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Some patients develop breast/chest lymphoedema following breast cancer treatment. Historically this group of patients has been managed in the same way as those with limb lymphoedema, through the application of compression in the form of vests or bras. Some patients reported pain and the feeling of being in a 'strait jacket' and, therefore, abandoned these items for lighter and more comfortable garments without any adverse effects. Reflecting on this insight, the author adapted breast/chest lymphoedema management by suggesting a change to lighter garments to patients who reported improved comfort, with no obvious negative impact on their lymphoedema. Within this article, the author gives a brief explanation of lymphatic mechanisms and factors relating to lymphoedema including signs and symptoms of breast oedema. There will be an exploration of the available treatments for lymphoedema along with treatment plans found to be effective by the author. [ABSTRACT FROM AUTHOR]

Objective: It has been frequently observed that patients with lymphedema experience problems that impair quality of life (QoL), such as pain, edema and sleep disturbances. The positive effects of complex decongestive therapy (CDT) on pain, extremity volume and QoL have been reported in the literature. The aim of this study was to investigate the effects on sleep quality, pain, extremity volume, and QoL of the first phase of CDT applied to patients who developed lymphedema after cancer surgery. Materials and Methods: The study included a total of 48 female patients with unilateral lymphedema (23 breast cancer and 25 urogynaecological cancer) who developed upper or lower extremity lymphedema after cancer surgery. The patients were questioned about QoL, pain, extremity volume, medical history, and demographic data before starting treatment. Then CDT was applied five days a week for three weeks, as a total of 15 sessions, after which the patients were re-evaluated. Pain severity was evaluated using a visual analog scale, sleep quality with the Pittsburgh sleep quality index, QoL with the lymphedema QoL questionnaire, and extremity volume was measured and calculated using the Frustum formula. Results: A significant improvement was detected in pain (p<0.001), extremity volume (p=0.015), sleep quality (p<0.001) and overall QoL score (p=0.012) in the group that developed lymphedema in the upper extremity after treatment. A significant improvement was achieved in pain (p<0.001), extremity volume (p<0.001), sleep quality (p<0.001) and overall QoL score (p<0.001) in the group that developed lymphedema in the lower extremity. Conclusion: This study is the first to demonstrate the effects of CDT on sleep quality while confirming its therapeutic effects on pain, extremity volume and QoL in patients who developed lymphedema after cancer surgery. When treating sleep disturbances in lymphedema patients, it is important to consider the therapeutic benefits of CDT on sleep quality. [ABSTRACT FROM AUTHOR]

Introduction: Automated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain. Methods: Each patient received 32-36 injections of 25 µg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30-60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function. Results: All 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient. Discussion: This proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted. [ABSTRACT FROM AUTHOR]

Objectives: To determine the demographics, outcomes, and healthcare utilization of patients with chronic venous insufficiency-associated lymphedema (CVI-LED) and the prevalence of lymphedema-specific therapy use after venous intervention. Methods: The IBM MarketScan Commercial and Medicare Claims Databases were examined for patients with CVI-LED. Patient demographics and the use of lymphedema-specific therapy before and after venous intervention were collected. Results: Of 85,601 LED patients identified, 8,406 also had a diagnosis of CVI. In the CVI-LED group, 1051 underwent endovenous ablation or venous stent placement. The use of lymphedema-specific therapy before and after venous intervention was 52% and 39%, respectively (p <.05). The mean time of initiation of LED-specific therapy following venous intervention was 265 days after ablation and 347 days after stent placement. Conclusion: Treating venous hypertension improves certain venous-related signs and symptoms of CVI. However, a significant proportion of patients have persistent edema which may reflect underlying, sub-optimally treated LED. [ABSTRACT FROM AUTHOR]

The pancreas is a vital organ nestled deep within the abdomen, playing a crucial role in both endocrine and exocrine functions. It is elongated and tadpole-shaped, with a head, body, and tail. The intricate connections to adjacent structures through a network of blood vessels, ducts, and supportive tissue transform pancreatic cancer into one of the most fatal malignancies globally as a result of a typically late diagnosis and metastatic form of the disease. Lymph node metastasis (LNM) is prevalent in the majority of individuals diagnosed with pancreatic cancer, signifying a critical factor influencing prognostic outcomes. The para-aortic lymph nodes (PALN) play an important role in the lymphatic drainage of various organs, including the kidneys, pancreas, and parts of the gastrointestinal tract. In pancreatic cancer, the risk of PALN metastasis holds considerable clinical significance, and diagnosing your involvement is primordial to therapeutic decisions and to increase the survival expectations of these patients. [ABSTRACT FROM AUTHOR]

Manual lymphatic drainage is an advanced therapy that enhances the movement of lymph via a gentle form of massage. In this article, Sarah Jane Palmer provides an overview of manual lymphatic drainage as a treatment for lymphoedema, and summarises the latest research in the area. [ABSTRACT FROM AUTHOR]

