Cardiovasc Endocrinol Metab. 2022 Apr 12;11(2):e0261. doi: 10.1097/XCE.0000000000000261. eCollection 2022 Jun.

ABSTRACT

In the early days of the first global wave of the COVID-19 pandemic, the potential for a postviral syndrome to manifest following COVID-19 infection was first recognized. Here, we present an analysis of a case series of the first 20 patients’ data collected in clinical practice to evaluate the potential of a possible alternative treatment for Long COVID.

METHODS: Face-to-face treatment sessions with Perrin technique practitioners occurred weekly involving effleurage/other manual articulatory techniques. The individuals being treated also undertook daily self-massage along with gentle mobility exercises. Patients recorded symptom severity using the self-report 54-item profile of fatigue-related states (PFRS) before and after treatment.

RESULTS: The mean age of male patients was 41.8 years (range, 29-53 years), and for female patients, 39.3 years (range, 28-50 years). None of the participants had a prior diagnosis of chronic fatigue syndrome, and all were new attendees to the clinics at the time of initial assessment. The average number of treatment sessions was 9.7 in men and 9.4 in women. The reduction in PFRS scores was 45% in men and 52% in women. The highest subscale scores on average were for fatigue, with the lowest for somatic symptoms. All subscale scores showed, on average, a similar reduction of approximately 50% postintervention, with the reduction in score relating to a decrease in the severity of symptoms.

CONCLUSION: Our findings suggest that a specific manual lymphatic drainage intervention may help to reduce fatigue symptoms related to Long COVID. Perhaps preventing acute symptoms through early intervention.

PMID:35441129 | PMC:PMC9010124 | DOI:10.1097/XCE.0000000000000261

J Physiother. 2022 Apr;68(2):110-122. doi: 10.1016/j.jphys.2022.03.010. Epub 2022 Apr 12.

ABSTRACT

QUESTIONS: 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)?

DESIGN: Multicentre, three-arm, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of assessors and participants.

PARTICIPANTS: At five hospitals in Belgium, 194 participants with unilateral chronic BCRL were recruited.

INTERVENTION: 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.

OUTCOME MEASURES: 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.

RESULTS: 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.

CONCLUSION: In patients with chronic BCRL, MLD did not provide clinically important additional benefit when added to other components of DLT.

REGISTRATION: NCT02609724.

PMID:35428594 | DOI:10.1016/j.jphys.2022.03.010

Sci Rep. 2022 Mar 22;12(1):4890. doi: 10.1038/s41598-022-09028-9.

ABSTRACT

Edema in the limbs can arise from pathologies such as elevated capillary pressures due to failure of venous valves, elevated capillary permeability from local inflammation, and insufficient fluid clearance by the lymphatic system. The most common treatments include elevation of the limb, compression wraps and manual lymphatic drainage therapy. To better understand these clinical situations, we have developed a comprehensive model of the solid and fluid mechanics of a lower limb that includes the effects of gravity. The local fluid balance in the interstitial space includes a source from the capillaries, a sink due to lymphatic clearance, and movement through the interstitial space due to both gravity and gradients in interstitial fluid pressure (IFP). From dimensional analysis and numerical solutions of the governing equations we have identified several parameter groups that determine the essential length and time scales involved. We find that gravity can have dramatic effects on the fluid balance in the limb with the possibility that a positive feedback loop can develop that facilitates chronic edema. This process involves localized tissue swelling which increases the hydraulic conductivity, thus allowing the movement of interstitial fluid vertically throughout the limb due to gravity and causing further swelling. The presence of a compression wrap can interrupt this feedback loop. We find that only by modeling the complex interplay between the solid and fluid mechanics can we adequately investigate edema development and treatment in a gravity dependent limb.

PMID:35318426 | PMC:PMC8941011 | DOI:10.1038/s41598-022-09028-9

Int J Ther Massage Bodywork. 2022 Mar 2;15(1):54-65. doi: 10.3822/ijtmb.v15i1.665. eCollection 2022 Mar.

ABSTRACT

OBJECTIVES: This case report aimed to explore the process and outcomes of a seven-week massage therapy treatment on post-surgical intervention to reduce humeral shaft fracture.

PARTICIPANT: An active 9-year-old girl who recently moved in the region and who underwent two surgeries following a humeral fracture with displacement after a fall at school.

INTERVENTION: The treatment used various techniques such as manual lymphatic drainage (MLD), myofascial release (MFR), therapeutic massage, and neuromuscular techniques (NMT) in conjunction with the physiotherapist rehabilitation programme to help the client recover both physically and emotionally from the trauma. Evaluation of the outcome measures (OM) took place throughout the study and after the four-week interim that followed the intervention period.

RESULTS: The massage therapy intervention indicated improvement regarding range of motion (ROM) and muscular strength. The clients’ progress using the Patient-Specific Functional Scale (PSFS) indicated a gradual evolution to reach almost a 95% gain, and the Upper Extremity Function Index (UEFI) also showed improvement in everyday activities with a 21.5% positive change. The Child Outcome Rating Scale (CORS) and subsequent Child Session Rating Scale (CSRS) monitored therapeutic progress and indicated improvement on biopsychosocial (BPS) aspects throughout the treatment.

