Manual Lymph Drainage: What is lymphoedema:

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Is a swelling of a body part, most often an extremity caused by the abnormal accumulation of lymph fluid. Can be described as the accumulation of protein-rich fluid in the interstitial spaces as a result of lymph system dysfunction. Can be recognized by signs and symptoms of infection – redness, heat, pain, (indications of viral and/or bacterial infection combined with fluid retention). Can be recognized by a deep ache, loss of limb function and a visible increase in size of limb as a result of swelling. Can be indicated by pitting oedema – the oedematous tissue will pit if pressed with a thumb. However, it gradually becomes larger and harder and will no longer pit. May cause oedematous tissue to feel cool to the touch if it is cut off from the circulatory or lymphatic system. If longstanding, can lead to fibrosclerotic changes in interstitial spaces of the superficial fascia causing hardening of the skin. Due to congenital malformations in the lymphatic system such as defective valves or vessels is referred to as primary lymphoedema. That is considered secondary or acquired lymphoedema may result from: Surgery – particularly when lymph nodes are removed after treatment for cancer: breast, prostate, gynaecological, head or neck, sarcoma or melanoma. Radiotherapy – this kills cancer/tumour cells but it can also cause scar tissue that interrupts the normal flow of lymph in the lymphatic system. Accidental trauma/injury or infection that may damage the lymph vessels and therefore, reduces drainage of lymph. Reduced mobility/paralysis – muscle contractions (during activity/exercise) are important to help the lymph to move. Problems with veins not working very well (varicose veins/after deep vein thrombosis) – often known as venous insufficiency. This results in the lymph system becoming overloaded and unable to function effectively. Cancer itself may also result in a blockage of the lymphatic system. May cause embarrassment, can lead to depression and causes a general worsening of the patient’s life and health. (If the lymphoedema is severe especially if more than one limb is involved, the patient is excessively heavy) May be caused by a type of parasitic infestation known as filariasis in developing countries. Can affect any part of the body but is most commonly seen in an arm or a leg. May develop rapidly (e.g. after an operation) and will cause great pain as the tissues are torn apart. May cause adjacent areas, which are receiving excess lymph diverted from the blocked region, also often ache (e.g. the shoulder adjacent to a lymphoedematous arm). May be painless when developing slowly, except during bouts of infection. REFERENCES: Hardy, D & Mortimer, P.S. Prof., http://www.lymphoedema.org/lsn/lsn010.htm#TOP The Lymphoedema Association of http://www.lymphoedema.org.au/lymphoed.html Premkumar, K. 1999. Pathology A to Z — A handbook for massage...

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Manual Lymph Drainage: Starling’s equilibrium for capillary exchange

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The lymphatic system is an accessory route by which fluid can flow from the interstitial spaces into the blood. But how do the fluids manage to leave the blood vessels and enter the tissues? That is exactly what the English physiologist, Ernest Henry Starling (1866 to 1927), a founder of endocrinology and the man who coined the term hormone, wanted to know. Starling tried to find the relationship between blood pressure and the behaviour of blood in the capillary system. According to theEncyclopaedia Britannica, Starling soon realized that the high pressure of the arterial system is enough to force fluids through the thin-walled capillaries into the tissues, but as the blood is divided through more and more capillaries its pressure falls. By the time it reaches the venous system the pressure of the fluid in the surrounding tissues is higher than that of blood in the venous capillaries, allowing much of the fluid lost from the arterial side to be regained. In 1896 this scientist managed to demonstrate the Starling equilibrium: the balance between hydrostatic pressure causing fluids to flow out of the capillary membrane and osm otic pressure causing the fluids to be absorbed from the tissues into the capillary. He showed that under normal conditions a state of near-equilibrium exists at the capillary membrane as the amount of fluid filtering outward from the arterial ends of the capillaries equals almost exactly the fluid returned to circulation by absorption. The slight disequilibrium that does occur accounts for the small amount of fluid that is eventually returned by way of the lymphatics. Under normal conditions the capillary pressure (30-40 mmHg) at the arterial end and 10-15 mmHg at the venous end of the capillary, tends to remain constant. Starling’s equilibrium is largely dependent on four forces: Capillary pressure or the pressure that forces fluid out of the capillaries Plasma colloid osm otic pressure exerted by the tendency of proteins within the plasma to hold water Interstitial fluid pressure that tends to force out fluid into the capillaries when positive and in when negative. Interstitial fluid pressure exerted by the tendency of proteins in the interstitial fluid to hold...

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Manual Lymph Drainage: A technique? A therapy? A specialisation?

