the pain receptor can be stimulated once and keep reacting, whereas the touch receptors, in order to be activated need constant stimulation. Now, in MLD that’s what we do, we constantly and gently stimulate the mechanoreceptors. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. In fact, we keep inhibiting the pain receptors, reducing the pain signal frequency. Secondly, and no less important, by stimulating the lymphatic system activity, we reduce the amount of nociceptors. Per nociceptor, we refer to the actual sensory neuron that transports the pain signal to the spine and brain. Furthermore, by reducing the pain, the client can start experiencing a high state of relaxation. Indeed a high state of relaxation is another efficient way to deal with pain and eventually pour mobility, due to the injury the client is dealing with. In conclusion, this is how MLD can reduce the pain in an injured area.

The importance of Manual Lymphatic Drainage

Giovanni giving MLD on patient's calf

Manual Lymphatic Drainage if used along the correct type of condition, is a safe and well utile manual therapy. In the previous two blogs (Link 1, Link 2) I described how the Lymphatic System works and its relation to MLD. What body find benefit from Manual Lymphatic Drainage? As previously mentioned, the lymphatic system is so important to keep the homoeostasis of the body. Indeed, along with the following conditions, homoeostasis is compromised: Skin Burn Chronic Inflammation (plantar fascitis, tendinitis…) Lymphodema Oedema Scar reduction and prevention Pre and post-operation body rehabilitation Improving the bell function Head-each Skin puffiness and or Acne and more… How can Manual Lymphatic Drainage help with these conditions? Firstly, what all those conditions have in common, is that they are related to how the Lymphatic System deal with them. So again, the healthier and more vital is the lymphatic system, the better the body’s homoeostasis. If we look into oedema due to a hammered hand, we need a responsive and well-functioning lymphatic system to absorb that swelling. The stronger the lymphatic system, the quicker the healing process will be. Even a scar from a post-operation could heal faster if the lymphatic system gets adequately stimulated. More nutrients and less dangerous components will float around the wound if the lymphatic system works stronger. Secondly, some of these conditions are so painful that a massage is not applicable. As we applied MLD, we would not increase the pain, thanks to the light touch. If this post is talking to you, and you need a massage, book your next session by clicking here. Why should MLD not be painful? When we apply the different strokes by dragging the skin gently around, we will stimulate the lymph vessels to collect the obligatory lymph load. Still, we will not generate pain by stimulating pain receptors. Furthermore, the repetitive mechanical stimulation would activate what in science is called the gate theory. The gate theory looks into the interneurons’ inhibitory response, which reduces the pain signal reaching the brain, consequently decreasing the pain response. MLD and coontroindications. MLD can’t be applied to Acute infection, Untreated Cancers, Untreated Thrombus, Congestive heart failure, or intoxicated persons. Minor contraindications include Hypertension/Diabetes n1, Autoimmune disease, Asthma, Hypo/Hyperthyroidism, pregnancy, and a history of tuberculosis. In conclusion, I am honoured to have the knowledge and the skill to use and apply such a technique. Even though, for now, I can’t yet treat people with Lymphodema and or clients who had lymph nodes removed or are looking for a post-cancer treatment. What I got to offer to this patient, anyway, is a reference for other practitioners. So if this is you, please get in touch with me, and I can refer you to your nearest practitioner.      

Arm Lymphoedema Quiz

Based on the original document - Piller,NB (2006) Lymphoedema Research unit Department of surgery, Flinders Medical Centre, Bedford Park, South Australia,  5042 (Adapted and reprinted with permission). This guide is designed as an educational aid-based primary on experience, no evidence in literature.

1. More than 10 nodes removed from armpit
2. Radiotherapy to armpit area
3. More than 2 infections (redness) in the limb per year
4. Whole of Breast Removed (Mastectomy)
5. More than 2 but less than 10 nodes removed from armpit
6. Radiotherapy to chest/breast area
7. Fluids drained from wound more than 1 week
8. Infection at the wound site
9. One infection (redness) in the limb per year
10. Heaviness, tightness or tension in the limb at times
11. Frequent cuts/scratches to the limb
12. Dry skin
13. Part of Breast removed
14. 1 or 2 nodes removed from armpit
15. Limb feels different as the day progresses

OTHER PROBLEMS WHICH MAY ADD TO RISK

16. Body weight is very high (obese)
17. Surgery was on side of dominant hand
18. Generally experience high stress levels
19. Generally have high non-controlled blood pressure
20. Body weight is a little high (overweight)
21. Frequent long distance air traveler
22. Previous or current other injuries to limb/shoulder
23. Thyroid gland activity is not normal and not medicated
24. “At risk” limb is used for repetitive actions
25. Often carry heavy loads for long periods using “at risk” arm
26 Smoking is currently part of my life
27. Swelling was present in limb prior to surgery

What to do now?

  • If you are at LOW RISK, then you will benefit from a range of appropriate educational literature that may be able to even further reduce the risk of developing lymphoedema.