Mobilization with movement (MWM) and myofascial release (MFR) are treatment techniques that increase ankle dorsiflexion range of motion (DFROM). Manual lymphatic drainage (MLD) facilitates waste drainage and improves soft tissue tension in peripheral tissues. To date, no studies have investigated how the combination of MLD, MWM, and MFR influences the human body. The purpose of this study is to determine how the combination of MLD, MWM, and MFR affects DFROM and balance ability. We randomly assigned 16 individuals (26 feet) to one of three groups: MWM-MFR (MR), MWM-MLD (MD), or MWM-MFR-MLD (MRD) intervention. To confirm the intervention effect of each group, DFROM was assessed using a modified lunge test, and dynamic balance was measured using a modified star excursion balance test. In the results, differences were found between the MR and MRD groups in PL and mGCM activities in the 1 section (p = 0.008, p = 0.036) and between the MD and MRD groups in mGCM activity in the 4 and 5 sections (p = 0.049, p = 0.004). We suggest that the application of MRD is the most effective intervention for increasing muscle activation of the PL and mGCM during the modified star excursion balance test. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is among the most prevalent malignancies in women worldwide, with substantial morbidity and mortality. Upper limb lymphedema (ULL) is a common complication after breast cancer surgery that affects patients' daily activities and quality of life. Decongestive lymphatic therapy (DLT) and intermittent pneumatic compression (IPC) therapy are 2 primary treatment methods for ULL. Objectives: This study aimed to compare the efficacy of DLT with IPC versus DLT alone in the management of ULL following breast cancer surgery. Method: PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane Trial Registry, Google Scholar, and Clinicaltrials.gov databases were comprehensively searched for randomized controlled trials (RCTs) comparing DLT with IPC and DLT alone in patients with breast cancer-related ULL. The risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models. Results: A total of 1,894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled standardized mean difference (SMD) for percentage volume reduction was 0.63 (95% confidence interval [CI]: −0.24 to 1.50; I2 = 90.9%), showing no significant difference between the DLT alone and DLT combined with IPC (p = 0.15). Pain and heaviness scores were also comparable between the groups. However, there was a significant difference in external rotation joint mobility (SMD = 0.62; 95% CI: 0.08–1.16; I2 = 23.8%), favoring DLT with IPC. Conclusions: Our findings suggest that DLT with IPC and DLT alone showed similar findings in managing ULL after breast cancer surgery, with DLT with IPC showing a greater impact on external rotation joint mobility. Healthcare providers should consider patient preferences and individual factors when selecting the most appropriate treatment modality for ULL management. [ABSTRACT FROM AUTHOR]

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below. [ABSTRACT FROM AUTHOR]

Lymphoedema is a long-term condition which is incurable at the present time. Due to the nature of the condition, being both long-term and manifesting in physical changes (swelling), its impact on the person and their lives can be hard to quantify. Management options need to be considered within a person-centred approach, with the four cornerstones of treatment being skin care, exercise, compression therapy and manual lymphatic drainage (MLD). Evidence for each is varied and practitioners need to determine their therapeutic benefit. Beyond the cornerstones of treatment, future developments are ongoing within the areas of surgery, such as venous anastomosis and pharmacological interventions, which may reduce the effects of continual inflammation. In the future, these developments may become part of the care delivered to those affected by lymphoedema. However currently, skin care, exercise, and compression therapy remain fundamental, with MLD included if therapeutically indicated, as well as educating and empowering those involved in self-management with the support of practitioners. [ABSTRACT FROM AUTHOR]

Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA ("Direct Anterior Approach with bikini incision") are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes. Methods: This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded. Results: For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05). Conclusion: The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study. [ABSTRACT FROM AUTHOR]

Background: Complete decongestive therapy is the standard treatment for lymphedema. Manual lymphatic drainage and short-stretch multilayer compression bandaging are two daily stages of complete decongestive therapy during which physiotherapists work with patients. Objective: The aim of this study was to assess the risks of musculoskeletal disorders to which physiotherapists are exposed during these two phases. Method: Five physiotherapists performed five 20 min manual lymphatic drainages, followed by the compression bandaging phase. From the video recordings, 8477 postures defined by 13 joint angles were grouped into clusters using hierarchical cluster analysis. The risk of musculoskeletal disorders in physiotherapists' postures was assessed using ergonomic tools. Results: Seven clusters, called generic postures (GP), were identified and defined throughout the mean joint angle values and standard deviation. Four seated GPs were found for the drainage phase, and three standing GPs were identified for the bandaging phase. This phase corresponded to a quarter of the total duration. The GP's ergonomic scores ranged from 4.51 to 5.63 and from 5.08 to 7.12, respectively, for the Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). GP1, GP3, and GP4 presented the highest ergonomic scores (RULA scores: 5.27 to 5.63; REBA scores: 6.25 to 7.12). The most affected areas were the neck (flexion > 20° for all GPs), trunk (flexion between 25 and 30° for GP2, and GP7 during the bandaging phase and GP4 during the drainage phase), and shoulder (flexion and abduction >20° for all GPs except GP5). Conclusions: These results highlighted that the two complete decongestive therapy phases could be described as a combination of GP. Ergonomic assessment showed that compression bandaging as well as drainage phases expose physiotherapists to moderate musculoskeletal disorder risks that require "further investigation and change soon". [ABSTRACT FROM AUTHOR]