CONCLUSION: The client felt strong and more confident after each massage intervention. A combination of techniques and the child’s empowerment positively affected the client’s overall wellness and confidence to return to activities.

PMID:35280241 | PMC:PMC8887858 | DOI:10.3822/ijtmb.v15i1.665

Int J Appl Basic Med Res. 2022 Jan-Mar;12(1):57-60. doi: 10.4103/ijabmr.ijabmr_207_21. Epub 2022 Jan 31.

ABSTRACT

Free vascularized lymph node transfer (VLNT) is one of the new and highly efficacious procedures in the cases of lymphedema. In this case, we present a case of lower-limb lymphedema which was managed by this procedure where a supraclavicular LN was harvested and transferred to the lower leg. VLNT from the supraclavicular region is a very effective treatment for physiological restoration of the lymphatic flow in established cases of lower-limb lymphedema because of well-hidden favorable scar and minimal chances of secondary iatrogenic lymphedema in the donor region unlike other sites such as groin and axilla. The VLNT should be preferred over manual lymphatic drainage because it is very effective treatment for physiological restoration of the lymphatic flow, however, the further analytical studies are required to confirm statistically the effectiveness of the same over other modalities.

PMID:35265484 | PMC:PMC8848553 | DOI:10.4103/ijabmr.ijabmr_207_21

Phlebology. 2022 May;37(4):252-266. doi: 10.1177/02683555211053532. Epub 2022 Mar 8.

ABSTRACT

BACKGROUND: Lymphedema imposes a significant economic and social burden in modern societies. Controversies about its risk factors, diagnosis, and treatment permeate the literature. The goal of this study was to assess experts’ opinions on the available literature on lymphedema while following the Delphi methodology.

METHODS: In December of 2019, the American Venous Forum created a working group tasked to develop a consensus statement regarding current practices for the diagnosis and treatment of lymphedema. A panel of experts was identified by the working group. The working group then compiled a list of clinical questions, risk factors, diagnosis and evaluation, and treatment of lymphedema. Fifteen questions that met the criteria for consensus were included in the list. Using a modified Delphi methodology, six questions that received between 60% and 80% of the votes were included in the list for the second round of analysis. Consensus was reached whenever >70% agreement was achieved.

RESULTS: The panel of experts reached consensus that cancer, infection, chronic venous disease, and surgery are risk factors for secondary lymphedema. Consensus was also reached that clinical examination is adequate for diagnosing lymphedema and that all patients with chronic venous insufficiency (C3-C6) should be treated as lymphedema patients. No consensus was reached regarding routine clinical practice use of radionuclide lymphoscintigraphy as a mandatory diagnostic tool. However, the panel came to consensus regarding the importance of quantifying edema in all patients (93.6% in favor). In terms of treatment, consensus was reached favoring the regular use of compression garments to reduce lymphedema progression (89.4% in favor, 10.6% against; mean score of 79), but the use of Velcro devices as the first line of compression therapy did not reach consensus (59.6% in favor vs 40.4% against; total score of 15). There was agreement that sequential pneumatic compression should be considered as adjuvant therapy in the maintenance phase of treatment (91.5% in favor vs. 8.5% against; mean score of 85), but less so in its initial phases (61.7% in favor vs. 38.3% against; mean score of 27). Most of the panel agreed that manual lymphatic drainage should be a mandatory treatment modality (70.2% in favor), but the panel was split in half regarding the proposal that reductive surgery should be considered for patients with failed conservative treatment.

CONCLUSION: This consensus process demonstrated that lymphedema experts agree on the majority of the statements related to risk factors for lymphedema, and the diagnostic workup for lymphedema patients. Less agreement was demonstrated on statements related to treatment of lymphedema. This consensus suggests that variability in lymphedema care is high even among the experts. Developers of future practice guidelines for lymphedema should consider this information, especially in cases of low-level evidence that supports practice patterns with which the majority of experts disagree.

PMID:35258350 | PMC:PMC9069652 | DOI:10.1177/02683555211053532

Arch Physiother. 2022 Mar 3;12(1):5. doi: 10.1186/s40945-022-00130-9.

ABSTRACT

BACKGROUND: Lymphedema is defined as the abnormal accumulation of interstitial fluid and fibro-adipose tissues resulting from injury, infection, or congenital abnormalities of the lymphatic system. The gold standard approach in the treatment of lymphedema is Complete Decongestive Therapy and it has many components that require practical knowledge and skills. YouTube can be a useful tool to provide these skills to healthcare professionals and patients. The aim of this study was to examine the videos about lymphedema rehabilitation on YouTube and analyze their technical features, sources, contents, educational value and reliability.

METHODS: The YouTube database was searched using the “lymphedema rehabilitation”, “lymphedema treatment”, “complete decongestive therapy”, “lymphedema massage”, and “lymphedema exercises” keywords. Two reviewers (Physical medicine and rehabilitation specialist) assessed videos for educational quality using a Global Quality Scale (GQS). To evaluate the reliability the 5-point Discern scale was used.

