16 Lymphedema

7/29/2019 16 Lymphedema

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Lymph Drainage Therapy (LDT)









• Today this technique is widely spread throughout Europeand is so highly recognized in the medical field thatdoctors now commonly prescribe these treatments which

are used in hospitals and reimbursed by Social Security.This work is facilitated by physiotherapists, chiropractors,nurses and bodyworkers.

• Concisely we can say that the three main actions of lymphatic drainage are: –

Stimulation of body fluid circulation. It activates• lymph function and lymph circulation.

• Indirectly stimulate the blood circulation of the Body (enhance bloodcapillaries resorption, increase pulsation of capillaries, activatevenous circulation, . . .).

– Stimulation of the immune system: the passage of lymph in thelymph nodes stimulate the immune system (the humoral as

much as well as the cellular immunity). The stimulation of lymphcirculation activate antigen/antibody presentation and immunereactions.



A NEW CONCEPTION OF

LYMPHATIC DRAINAGE

•

Lymphatic Drainage is a specialized massage techniquedesigned to activate and cleanse the human fluidsystem.

• Because the lymphatic system itself is responsible for optimum functioning of the water circulation and immune

system, Lymphatic & Energetic Drainage is a key tomaximizing our ability to rejuvenate and to establishresistance to stress and disease.

• Lymphatic drainage was initially developed in Europe in1932 by Dr. E Vodder. By the late 60's it established thecredibility necessary to be taken seriously by the medicalprofession. Dr. Johannes Askonk, a prominent Germanphysician, then successfully tested 20,000 patients inhospitals in order to verify its credibility, measure itsefficiency and find its indications and counter-indications.



MLDV

• Emil Vodder was a very inspired man who

made remarkable discoveries.

• LDT is based on and follows the natural

progression of Vodder's work, using

scientific discoveries and improvements in

bodywork techniques and osteopathy to

take his findings a step further.



• Using exacting anatomical science and

distinctive manual processes, LDT enablespractitioners to detect the specific

– rhythm,

– direction,

– depth and – quality of the lymph flow anywhere in the body.

• From there they can use their hands to perform

Manual Lymphatic Mapping (MLM) of the

vessels to assess overall circulation and

determine the best alternate pathways for

draining body-fluid stagnations.



• Therapists work with flat hands, using all

the fingers to simulate gentle, specificwave-like movements. These subtle

manual maneuvers activate lymph and

interstitial fluid circulation as well as

stimulate the functioning of the immuneand parasympathetic nervous systems



the results can be:

• Reduction in edemas (swelling) and lymphedemas of

various origins• Detoxification of the body

• Regeneration of tissue, including burns, wounds andwrinkles

• Anti-aging effects

• Relief of numerous chronic and subacute inflammations,including sinusitis, bronchitis and otitis

• Relief of chronic pain

• Reduction in the symptoms of chronic fatigue syndrome

and fibromyalgia• Antispastic actions to relieve conditions such as muscle

hypertonus and some forms of constipation

• Deep relaxation to aid insomnia, stress, loss of vitalityand loss of memory

•

Alleviation cellulite tissue



applications

• The specific rhythm of the lymph flow, consistent with thediscoveries of W. Olszewski (1979, 1980, 1981)

• The specific direction of the lymph and interstitial fluidflow in the superficial and deep tissue layers

•

The specific pressure/depth (helps specify the level of treatment: superficial tissue, deep layer, subcutaneoustissue, mucosa, muscles, viscera, periosteum, organ of the senses, etc.)

• The quality of the lymph and interstitial fluid flow("potency")

• The specific drainage of the muscles, bones/periosteumand articulations (articulations release)

• The abdominal and thoracic viscera, including the liver,spleen, uterus, large and small intestines, prostate,lungs, pleura, kidneys, adrenals, pericardium, etc.