Background: Persistent symptoms after SARS CoV-2 infection such as fatigue, shortness of breath, and cognitive dysfunction that cannot be explained by an alternative diagnosis have been termed long COVID and present a significant emerging public health problem. Current approaches include rehabilitation and symptom management involving multiple health disciplines and as yet there are no pharmaceutical approaches other than routine symptom management. Manual lymph drainage (MLD) has been used to support recovery during pulmonary rehabilitation and reduce chronic inflammation including symptoms associated with long COVID. Case description and outcomes: Two adult females who had reported long-COVID symptoms more than 10 weeks after the resolution of the acute infection were treated with MLD by Remedial Therapists trained in the Dr Vodder method of MLD. Respiratory function (Peak Flow Meter) and blood oxygen levels (Oximeter) were recorded before and after a one-minute sit-to-stand test prior to the treatment. The Dyspnea-12 Questionnaire, the Revised Piper Fatigue Scale, and Likert scales were used to collect client-reported outcomes. Six 45-min treatments were applied weekly, with a follow-up review and treatment at three months. In both cases, all outcomes improved after the third treatment with further improvement noted at three months. Conclusions: MLD may offer a non-invasive, non-pharmaceutical approach to the resolution of long-COVID symptoms such as cough, breathlessness, and fatigue. [ABSTRACT FROM AUTHOR]

Context: Fast and adequate recovery after exercise and activity is important for increasing performance and preventing injuries. Inadequate recovery usually causes changes in the biomechanical and viscoelastic properties of the muscle. Objective: To compare the immediate effect of petrissage massage (PM) and manual lymph drainage (MLD) following submaximal exercise on the biomechanical and viscoelastic properties of the rectus femoris muscle in healthy women. Design: Cross-sectional, repeated-measures. Setting: Marmara University. Participants: 18 healthy female students. Intervention(s): Following the submaximal quadriceps strengthening exercise performed in 3 sets of 8 repetitions with intensity of 75% of 1 maximum repetition, participants' right leg received a 5-minute PM (PM group) and the contralateral leg received a 5-minute MLD application (MLD group). Main Outcome Measures: Skin temperature was measured using P45 thermographic thermal camera (Flir System; ThermaCAM, Danderyd, Sweden), and muscle tone, biomechanical, and viscoelastic features were measured with a myometer (Myoton AS, Tallinn, Estonia) at baseline, immediately postexercise, post-PM/MLD application, and 10 minutes postexercise. Results: In the PM group, the tonus (P =.002) and stiffness (P <.001) values measured after the massage and at the end of the 10-minute resting period were found to be statistically different than those measured right after the exercise (P <.05). Relaxation time and creep values at all measurement times were significantly different (P <.05). In the MLD group, it was observed the tonus (P <.001), stiffness (P =.025), and relaxation time (P <.01) values decreased significantly after the MLD compared with the values measured after the exercise; however, the creep value was found to be significantly different in all measurements (P <.05). Conclusion: PM and MLD reduce passive tissue stiffness and improve the extent of muscle extensibility over time against the muscle tensile strength. PM and MLD are therapeutic methods that can be used to support tissue recovery after exercise and prevent injuries. [ABSTRACT FROM AUTHOR]

Objectives: Lower extremity lymphedema due to secondary causes is a lifelong complication that can be encountered. Its treatment is essential, because it has significant impact on quality of life and daily living activities related to lower extremity involvement. This research aims to compare the effects of Manual Lymphatic Drainage Massage (MLD) and Negative Pressure Massage Therapy (NPMT) treatments in order to provide maximum benefit to patients. Methods: This prospective, randomized study included 30 patients with lower extremity lymphedema due to secondary causes. Patients, randomized using computer software, were divided into two groups. The first group (n =15) received 45 minutes, 15 sessions of MLD, while the second group (n =15) received 45 minutes of 15 sessions of NPMT using the LymphaTouch device. Compression bandaging was applied to both groups and self-drainage training was given to all patients. The circumference of the extremity at 6 reference points were measured and their pain and discomfort assessed by the Visual Analogue Scale (VAS) were recorded before and after treatment. Changes within the groups and between the groups were compared using the SPSS statistical program. Results: Statistically significant improvement was observed in all parameters in both treatment groups. The decrease in VAS pain and VAS discomfort scores (p < 0.05 and p < 0.01; respectively), circumference measurement of the extremity (p < 0.01) was statistically greater in the NPMT group compared to the MLD group. Conclusions: In conclusion, NPMT appears to be a beneficial non-invasive treatment method for reducing extremity volumes and decreasing subjective pain and discomfort in lymphedema patients. [ABSTRACT FROM AUTHOR]

Background: This case series follows the relective processes undertaken, when ive slim women presented with reactive oedemas of the forearm and hand, that did not respond to usual therapy. Aim: To raise awareness about Aromatase Inhibitor (AI), Letrozole. Methods: Possible causes, including Cyclin-Dependent Kinase 4 and 6 (CDK4/6) inhibitors, Ribociclib and Axillary Web Syndrome, were explored and reviewed, and potential effective treatment options were then sought. New cases presented, which discounted each theory, until Letrozole was suspected. Results: Inlammatory oedemas were explained by the mechanisms-of-action relating to Aromatase Inhibitor Associated Musculoskeletal Syndrome (AIMSS), the severity of which, especially for slim women with oestrogen deprivation, causes almost 50% of women to cease treatment within 6 months; risking disease reoccurrence. Conclusion: Permissions were gained, a table was collated and sent to referring consultants, requesting risk/beneit analysis of Letrozole with a medication review. If non- responsive, inlammatory oedemas present in clinic, AIs should be considered as a trigger. [ABSTRACT FROM AUTHOR]

