{"id":9514,"date":"2023-08-30T00:28:06","date_gmt":"2023-08-29T22:28:06","guid":{"rendered":"https:\/\/pes-luxembourg.lu\/bascharage\/lymphatic-drainage\/"},"modified":"2024-01-24T16:20:58","modified_gmt":"2024-01-24T15:20:58","slug":"lymphatic-drainage","status":"publish","type":"page","link":"https:\/\/pes-luxembourg.lu\/bascharage\/en\/lymphatic-drainage\/","title":{"rendered":"Lymphatic drainage"},"content":{"rendered":"
Physiotherapy techniques used in the treatment of limb lymphedema are evolving. Based on the facts, it is now possible to recommend an approach using recognized techniques: manual drainage, decongestion bandages and pneumatic pressotherapy.<\/p>\n
The observation of a wide range of results has enabled us to reconsider the application of certain techniques and improve their implementation. This is always strictly personalized to the patient’s clinical situation.<\/p>\n
Successful treatment results depend on the combination of these techniques. Lymphedema is a chronic disease, and once treated, it requires the use of compression stockings, maintenance physiotherapy and therapeutic education, otherwise the benefits of decongestion will be lost.<\/p>\n<\/div>
Lymphedema is excess interstitial fluid caused by a deficiency in the lymphatic system. Classically, a distinction can be made between primary and secondary lymphedema.<\/p>\n
In both cases, tissue infiltration is achieved by exaggerating the concentration of high-molecular-weight substances (HMW), which only the lymphatic system can absorb and return to the bloodstream. Their hydrophilic properties capture a large number of water molecules, which cause the limb to swell.<\/p>\n
Subsequently, with chronicity, the initially fluid edema thickens in structure, with the appearance of two phases: one fibrous, the other fatty. Lymphedema is a chronic, permanent condition with a progressive tendency.<\/p>\n
Decongesting lymphedema involves not only dehydrating the lymphedematous area, but above all draining the SHPM. In parallel with these tissue changes, the lymphatic system has undergone a host of anatomical and functional modifications, which must be taken into account when updating its management.<\/p>\n<\/div>
The initial rapid decline has stabilized at a minimal level. Only in very exceptional cases does this minimum level correspond to the volume of the contralateral limb, which is assumed to be normal. This observation leads to three recommendations:<\/p>\n
This three-step cycle can be repeated regularly for lymphoedemas that have not stabilized. The third phase seems to be decisive for maintaining results.<\/p>\n
Observation of perimeter reductions, which are rapid in the initial treatment, means that bandages need to be readjusted after each session. To avoid this constraint, it has been proposed to apply orthoses of successively smaller sizes. This approach has been evaluated in the context of secondary lymphedema of the upper limb. It does indeed relieve limb congestion, but less so than bandaging. As a result, a bandaged approach is recommended.<\/p>\n
The duration of the initial treatment is well evaluated. It must be carried out intensively, with once-daily or twice-daily care, 5 days a week. Most of the decongestion is already achieved within the first week. In most cases, the duration of this treatment should not exceed 2 weeks. This mostly outpatient approach may be taken up in hospital under certain conditions.<\/p>\n<\/div>
“Manual drainage is an original form of massage that uses a series of maneuvers to roll off the skin with the hand or both hands, one or more fingers, or a single fingertip. What they have in common is a blotting motion, i.e. an unrolling movement without slipping, which is repeated several times on the spot. These maneuvers are characterized by a contact that starts upstream of the edema and moves downstream, in the direction of the subject’s return circulation. These maneuvers are performed by stretching the skin and applying specific pressure. By increasing tissue pressure, they enhance veno-lymphatic resorption and evacuation of captured fluid. They also move edema into the interstitial zone. The right choice of maneuver direction is of vital importance, as it can move the edema from one area in circulatory insufficiency to another in good health”.<\/p>\n
Manual drainage is a circulatory massage technique that aims to reproduce the two stages of lymphatic function: resorption and evacuation of lymphedema fluid. Under certain conditions, this technique can also be used to displace it from the interstitial environment.<\/p>\n
While manual drainage is recommended, it is important to specify the form in which it should be performed. This technique can be applied in a wide variety of ways, from identical stereotyped reproductions close to the trainer’s dogma, to the most eccentric adaptations. How to find your way around?<\/p>\n
DM on lymphedema differs considerably from that on healthy subjects. Whether primary or secondary, lymphedema is a pathology that leads to anatomical and physiological changes in the lymphatic system. Very early on, lymphatic pathways undergo numerous changes. The anatomy of the lymphatic channels is sometimes transformed.<\/p>\n
Recordings of endo-lymphatic and tissue pressures show marked and sometimes very significant increases compared with healthy subjects. Initial lymphatics are saturated and spontaneous resorption is deficient. Vessel dilatation and valvular incompetence appear.<\/p>\n
The lymphangions’ emptying capacity is impaired, and their contractile properties may have completely disappeared. As the pathology worsens, spontaneous lymph flow diminishes or even disappears. Re-priming can be achieved by simple massage. But this positive response to massage cannot be generalized.<\/p>\n
Based on current knowledge, the following adaptations can be proposed:<\/p>\n
Highly adaptable by professional hands, manual lymphatic drainage can be adapted to the pathophysiology of any stage or evolution of any lymphedema. And while it doesn’t offer very significant volume reduction, it does have the potential to absorb proteins. Performed over a bandage or prior to its application, it optimizes lymphedema volume reduction. Combined with bandages, DM increases decongestion.<\/p>\n<\/div>