RESULTS: A total of 90 videos, which met the inclusion criteria were included in the analysis. The mean duration of the videos was 8.9 ± 10.5 min. The mean number of daily views was 22.7 ± 47.1 for a day. The majority of the videos were created to inform patients (57.8%).The uploaders were mostly private healthcare institutions or healthcare professionals (65.6%). Information providers were lymphedema therapists mostly (63.3%). Manual lymphatic drainage was observed to stand out as the most mentioned lymphedema rehabilitation component on YouTube. The mean of reliability and GQS scores of the videos were 2.2 ± 1.0 and 2.7 ± 1.0, respectively.

CONCLUSIONS: The biggest obstacle for YouTube to be an excellent source of information is that it hosts large volumes of uncontrolled and low-quality data. When Youtube content related to lymphedema rehabilitation was examined, it was observed that many videos were quite insufficient and incomplete even though there were useful videos. If careful controlling measures are implemented and if medical videos aim to meet reliability and GQS criteria, YouTube can become an effective and useful source of information for lymphedema rehabilitation.

PMID:35236412 | PMC:PMC8890817 | DOI:10.1186/s40945-022-00130-9

Medicina (Kaunas). 2022 Feb 11;58(2):273. doi: 10.3390/medicina58020273.

ABSTRACT

to try to assess the effect of manual lymphatic drainage on the biochemical parameters and quality of life of patients with abnormal body mass index. The study included three women, average age 46 years (patient 1 with normal body weight as a control; patient 2: overweight; patient 3 with class 2 obesity). After qualification, physiotherapeutic interview and examination was carried out; the concentrations of glycosylated haemoglobin (HbA1c), C-peptide, high-sensitivity C-reactive protein (hsCRP), lipid profile, and quality of life were also examined. Additionally, in patients with abnormal body mass index, biochemical parameters were monitored for 3 months. Each patient underwent 10 manual lymphatic drainage (MLD) therapy sessions, three times a week for 30 min. In the overweight patient (patient 2), a decrease in the concentration of C-peptide, hsCRP and triglycerides was observed after the series of MLD therapy. An improvement in the quality of life, intestinal motility, and a reduction in the frequency of flatulence were also noted. Moreover, after the therapy, patient 2 reported better sleep and increased vitality. In contrast, in patient 3 (with grade 2 obesity), a decrease in triglyceride levels, but not other biomarkers, was detected after the series of MDL therapy. Additionally, in patient 3, an improvement in the quality of life, an improvement in intestinal peristalsis, and reduction of menstrual pain were observed after MLD therapy. For comparison, in a patient with a normal body weight as a control (patient 1), there were no changes in biochemical parameters or improvement in the quality of life after MLD therapy. Our preliminary research indicates improvement of the concentration C-peptide, lipid profile, a reduction in the inflammation, and improved quality of life in patients with abnormal body mass index after MLD therapy. However, more studies are needed to elucidate the effectiveness of MLD therapy in patients with varying degrees of abnormal body mass index, i.e., from overweight to obesity.

PMID:35208596 | PMC:PMC8878077 | DOI:10.3390/medicina58020273

Sports Med Open. 2022 Jan 15;8(1):8. doi: 10.1186/s40798-021-00402-x.

ABSTRACT

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.

PMID:35032224 | PMC:PMC8761194 | DOI:10.1186/s40798-021-00402-x

Lymphat Res Biol. 2022 Oct;20(5):514-521. doi: 10.1089/lrb.2021.0025. Epub 2021 Dec 9.

ABSTRACT

Background: Recent advances in technology have allowed intermittent pneumatic compression (IPC) devices to develop so that their function mimics the process and principles of manual lymphatic drainage (MLD); however, research into the effectiveness of such devices is lacking. This study aimed to investigate the effectiveness of a patented IPC technique designed to mimic MLD (the LymphAssist), compared with a typical sequential IPC regimen. Methods and Results: Forty patients with a confirmed diagnosis of lower limb ISL (International Society of Lymphology) stage II or III lymphedema were recruited into this three-phased study. A bilateral leg volume assessment and quality-of-life assessment were completed at four clinic visits across the course of the study. The LymphAssist IPC regimen was significantly more effective in reducing distal leg volume than the sequential mode (mean volume reduction: 230 ± 135 mL vs. 140 ± 84 mL, respectively, p = 0.01). Improvements in leg volume were transient as both groups demonstrated a rebound or increase in volume during the washout period (LymphAssist: 238 ± 168 mL, sequential: 276 ± 158 mL, p = 0.3). Overall, IPC was effective in improving quality-of-life scores (mean reduction: 10 ± 11, p < 0.001). Conclusion: IPC is effective in reducing limb volume and improving quality of life for patients with lower limb lymphedema. IPC that mimics the MLD process has been shown to be more effective in reducing leg volume compared with traditional sequential IPC in the distal aspect of the leg. The increase in leg volume observed after discontinuation of IPC suggests that regular treatment is required to maintain its associated effects. Clinical Trial Registration Number: NTC 03856281.

PMID:34883036 | PMC:PMC9603280 | DOI:10.1089/lrb.2021.0025