The aim was to investigate the effectiveness of Kinesio taping for lymphedema following head and neck cancer therapy and its effect on patient compliance and quality of life. A total of 66 patients with lymphedema following head and neck cancer therapy were randomly allocated to the therapeutic Kinesio taping group (n = 33) and the sham Kinesio taping group (n = 33). All participants received manual lymphatic drainage, Kinesio taping, and home exercises for the first four weeks, and only home exercises for the second four weeks. The tape measurements, a scale of external lymphedema, a scale of the internal lymphedema, and quality of life were evaluated in both groups. The perceived discomfort consisting of limitation of daily living activities, pain, tightness, stiffness, and heaviness were also recorded. When the group x time effect was evaluated, it was observed that external lymphedema was significantly reduced in both groups according to neck and face composite measurements (p <.001). However, in these measurements, a significant difference was found between the groups in favor of the KT group (p =.001, p =.032, respectively). At the end of the study, there was no significant difference in terms of internal lymphedema in both groups (p =.860). The quality of life parameters such as global health status and swallowing were significantly better in the Kinesio taping group (p <.001). There was no significant difference in the parameters of perceived discomfort between the two groups (p =.282, p =.225, p =.090, p =.155, p =.183, respectively). Kinesio taping is effective in tape measurements and positively affects the quality of life in lymphedema following head and neck cancer therapy. [ABSTRACT FROM AUTHOR]

Controlling early symptoms following total knee arthroplasty (TKA) is critical for long-term outcomes. The purpose of this study was to compare the efficacy of manual lymphatic drainage (MLD) and Kinesio Taping®(KT) applications in terms of reducing lower extremity edema, pain, and improving function in the early postoperative period of TKA. Forty-five female patients with unilateral TKA were allocated to an additional postoperative MLD treatment (n = 15) with exercises, additional Kinesio Taping® (n = 15) with exercises, or exercise-only (n = 15). Lower limb circumference, range of motion (ROM), pain level, and knee osteoarthritis outcome score (KOOS) were compared. Both MLD (p <.001; effect size range = 0.65–0.87) and the KT group (p =.001; effect size range = 0.74–0.78) had lower edema and pain levels (MLD group: p <.001; effect size = 0.84; KT group: p <.001; effect size = 0.78) compared to the control group on postoperative day 4. These beneficial effects continued only two weeks postoperatively, and no group differences were found by six weeks. Additional MLD or KT applications to standard exercises were both effective on early-stage lower extremity edema and pain levels. Clinicians might implement one of these applications to the standard rehabilitation programs to control pain and edema following TKA. [ABSTRACT FROM AUTHOR]

Manual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment for lymphoedema. This case study examines the effectiveness ofMLD in combination with bio-electric massage therapy (BMT)/transcutaneous electrical nerve stimulation (TENS) for those living with lymphoedema and lipoedema. The use of non-invasive multi-modal treatment methods such as these in the treatment/management oflymphoedema and lipoedema can be useful reducing limb volume and improving quality oflife for people living with this condition. Results obtained in this case study showed reduction in volume oflimbs, as well as texture changes and positive effects in symptom-related outcomes. During the case study, the client became more optimistic about her condition and motivated to try more physical activities. This case study highlights the need for further experimental studies on the effectiveness ofMLD with BMT in lymphoedema and lipoedema. [ABSTRACT FROM AUTHOR]

Head and neck lymphoedema occurs frequently after head and neck cancer treatment and causes physical and psychosocial disability Imaging is not routinely used to diagnose or inform its conservative treatment. Indocyanine green (ICG) lymphography is used for these purposes in upper and lower limb lymphoedema. Aim: The study aimed to explore the clinical potential of ICG lymphography in diagnosis and conservative management ofhead and neck lymphoedema. Methods: Participants underwent a single examination with ICG lymphography The tracer injection sites were determined by anatomic lymphatic territories. Presence of dermal backflow was used to diagnose lymphoedema. Imaging data were recorded using a bespoke audit tool to document lymphatic movement features and manual lymphatic drainage observations. Results: Six participants underwent head and neck ICG lymphography Lymphatic vessels and dermal backflow were visualised in all participants. Manual lymphatic drainage observations suggested all participants required very firm pressure to move the ICG dye through areas of dermal backflow whereas only light pressure was required in areas with linear lymphatic vessel flow: Conclusion: ICG lymphography can identify lymphatic structures and drainage patterns in the head and neck region and is considered a potential tool for diagnosis and conservative treatment planning for head and neck lymphoedema. [ABSTRACT FROM AUTHOR]

Previous studies suggest that craniofacial manual lymphatic drainage (MLD) facilitates brain fluids clearance, reducing intracranial pressure and reabsorbing chronic subdural hematoma. This study aimed to explore the effect of craniofacial MLD in combination with pharmacological treatment for improving cranial pain intensity, vital signs, and cerebral edema (Hounsfield units, HUs) in moderate traumatic brain injury (mTBI). Patient 1 received pharmacological therapy, while patient 2 received both pharmacological and craniocervical MLD treatment. Patient 2 showed decreased cranial pain intensity and systolic blood pressure (66%–11.11%, respectively) after two 30 min daily sessions of treatment for three days. HUs in the caudate nucleus of both hemispheres (left 24.64%–right 28.72%) and in the left temporal cortical gray matter increased (17.8%). An increase in HU suggests a reduction in cerebral edema and vice versa. For patient 1, there were no changes in cranial pain intensity, but a slight increase in the systolic blood pressure was observed (0%–3.27%, respectively). HUs decreased in the temporal cortical (14.98%) and caudate nucleus gray matter (9.77%) of the left and right cerebral hemispheres (11.96%–16.74%, respectively). This case study suggests that craniofacial MLD combined with pharmacological treatment could reduce cerebral edema, decrease head pain intensity, and maintain vital signs in normal physiologic values in patients with mTBI. [ABSTRACT FROM AUTHOR]