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By Erika Kruger Some debate exists around the standing of Manual Lymph Drainage in relation to the profession of Therapeutic Massage Therapy. There appears to be three schools of thought: 1) that it is a separate therapy 2) that it is one of the many techniques available to a therapeutic massage therapist 3) that it is a field of specialisation of Therapeutic Massage Therapy. MLD AS A SEPARATE THERAPY? The arguments that MLD is a therapy separate from Therapeutic Massage Therapy does not hold water when compared to a standard definition of massage namely the manual mobilisation of soft tissue (e.g. muscle, fascia and body fluids etc.) to restore normal systemic, biomechanical and functional use including the circulatory and lymphatic functioning. MLD is a manual technique, it affects soft tissue –lymph tissue in particular but indirectly the surrounding tissue e.g. muscles and it aims to restore normal circulatory function. MLD AS A TECHNIQUE? It follows therefore that MLD should be considered one of the tools available to a therapeutic massage therapist in achieving a particular goal namely to stimulate the flow of lymph from the affected area under specific circumstances. MLD AS A FIELD OF SPECIALISATION? Does that make MLD a field of specialisation for the Therapeutic Massage Therapy profession? May a therapist, on his or her stationery, make it known to the public that they specialise as an MLD therapist? The law is very clear on this: MLD cannot be considered a specialisation field of the Therapeutic Massage Therapy profession. According to the Ms Debbie Drake-Hoffmann, in an article in the most recent edition of Access, the Allied Health Professions Council (SA) newsletter, a therapist is only allowed to state the qualifications that they are registered for or any other qualification approved by the council. “No further qualifications obtained after your registration may be stated unless the relevant professional board has recommended such qualification can be added and such recommendation has been approved by council”, she explains. Hence therapists are not allowed to use phrases such as specialising in ….. This implies that describing oneself as a Therapeutic Massage Therapist specialising in MLD on official stationary, is not permitted. Also adding words before or in their official title e.g. Therapeutic Sports Massage Therapist or Manual Lymphatic Drainage Therapist is prohibited. If therapists allude to or state that they specialise in a particular area, the public legitimately assumes that they hold an AHPCSA-recognised and evaluated qualification or a registered speciality over and above the general requirements for registration. In cases of litigation this may be construed as deception. “Until such areas of interests are formally registered as specialities, such interests may not be stated on professional stationery and shall...

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History of Manual Lymph Drainage

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A short history of Manual Lymph Drainage by Vaunda Parsonage The development of manual techniques for the lymphatic system has a long history: Per Henrik Ling (1776-1839) developed the system most familiar to massage therapists. He laid the ground work for several types of massage using relatively heavy pressure. Belgian surgeon, Alexander of Winiwarker (1848- 1910), was one of the first people to introduce in hospitals the use of manual techniques for draining lymphatic oedema. He also proposed the use of heavy manual techniques. It was Emile Vodder (1896- 1986), a Danish massage practitioner and doctor of philosophy, who developed the techniques known as manual lymph drainage or MLD. He had an uphill battle to prove the efficiency and safety of his techniques. At the time scientists were concerned that MLD would spread bacteria and toxins from the lymph system throughout the body. As a result there was little acceptance of Vodder’s work. It was not until 1967 that a German physician tested his techniques on 20 000 patients and revealed definite medical...

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Easy does it …. with Manual Lymph Drainage

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InTouch speaks to two therapeutic massage therapists with a particularb interest in manual lymph drainage. Vaunda Parsonage and Corolyn Hoffman answers our questions. Vaunda Parsonage Vaunda is a registered nursing sister and midwife as well as a Therapeutic Massage Therapist and Aromatherapist. She has been working in the field of lymphoedema management for a number of years both in a hospital environment as well as at her practice in Plumstead. She has completed  an internationally recognized course in lymphoedema management  in Belfast, . This course was presented in conjunction with the renowned Földi Clinic in that specialises in diagnosing and treating lymphological disorders. In the last month she also completed a course on lympoedema management with the Norton School of Lymphatic Therapy Training from the . This course was held at the University of the Western Cape . Carolyn Hoffman BSc HDE  TMT: Carolyn works as a lymphoedema therapist, in a multi-disciplinary team at the Plastic and Reconstructive Surgery Unit, Vincent Pallotti Hospital, Cape Town, . She applies both her extensive massage therapy expertise and lymphoedema experience and training to support patients from oncology, orthopaedic, rheumatology, c osm etic surgery, reconstructive surgery, paediatric, obstetric departments. She completed a B.Sc and HED at the University of Cape Town in 1983. In 1990 Carolyn received certification in Swedish Massage Therapy from the Mesilla Valley School of Therapeutic Arts in Las Cruces, New Mexico, USA and in 1991 for pregnancy, post-natal and infancy massage in Austin, Texas. Back in she did a sports massage course at the Cape Massage Academy and registered with the AHPCSA in 2001. Manual lymph drainage training with Vodder-accredited teacher ( Cape Town ) followed in 2004. In 2007 Carolyn completed a certification course in CLT (complex lymphatic therapy) in Moss Vale, NSW, . InTouch: What exactly is Manual Lymph Drainage or MLD? Vaunda Parsonage: Manual Lymph Drainage (MLD) is a specialised massage technique performed to stimulate the flow of lymph. It evacuates extra cellular fluid from the interstitial spaces while at the same time, removing many cellular metabolic waste products. It is possible to evacuate excess fluid from the area because one, the fluid is captured by the initial lymphatics and two, the lymph is evacuated via the collector lymphatics. The absorption of the initial lymphatics is the result of a local increase in tissue pressure. The lymph is then shifted from the pre-collectors to the collector lymphatics all of which is facilitated by MLD. Lymphatic drainage focuses on stimulating the functions of the lymphatic and immune systems. This sets it apart from massage therapy which focuses on the muscles and joints of the body. The hand manoeuvres used in MLD require a gentle and careful touch yet...

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