  • If you are at MODERATE or HIGH RISK, then the educational materials will also benefit you. Ideally, if you are in these categories, you should have a non-invasive assessment (Bio-impedance spectroscopy or Tissue Dielectric Constants) to determine if there are already some fluid accumulations in your "risk" limb.

Independently of your level of risk, Giovanni offers 15-minute Online Consultation to better guide you on how to manage this presentation, or prevent any degeneration.

Book your free 15-minutes online consultation now.

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Lipedema Quiz

This is not a diagnostic tool but only a guide.
To learn more about the Lipedema presentation, contact Giovanni by sending the result, or booking a free 15-minute online consultation. Be sure to include your full name and email address in the form below (At the end of the quiz).

If you prefer to contact Giovanni anonymously, call with a private number at 0449790781.

Texture of fatty tissue may feel granular and/orfibrotic
Symmetrical, disproportionate accumulation of fatty tissue (refer to picture on the Lipedema page)
The waist may be small in proportion to thighs, buttocks, and legs
Cuffs or bulges may develop around joints (e.g. ankles, knees, elbows, wrists). Feet remainunaffected unless lymphoedema is a comorbidity
Legs are often hypersensitive to touch and pressureand may feel cold
Affected areas may bruise easily with minimaltrauma
Patients describe affected areas as sore, painful, heavy, swollen and tired
Symptoms can worsen in hot weather, during orafter exercise, standing or sitting for long periods
Fat pads, which can be tender or painful, accumulate on the upper outer thighs, inner thighs, and around the knee area, can cause abnormal gait,and contribute to joint pain
Filling of the retromalleolar sulcus
Hypermobility
Soft, thin skin with loss of elasticity. Skin can havea lumpy appearance.
Non-pitting oedema and negative Stemmer’s sign on feet and hands in the absence of coexisting lymphoedemaPitting oedema is when by appling pressure to the area with a finger, for more than 60 seconds, you get left an indentation in the skin.
Difficulty losing weight from affected areas despite exercise, modified diet or bariatric surgery. If well-directed, these measures may help reduceinflammation and co-existing obesity if present
Abnormal nerve sensations
Pain on blood pressure check (larger cuff may berequired)
Relatives with similar body shape or fat distribution

Out of 17 questions, the number above, tells you how many symptoms applies to you. The more symptoms, the more luckily you are suffering from a Lipedema presentation. Get in touch with Giovanni now, via the form below, for further understanding on how to manage Lipedema presentation.

Reference list

This quiz is a reproduction of a flyer from the association Lipoedema Australia.
The reference list is Adapted from 1, 4, 5, 6, 7, 8, 9, 12, 13,14[1] , 16, 18 and available here (PDF).

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Leg Lymphoedema Quiz

Based on the original document - Piller,NB (2006) Lymphoedema Research unit Department of surgery, Flinders Medical Centre, Bedford Park, South Australia,  5042 (Adapted and reprinted with permission). This guide is designed as an educational aid-based primary on experience, no evidence in literature.

1. More than 10 nodes removed from the groin
2. Radiotherapy to the groin/pelvic area
3. Average of more than 2 infections (cellulitis) in the limb per year
4. Dry or scaly skin on lower legs/feet
5. More than 2 but less than 10 nodes removed from groin
6. Fluids drained from wound more than 1 week
7. Infection at the wound site after surgery
8. Average of one infection (cellulitis) in the limb per year
9. Frequent cuts/scratches to the limb
10. 1 or 2 nodes removed from the groin
11. Heaviness, tightness or tension in the limb at times
12. Limb feels worse as the day progresses

OTHER PROBLEMS WHICH MAY ADD TO RISK

13. Family history of leg swelling
14. Frequent long distance air/bus/car traveler
15. Previous or current other injuries to legs, ankles or feet
16. Limb is most often in a dependant position (standing)
17. Generally experience high stress levels
18. Generally have high blood pressure
19. Thyroid gland activity is not normal and not medicated
20. Diabetic but controlled by diet or medication
21. Diabetic uncontrolled
22. Some varicose veins or spider veins
23. Many varicose veins or spider veins
24. Prior varicose vein stripping and scars
25. Smoking is currently part of my life
26. Body weight is a little high (overweight)
27. Body weight is very high (obese)
28. Diet is rich in animal (omega 6) fats
29. Swelling was present in limb prior to surgery/radiotherapy

What to do now?

  • If you are at LOW RISK, then you will benefit from a range of appropriate educational literature that may be able to even further reduce the risk of developing lymphoedema.

  • If you are at MODERATE or HIGH RISK, then the educational materials will also benefit you. Ideally, if you are in these categories, you should have a non-invasive assessment (Bio-impedance spectroscopy or Tissue Dielectric Constants) to determine if there are already some fluid accumulations in your "risk" limb.

Independently of your level of risk, Giovanni offers 15-minute Online Consultation to better guide you on how to manage this presentation, or prevent any degeneration.

Book your free 15-minutes online consultation now.

Save as Draft

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