Previous studies have reported success of edema management with manual lymphatic drainage (MLD) or Kinesio® taping. However, there is limited evidence investigating the use of a combination of the two postoperatively and evidence is conflicting due to limitations of published trials. The purpose of this case report was to describe the utilization of MLD and Kinesio® taping in the physical therapy (PT) management of edema and ecchymosis post-arthroscopic meniscectomy. A 51 year-old male was referred to PT 10 days after meniscectomy. He presented with increased edema that was not atypical secondary to a suspected saphenous vein injury. Severe edema and ecchymosis began 24 hours after surgery, which led to pain and decreases in range of motion (ROM) and difficulty with gait. Interventions for edema management consisted of MLD, Kinesio® taping and therapeutic exercise. The patient was seen for five visits over 10 days for edema management that resulted in decreases in girth and pain and increases in ROM and the Lower Extremity Functional Scale, and Patient Specific Functional Scale. He was able to sleep, return to the gym, and squat without pain. Following MLD and Kinesio® taping in conjunction with therapeutic exercises, edema and ecchymosis were reduced allowing for improved function acutely. Early and aggressive edema management postoperatively should be considered to optimize patient outcomes. This case demonstrated early management of edema facilitated increases in ROM and ease of patient-specific activities and decreased pain in five visits. [ABSTRACT FROM AUTHOR]

Simple Summary: Axillary web syndrome (AWS) is a common post-surgical sequela of breast cancer (BC) treatment. It determines pain and it limits the upper limb range of motion (ROM), reducing the quality of life of BC survivors. To date, various treatments and combinations of rehabilitative approaches have been proposed, but standardized guidelines are still lacking. The aim of our retrospective study was to assess the safety and tolerability of our specific AWS rehabilitative treatment protocol, and to determine its efficacy in reducing pain and improving upper limb ROM. We found that 60-min rehabilitative sessions composed of manual lymphatic drainage, stretching and mobility exercises, and soft tissue mobilization, performed three times/week until clinical resolution, represents a safe and well-tolerated rehabilitation protocol. Moreover, 98% of the patients reached complete shoulder ROM in flexion and abduction after the treatment, and there was a significant reduction in pain. Axillary web syndrome (AWS) is a highly prevalent surgical complication affecting BC survivors. It presents as a subcutaneous cording that limits the upper limb range of motion (ROM) and causes pain. Its etiology is still debated, and its treatment is not well defined. Therefore, we aimed to investigate the safety, tolerability and efficacy of our specific AWS rehabilitative treatment protocol. We conducted an observational retrospective study on a cohort of 92 AWS patients referred to the oncological outpatient service of a university hospital. We collected data from medical records before (T0) and after (T1) the treatment. The studied protocol was composed of 60-min sessions, carried out 3 times/week by specialized physiotherapists, until the clinical resolution of AWS. We found that a mean of 8.74 ± 2.12 rehabilitative sessions were needed, and only one patient stopped early. At T1, shoulder ROM was complete in both abduction and flexion in 98% of patients; AWS was no longer detectable in 64% of them, and pain significantly decreased compared to T0. In conclusion, our protocol proved to be safe, well-tolerated and seemed to be effective in treating AWS. [ABSTRACT FROM AUTHOR]

