Tag Archives: swelling

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.      

MLD

MLD

MLD stands for Manual Lymphatic Drainage. As per a deep tissue massage, MLD treatment works on the lymphatic system and not the musculoskeletal system. This technique aims to boost the capacity and ability of the lymphatic system. Manual Lymphatic Drainage history. MLD is a technique implemented by Dr Vodder and his wife, Estrid Vodder, with the help of many other scientists and researchers. Dr Vodder can be described as a visionary of the lymphatic system role. He dedicates his life to the realisation of this technique. Dr Vodder and his wife formulated a series of hypotheses on how the lymphatic system works, and how it is essential to speed up recovery from diverse conditions. All their hypothesis, along the 20th century, were then confirmed and transformed in theory thanks to the works of many other scientists. As per result, after their first few years of hypothesis formulation, in the early 20th century, they could start promoting their work and run seminars and classes about MLD all around Europe. Nowadays, is in Austria in the village of Walchsee -Tyrol -Austria resides the Dr Vodder Academy –Lymphedema Clinic Wittlinger. The Austrian clinic was founded in 1971, and since that, the MLD spread all around the world, with courses that are taught in any continent. The Lymphatic System. To understand the importance of this technique, let’s analyse the body’s anatomy and the lymphatic system’s role. Indeed, for doing so, let’s compare the lymphatic system with the blood circulatory system. Firstly, the lymphatic system is an open system of “capillaries” (lymph vessels) and “veins” (pre-collector and collectors). Secondly, It differs from the blood circulatory system as it transports lymph, not blood, and is open and not closed. Thirdly, the lymphatic system doesn’t have a pump, as is the heart for the circulatory system. In fact, the lymphatic system, pushes the lymph around through a mechanism of osmosis pressure (at the lymph vessels system) and throughout an inner system of inner valves. Furthermore, the lymphatic system has filtering stations: lymph nodes. It is here where specific white cells live. Indeed, the role of the white cells is to help fight back infections carried by viruses and bacteria. Said so, the lymphatic system’s primary role is to collect waste. This happens at two different levels. At the superficial level (80%), where the lymph vessels are (lower dermis and the superficial zone of the subcutaneous tissue) and deep level of the body (20% below the deep fascia) return this waste to the blood system will then direct all the waste to the organs that clean the body, such as liver, kidney etc. How the lymphatic system works. So, our body is covered in skin, right? Below the skin, before the fascia and muscle layers, we got lymph vessels (the equivalent of capillary for the blood system). The lymph vessel spread on a vertical level all along the body in different concentrations. As per role, the lymph vessel collects the Lymph-obligatory load, the waste and excess material the body doesn’t need. Lymph-obligatory load is made from water, protein, lipids, exogenous substances, cells etc… The collection of the lymph-obligatory load comes through a suction and osmosis approach. The lymph obligatory load travels down to the pre-collectors from the lymph vessel. Indeed, pre-collectors are slightly more significant than the lymph vessel Furthermore,  rather than spread along the undersurface of the skin, they travel deep down and pass the lymph fluid to the collectors. As per result, the collectors that interconnect the lymph nodes transport the lymph-obligatory load to the blood circulatory system. Another specification to look for is that the lymphatic system is divided into superficial and deep. But we will look at this specification in the next blog post, where we will also talk about the watershed and body quadrant. Manual Lymphatic Drainage compared to the massage technique. So, now that we have a better idea of what the lymphatic system is and how it works, we can say that massage techniques such as Myotherapy, Thai Massage, Remedial Massage, or even Relaxation Massage are not the most indicated for helping the lymphatic system. They still would improve its work, but as the lymphatic system sits right below the skin and works by light stimulation, the friction and pressure applied with these techniques would be too strong. Even though no damage occurs to the lymphatic system when significant pressure is applied to it.

Functional Test and Shoulder Pain

Empty can test, functional test

Functional test and the empty can test. What is a functional test? What is an empty can test and how does it work? Firstly, functional tests are used to test the strength or load capacity of a single muscle. Secondly, the importance of a functional test is due to avoid misinterpretation of the muscle status and joint health conditions. Furthermore, functional tests can be positive or negative. So, for positive, we refer to a test that gave us the result we were suspicious of. For example, if I do an empty can test, and the client during the test complains of pain in the shoulder acromion, the test is positive. But if for instance, the client complains of pain in another area of the shoulder or arm, the test is negative. Even so, as a therapist, we are aware that other area of the arm or shoulder needs to be looked after. What is an “empty can test”? An “empty can test” is a functional test used to validate the state of health of the supraspinatus tendon, at the high of the acromioclavicular joint. In addition, to better understand how this specific test works, let’s look in too the anatomy of the Supraspinatus m. Origin: Supraspinatus fossa of scapula Insertion: Greater tubercle of the humerus Action: Abduct the shoulder and stabilise the humeral head in the glenoid cavity. As per result, the action of the supraspinatus is to laterally elevate the arm and hold in place the humeral head (the Humerus is the bond of the upper arm). Furthermore, the supraspinatus is one of the rotator cuff muscles. The rotator cuff muscles are: Supraspinatus, Teres minor, Infraspinatus and subscapularis. But let’s get back to the empty can test. The empty can test can be done from seated or standing. In addition, the test is conducted in 2 different stages. Initially, we will ask the client to bring the arm in flexion at about 45° and in abduction at 45°. The arm now is sitting aside from the client’s body, on a diagonal line. Now will ask the client to rotate the arm on itself, as if they are emptying a can. As per the result, if at this stage of the functional tests, the client feels pain in the shoulder at the acromioclavicular joint, the test is positive. If that’s not the case, then we can proceed with the resistant part. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. The resistant part consists of placing our hand on the client’s forearm and asking the client to meet the resistance, at 3 different stages. For each stage, the resistance increases and lasts from 3 to 5 seconds. If during any of the 3 stages the client feels pain, at the high of the acromioclavicular joint, the test is positive. But why the client can feel pain during this type of functional test? To answer this question, we have to look in too the acromioclavicular joint anatomy, but I will talk about this topic in the next blog post.            

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.

(Optional)
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 Questionnaire

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.

(optional)
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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