Manual Lymphatic Drainage
Lymphatic Drainage is a technique that can assist greatly in improving function and appearance to areas of the body affected by
Lymphedema.
Before one can look at what Manual lymphatic Drainage is one has to have an understanding of the lymphatic system, what it does and what happens when it stops working.
Function and anatomy:
The lymphatic system has four major functions:
1. To drain excess interstitial fluid.
2. To transport dietary Lipids from the intestines,
3. To facilitate immune response.
4. To transport Proteins from the blood, through the interstitial fluid and into the lymph vessel system.
The Lymphatic system consists of vessels that are similar to those in the circulatory system, beginning with capillaries, which converge to form larger vessels. These resemble veins but have thinner walls and more valves than veins.
Unlike the circulatory system the lymphatic system is interspersed with bean shaped lymph nodes. These act as filters for the lymphatic fluid, and “garrisons” of T and B immune cells.
The immune cells are not created in the lymph nodes but are released from them when an immune response is needed. There are about 600 of these nodes in the body, 160 or so in the neck. Others can be found in the armpits, thorax, abdomen, inguinal area, and the cubital and popliteal fossas.
Also unlike the circulatory system, the lymphatic system has no central “pump” to move fluid around, and relies on muscle pump action to help to move lymphatic fluid.
The difference between lymphatic fluid and interstitial fluid is really a matter of location. Lymphatic fluid is present inside the lymph vessels, Interstitial fluid is present in the tissues of the body.
Signs and Symptoms:
Because one of the main functions of the
lymphatic system
is to move or drain excess interstitial fluid the most obvious sign is dysfunction in the lymphatic system is edema, excess fluid or swelling.
Lymphedema is edema caused by some form of dysfunction in the lymphatic system. Lymphedema is broken down in to two types:
Primary Lymphedema: is defined as lymphedema without an external cause. This can be due to birth defect, or other hereditary factors.
Secondary Lymphedema: has an external cause. This can be trauma to the lymphatic system such as radiation or removal of lymph nodes or blockage of the lymphatic system as occurs with Filariasis (philariasis) a parasitic infection of thread-like nematodes that accumulate in the lymph vessels.
The most common cause of lymphedema in North America is usually caused by cancer treatments, such as the surgical removal of lymph nodes or damage to the lymphatic system from radiation.
It can take many years after trauma has been done to the lymphatic system before noticeable changes occur although lymphedema can develop soon after surgery and be persistent. Often these changes can be misdiagnosed by Doctors unfamiliar with the lymphedema.
Three Progressive Stages to Lymphedema:
Stage one: is a spontaneous reversible lymphedema. The tissue is soft and doughy in consistency, indentations are easy to make – pitting edema may or may not be present. Edema reverses when limb is elevated.
Stage 2: Spontaneous irreversible lymphedema. There is no regression with elevation of limb. Moderate to pronounced fibrosis is present. Indentations are difficult to make. Stemmers sign is present. ( thickened fold of skin at the base of the second toe or second finger that can be gently pinched and lifted.)
Skin alterations (eg Hyperkeratosis, Papillomatiosis, Pigmentation) are also present as a result of long term edema.
Stage 3: Marked Subcutaneous fibrosis or sclerosis, marked skin alterations (eg Hyperkeratosis, Papillomatiosis, Pigmentation) Inter-digital and nail fungal infections also occur because of reduced immune function.
Heath care and Lymphedema:
Unfortunately the Canadian and Provincial health care systems do not provide payment for lymphedema treatments. Sufferers are left in the uncomfortable position of having to pay out of pocket for treatments that may take multiple applications to have significant effect, and shockingly high prices for custom fitted compression garments to keep the edema under control.
Lymphedema treatments can do more than improve the appearance of the affected area. Limbs that are affected by ongoing lymphedema can lose dexterity and function, they are much more likely to suffer from infections, ulcers and the potentially deadly complication of cellulitis.
Lymphedema Treatments:
Lymphatic Drainage Treatments are very gentle and are generally very relaxing for the client. Generally treatments start at the neck. The reasons for this are two-fold.
The first is because some 160 lymph nodes are located in the neck, and also the neck is closest to the terminus of the lymphatic system that empties into the venous return of the circulatory system.
By treating the neck first the `pump is primed` for drainage and the treatment moves from a proximal to distal treatment into the affected areas.
If the area treated is noticeably enlarged by edema the suggested next step in treatment is the application of bandaging.
Compression bandaging is applied in several layers and is used to keep the treated area from re-filling with fluid until the next treatment.
The compression provided by the bandaging can also provide a further “pumping” action as muscles flex and release under the bandages pushing more excess fluid out of the affected area.
Once the area has responded to treatment and reduced to an acceptable size for the client, it is recommended that the client invest in a custom fitted compression garment.
Treatment can be costly. Individual treatments are usually an hour long including application of bandages and are generally charged at the same rate as massage therapy.
However, in order to be successful, treatments must be frequent (once per day) and depending on the severity of the affected area treatments must be repeated for quite a few days and sometimes weeks.
Even if a client has extended health care coverage, that coverage can get used up very quickly leaving the client to pay out of pocket.
While there is a demand for this service, (I get phone calls once a week about it) very few clients have been able to afford treatments.
The times I have been able to use MLD have been very satisfying, as it is a highly effective treatment
Veronica Lelchuk has been a Registered massage Therapist for over three years and is a Certified Vodder Manual Lymph Drainage Therapist and Combined Decongestive Therapist.
You can reach Veronica at [email protected]
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For more information about Lymphatic drainage training, or to find a an MLD Therapist you can contact the Vodder School: http://www.vodderschool.com/
References:
Principals of Anatomy and Physiology 11 th edition: Gerard J. Tortora, Brian Derricson. john Wiley and Sons Inc 2006.
Textbook of Dr Vodders Manual Lymph Drainage Volume 1, 7 th edition: Gunther Wittlinger. Hildegard Wittlinger. Thieme Stuttgart – New York 2004
Textbook of Dr Vodders Manual Lymph Drainage Volume 2: Gunther Wittlinger. Hildegard Wittlinger, Thieme Stuttgart – New York 2004
Lymphedema Diagnosis and Therapy: Horst Weissleder, Christian Schuchhardt. Viavital Verlag Gmbh, Esson, 2008.
For more information on Lymphedema, products services or therapists visit the Lymphedema association of Ontario:
Or the lymphovenus Canada:
http://www.lymphovenous-canada.ca/