Introduction: there are currently discrepancies about when to use conservative treatment in lymphoedema and many health professionals doubt abaut its efficacy, proposing other therapeutic options such as invasive interventions, casting doubt on whether complex decongestive therapy is the only possibility for conservative treatment of lymphoedema. Objective: to identify the degree of usefulness and efficacy of Physiotherapy treatment in lymphedema. Material and method: a search was carried out in February 2021 of articles published in the last 5 years in the Pubmed, Medline and Cinahl databases, using the descriptors "Physical Therapy Modalities", "Physical Therapy" and "Lymphedema". Results: a total of 46 articles were obtained, of which 17 met the selection criteria and were valid for analysis. The scientific evidence reviewed reaffirmed the efficacy of treatments based on techniques included in complex decongestive therapy, such as manual lymphatic drainage, pressure therapy and compression stockings, but also of other techniques such as hydrotherapy, kinesitherapy or therapeutic exercise and even modifications of complex decongestive therapy. Conclusion: Physiotherapy is beneficial for the treatment of lymphedema, but we cannot establish which technique is the most beneficial since there is heterogeneity in the therapies used by the different studies. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of the study was to explore the application value of manual lymphatic drainage combined with vacuum sealing drainage in axillary web syndrome (AWS) after breast cancer surgery. From 1 April 2020 to 1 June 2020, a total of 102 patients with AWS after axillary lymph node biopsy or axillary lymph node dissection in our hospital were included in this prospective study. According to the random number table method, all patients were divided into the study group (n = 51) and the control group (n = 51). The study group received the treatment of manual lymphatic drainage combined with vacuum sealing drainage, and the control group received health education and the treatment of functional training. The efficacy observation indicators included duration time to the disappearance of relevant clinical symptoms, degree of pain, angle of abduction of the affected limb, degree of upper limb disability function and quality of life. The duration time to the disappearance of cord‐like nodules and tightness in the study group was both significantly shorter than that in the control group (both P <.05). In the time point of 1 and 3 months after the intervention, compared with that in the control group, the study group had a significantly lighter degree of pain, a better degree of upper limb disability function and higher quality of life (all P <.05). Manual lymphatic drainage combined with vacuum sealing drainage can shorten the disappearance time of relevant clinical symptoms, relieve the degree of pain, improve the upper limb disability function and improve the quality of life in patients with AWS. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) versus that of traditional and placebo MLD, when added to decongestive lymphatic therapy (DLT) for the treatment of breast cancer–related lymphedema (BCRL) (EFforT-BCRL trial), on the suprafascial accumulation of lymphatic fluid and skin elasticity. Methods In this multicenter, 3-arm, double-blind, randomized controlled trial (EFforT-BCRL trial), 194 participants (mean age = 61 [SD = 10] years) with unilateral BCRL were recruited. All participants received standardized DLT (education, skin care, compression therapy, exercises) and were randomized to fluoroscopy-guided, traditional, or placebo MLD. Participants received 60 min/d of treatment during the 3-week intensive phase and 18 sessions of 30 minutes during the 6-month maintenance phase. During this phase, participants were instructed to wear a compression garment, to perform exercises, and to perform a self-MLD procedure once daily. This study comprises secondary analyses of the EFforT-BCRL trial. Outcomes were the amount of fluid accumulation in the suprafascial tissues (local tissue water, extracellular fluid, and thickness of the skin and subcutaneous tissue) and skin elasticity at the level of the arm and trunk. Measurements were performed at baseline; after intensive treatment; after 1, 3, and 6 months of maintenance treatment; and after 6 months of follow-up. Results At the level of the arm, there was a significant improvement over time in the 3 groups for most of the outcomes. At the level of the trunk, no remarkable improvement was noted within the individual groups. No significant interaction effects (between-group differences) were present. Only skin elasticity at the level of the arm, evaluated through palpation, showed a significant interaction effect. Conclusion All 3 groups showed similar improvements in response to DLT regardless of the type of MLD that was added. The effect of the addition of MLD to other components of DLT for reducing local tissue water and extracellular fluid or skin thickness and for improving skin elasticity and fibrosis in participants with chronic BCRL was limited. Impact Although MLD has been applied all over the world for many years, evidence regarding its added value in reducing arm volume in patients with BCRL is lacking. These results show that adding MLD to other components of DLT has limited value in reducing local tissue water and extracellular fluid or skin thickness and in improving skin elasticity and fibrosis in patients with chronic BCRL. To date, there is no clinical indication to continue including time-consuming MLD in physical therapist sessions for patients with chronic BCRL. [ABSTRACT FROM AUTHOR]

Objective: The aim of this case report is to describe the results of complex decongestive therapy (CDT) in a patient with poliomyelitis and bilateral lymphoedema, and to emphasise the effect of CDT on wound healing. Method: A 48-year-old female patient was given CDT for bilateral grade 3 lymphoedema in the lower extremities and a deep wound on the right foot. She had been diagnosed with poliomyelitis sequela and mobilised with a wheelchair for 26 years. The lymphoedema on both legs and the wound on the right foot sole had been present for five years and eight months, respectively. Detailed wound care had been performed previously upon the green, malodorous infected wound, without healing. The patient received skin care education, manual lymphatic drainage, multilayer bandaging and exercises for 4 weeks in a total of 20 sessions. The improvement was assessed by limb volumes prior to and at the end of the treatments. Results: The right and left lower limb volumes were decreased significantly at the end of treatments (3042cm³ (R) and 3165cm³ (L) before versus 2702cm3 (R) and 2401cm3 (L) afterward). The wound size decreased considerably and the green malodorous flow ceased. The patient continued self-massage and self-bandaging after hospital discharge. The control follow-up, one month later, revealed a completely healed wound with maintained volume. Conclusion: In conclusion CDT for a duration of 4 weeks in a female patient with poliomyelitis, bilateral lymphoedema and an infectious hard-to-heal wound, improved both the lymphoedema and wound healing. [ABSTRACT FROM AUTHOR]

Axillary web syndrome (AWS) is a rare condition characterized by the presence of a cord-like structure in the axillary region. This case report describes a 24-year-old female patient who presented with complaint of left shoulder pain and restricted range of motion with no apparent cause. She was diagnosed clinically with idiopathic AWS (IAWS) and her condition completely resolved within two weeks with four physiotherapy sessions. Imaging studies such as ultrasound and MRI are rarely helpful to diagnose this condition radiologically., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Marya et al.)

Introduction: Compression bandaging is a key component of complex decongestive therapy (CDT) for lymphoedema (Sezgin Ozcan et al, 2018) and there is increasing interest in using adjustable compression wraps for lymphoedema treatment (Thomas, 2017). Objective: To assess the feasibility of using an adjustable compression wrap in the intensive phase of secondary lymphoedema treatment. Methods: A 75-year-old patient with a history of breast cancer surgery underwent CDT with the compression bandaging replaced by a Juzo Adjustable Compression System. Results: There were no adverse reactions during treatment, skin condition improved during treatment and the patient could apply the garment independently. Small reductions in volume occurred during the intensive phase and were maintained at 3 months. Conclusion: This case study shows that the Juzo Adjustable Compression System Light is a feasible treatment option for the intensive phase of CDT. Further research is required. [ABSTRACT FROM AUTHOR]

A continuing education assessment for athletic trainers and athletic therapists about articles published in the issue, is presented.

When added to decongestive lymphatic therapy (DLT), what is the effect of fluoroscopy-guided manual lymphatic drainage (MLD) versus traditional MLD or placebo MLD for the treatment of breast cancer-related lymphoedema (BCRL)? Multicentre, three-arm, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of assessors and participants. At five hospitals in Belgium, 194 participants with unilateral chronic BCRL were recruited. All participants received standard DLT (education, skin care, compression therapy and exercises). Participants were randomised to also receive fluoroscopy-guided MLD (n = 65), traditional MLD (n = 64) or placebo MLD (n = 65). Participants received 14 sessions of physiotherapy during the 3-week intensive phase and 17 sessions during the 6-month maintenance phase. Participants performed self-management on the other days. All outcomes were measured: at baseline; after the intensive phase; after 1, 3 and 6 months of maintenance phase; and after 6 months of follow-up. The primary outcomes were reduction in excess volume of the arm/hand and accumulation of excess volume at the shoulder/trunk, with the end of the intensive phase as the primary endpoint. Secondary outcomes included daily functioning, quality of life, erysipelas and satisfaction. Excess lymphoedema volume decreased after 3 weeks of intensive treatment in each group: 5.3 percentage points of percent excessive volume (representing a relative reduction of 23.3%) in the fluoroscopy-guided MLD group, 5.2% (relative reduction 20.9%) in the traditional MLD group and 5.4% (relative reduction 24.8%) in the placebo MLD group. The effect of fluoroscopy-guided MLD was very similar to traditional MLD (between-group difference 0.0 percentage points, 95% CI –2.0 to 2.1) and placebo MLD (–0.2 percentage points, 95% CI –2.1 to 1.8). Fluid accumulated at the shoulder/trunk in all groups. The average accumulation with fluoroscopy-guided MLD was negligibly less than with traditional MLD (–3.6 percentage points, 95% CI –6.4 to –0.8) and placebo MLD (–2.4 percentage points, 95% CI –5.2 to 0.4). The secondary outcomes also showed no clinically important between-group differences. In patients with chronic BCRL, MLD did not provide clinically important additional benefit when added to other components of DLT. NCT02609724. [ABSTRACT FROM AUTHOR]

Background. Hallermann–Streiff syndrome (HSS) is a rare congenital abnormality involving multiple craniofacial malformations, such as micrognathia, prominent frontal and nasal bones, vision defects, and dental anomalies, which can result in obstructive sleep apnea syndrome. The aim of the present study was to report a case of nasal obstruction in an individual with Hallermann–Streiff syndrome who had never breathed through the nose during treatment for lower limb lymphedema involving cervical lymphatic therapy. Case Report. An 18-year-old female adolescent with a diagnosis of HSS was sent from the genetics service of a teaching school for the treatment of lower limb lymphedema. At around 11 years of age, the patient began to present edema in the left leg, accompanied by broadening of the face and neck. The patient reported having obstructed nostrils and breathing through the mouth her entire life. On the second day of treatment, the patient reported being able to breathe through one of the nostrils, this had never occurred before. Based on this finding, the decision was made to include linear facial lymphatic drainage using the Godoy method, which led to the complete resolution of the nasal obstruction in the first 15 minutes of treatment. Nasal obstruction in children with Hallermann–Streiff syndrome may be caused by lymphedema. Conclusion. A specific lymphatic drainage technique, such as cervical lymphatic therapy and facial linear lymphatic therapy, can resolve the obstruction and maintain the nostrils unblocked for months. [ABSTRACT FROM AUTHOR]

Context: Muscle damage and delayed onset muscle soreness (DOMS) can occur following intense exercise. Various modalities have been studied to improve blood lactate accumulation, which is a primary reason for DOMS. It has been well established that active recovery facilitates blood lactate removal more rapidly that passive recovery due to the pumping action of the muscle. The pedal pump is a manual lymphatic technique used in osteopathic manipulative medicine to increase lymphatic drainage throughout the body. Pedal pump has been shown to increase lymphatic flow and improve immunity. This may improve circulation and improve clearance of metabolites post-exercise. Objective: This study compared the use of pedal pump lymphatic technique to passive supine recovery following maximal exercise. Methods: 17 subjects (male n = 10, age 23 ± 3.01; female n = 7, age 24 ± 1.8), performed a maximal volume O2 test (VO2 max) using a Bruce protocol, followed by a recovery protocol using either pedal pump technique or supine passive rest for 10 min, followed by sitting for 10 min. Outcome measures included blood lactate concentration (BL), heart rate (HR), systolic blood pressure (SBP) and VO2. Subjects returned on another day to repeat the VO2 max test to perform the other recovery protocol. All outcomes were measured at rest, within 1- minute post-peak exercise, and at minutes 4, 7, 10 and 20 of the recovery protocols. A 2 × 6 repeated measures ANOVA was used to compare outcome measures (p ≤ 0.05). Results: No significant differences were found in VO2, HR, or SBP between any of the recovery protocols. There was no significant difference in BL concentrations for recovery at minutes 4, 7, or 10 (p > 0.05). However, the pedal pump recovery displayed significantly lower BL concentrations at minute 20 of recovery (p = 0.04). Conclusion: The pedal pump significantly decreased blood lactate concentrations following intense exercise at recovery minute 20. The use of manual lymphatic techniques in exercise recovery should be investigated further. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the treatment with intermittent pneumatic compression plus multilayer bandages is not inferior to classical trimodal therapy with manual lymphatic drainage in the decongestive lymphedema treatment. Study Design: Randomized, non-inferiority, controlled study to compare the efficacy of three physical therapies' regimens in the Decongestive Lymphatic Therapy. Participants: 194 lymphedema patients, stage II–III with excess volume > 10% were stratified within upper and lower limb and then randomized to one of the three treatment groups. Baseline characteristics were comparable between the groups. Intervention: all patients were prescribed 20 sessions of the following regimens: Group A (control group): manual lymphatic drainage + Intermittent Pneumatic Compression + Bandages; Group B: pneumatic lymphatic drainage + Intermittent Pneumatic Compression + Bandages; and Group C: only Intermittent Pneumatic Compression + Bandages. End-point: Percentage reduction in excess volume (PREV). Results: All patients improved after treatment. Global mean of PREV was 63.9%, without significant differences between the groups. The lower confidence interval of the mean difference in PREV between group B and group A, and between group C and group A were below 15%, thus meeting the non-inferiority criterion. Most frequent adverse events were discomfort and lymphangitis, without differences between groups. A greater baseline edema, an upper-limb lymphedema and a history of dermatolymphangitis were independent predictive factors of worse response in the multivariate analysis. Conclusions: Decongestive lymphatic therapy performed only with intermittent pneumatic compression plus bandages is not inferior to the traditional trimodal therapy with manual lymphatic drainage. This approach did not increase adverse events. [ABSTRACT FROM AUTHOR]

Manual lymphatic drainage (MLD), a specific type of massage performed by specialists that aims to enhance the filling and emptying of lymph vessels, is often recommended as an essential part of a successful management strategy for lymphoedema. However, the literature on its efficacy is often contradictory, and its addition may not always be necessary. To ensure optimal understanding of practitioners and benefit to patients, Francesca Ramadan summarises the evidence-based advantages and limitations of MLD. [ABSTRACT FROM AUTHOR]

The article describes the case of a 16-year old male high school football player with acute lumbar swelling and received a compressive biochemical taping for his lumbar Morel-Lavallée lesion to facilitate lymphatic drainage. The patient was also diagnosed with lumbar soft tissue contusion, seroma and hematoma using diagnostic musculoskeletal ultrasound of the lumbar spine. He was recommended to apply ice in the prone position to reduce swelling and avoid contact sports and heavy lifting.

The article discusses the skin care considerations in patients with chronic oedema or lymphoedema. Also cited are the benefits of skin care like preventing infection, managing fluid excretions, and assisting in pain management, the other management strategies aside from skin care like exercise, compression therapy, and manual lympathic drainage, and the recommendations by the British Lymphology Society (BLS) on oedema and lymphoedema care.

Massage as an integrative and complementary practice in the treatment of breast cancer is still controversial. There is a difficulty in establishing parameters of when to perform massage in individuals with cancer. Thus, this study aimed to analyze original studies that investigated massage as an integrative and complementary practice in the treatment or post-treatment of women with breast cancer. A systematic review was conducted using Pubmed, OVID, SciELO and MEDLINE as databases with the combinations of MeSH terms [breast cancer and massage] and [breast neoplasm and manual therapy] in English and Portuguese. Of the 711 articles found, only 10 met the inclusion criteria. The authors used different massage techniques (Manual Lymphatic Drainage [MLD], Foot Reflexology, Cranial Massage, Swedish Massage, Polarity Therapy, Chinese Traditional Medicine (Shiatsu) finger pressure and myofascial release). In conclusion, massage improves the symptoms of anxiety, fatigue and depression as well as the quality of life of women in treatment with breast cancer, but more research is needed to support the results in order to perform massage safely. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Cellulite is associated with variations in the skin appearance with cottage cheese, mattress-like, or orange peel. The most common areas for these lesions are the posterior or upper thighs and buttocks and mainly affect females after puberty. The objective of the study was to determine whether extracorporeal shock wave therapy (ESWT) or manual lymphatic drainage (MLD) is more effective for the reduction of the grade of cellulite after liposuction. Methods. This study is a single-blinded randomized controlled clinical trial. Thirty females with grade 3 cellulite were randomly distributed into two groups equal in number (n = 15), group A was equipped to ESWT and group B was equipped to MLD. The cellulite grading scale was used to assess cellulite grade, and the skinfold caliper was used to assess the thickness of subcutaneous fat. The assessment was carried out before and four weeks after starting the treatment. Both groups received topical retinol twice daily for four weeks; in addition, group A received ESWT, while group B received MLD, two times/week for 4 weeks. Results. The mean values of the skinfold caliper in group A decreased by 24.4% and in group B by 15.38% with a significant difference between the two groups p < 0.001 . Also, the mean values of the cellulite grading scale decreased significantly after treatment in group A compared with the mean values of group B p < 0.001 . Conclusions. There was more reduction in the grade of cellulite and thickness of subcutaneous fat in the ESWT group than the MLD group after liposuction. [ABSTRACT FROM AUTHOR]