• Manual Lymphatic Mapping (MLM) to assess thespecific direction of the superficial and deeplymph and interstitial fluids in physiological and

pathological conditions• Fibrotic techniques: 15 different techniques to

apply on the collagen fibers/fascia beforeapplying the lymphatic strokes (used for

lymphedema, post-surgery, post-radiation, etc.)• Applications for fascia restrictions (Lymphofascia

Release)/Connective Tissue Fibers Release(CTFR)

•

Applications for chronic scars: Scar ReleaseTherapy

• Special lymphatic reroutes for lymphedema



• Two levels of lymphedema/CDP certification (LLCC):140 and 170 hours

• Clinical connection between deep breathing and the

lymph flow• Working with three different lymphatic rhythms

• Working with other fluids, including the interstitial fluid,synovial fluid, cerebrospinal fluid (CSF), blood (veins andarteries)

• Specific maneuvers to access the cisterna chyli• Drainage of the central nervous system, including

drainage of the pia and dura maters

• Drainage of the sciatic nerves and other peripheralnerves

• Applications for trigger points (TP), Chapman reflexes,acupressure points

• Extensive breast protocol (Lymphatic Breast Care)



• Drainage of the chambers of the eyes

• Drainage of the ears, including the cochlea and the semicircular canals

• Drainage of the nasal cavity• Drainage of the oral cavity, including tonsils and eustachian tubes,

TMJ, gums, teeth

• Drainage of the synovial fluid; applications for body joints/articulations, including the spine, rib cage, skull and cranialsutures as well as the upper and lower extremities

• Full-body fluid diagnosis

• Release of veins and arteries

• Venous sinus drainage

• Cell structures and immune cells

• Applications for estheticians (specific "cellulite" techniques, wrinkle

techniques)• Applications for veterinarians to use on animals

• Emotional component of disease and trauma: Heart CenteredTherapy, trauma release, scar release, "cellular" fear, etc.



2. What are lymphangions?

• Anatomically, a lymphangion is the space between twovalves. These units comprise not only the layer of muscles, but all the layers in the contractile unit,including the external layer (externa), tunica media withthe muscles, and tunica interna with the endothelium of

the vessel.• For the lymphangions (Mislin, 1961), remember that

"angion" means heart. The lymphangions are the "littlehearts" in the lymph collectors. These are like littlepacemakers that have an extensive innervation from the

autonomic nervous system. (See the book Silent Waves,Part 1, Chapter 7.) The plural "lymphangia" (named byGeorge Lord) is not in common usage yet, but we canpropose it for inclusion in scientific literature.



What is the difference between

lymph and interstitial fluid?

• When the interstitial fluid (extracellular fluid or ECF) enters the first lymph capillaries, it hasbeen shown that some of the water from theinterstitial compartment exits the lymph

capillaries, so even at the very beginning thelymph is slightly different (at least moreconcentrated) than the interstitial fluid. Theyare clearly not the same fluids. Besides itsdifferent constitution, lymph also uses a very

specific medium: the lymphatic vessels andnodes into which it acquires its specific rhythm,direction and depth.



Nervous system:

• stimulate the parasympathetic nervous

system (relaxation effect, antispastic

effects -- muscle tonus -- , etc). The

constant stimulation of the C-fiber mechanoreceptors has inhibitory effects

(analgesi -anti-pain-action).



• Lymphatic & Energetic Drainage is an original method of Lymphatic Drainage developed by a French physician,Dr. Bruno CHIKLY. Today, lymphatic drainage has

reached a new level of effectiveness and efficiency. Theenhancements we have made to the original Vodder technique is by incorporating the most advancedscientific data on lymphology with whole-body healingvalues and direct listening techniques. As inCranioSacral Therapy, we can easily develop and teach

the skills to identify the very specific rhythm, thendirection and quality of the lymphatic flow. Dr. Chikly wasthe first in the world to make this breakthrough. Themethod, Lymph Drainage Therapy (LDT), offers patientsa myriad of benefits. Advance practitioner can really

assess their patients (lymphatic mapping), monitor their work and check the result of their work at the end of thesession. If needed (lymphedema, surgery, obstruction),they can finally find the best alternate pathways toreroute the lymph flow to a healthy area of the body.





The Lymph : an "Elixir of Life"• Lymph in its flow actually takes away the toxins, the germs, and the

large molecules that the venous system can't regain. It can, inparticular, remove "trapped proteins" and fat molecules in thetissues.

• Finally as it passes through the lymphatic nodes, small centers of filtration, it also manages our immune defenses. Lymph leaves thewaste and germs in the lymphatic nodes, and transportslymphocytes, specialized white corpuscles that produce antibodies.

• It is easy to understand, therefore, its importance for the strength of our immune system, the state of our tissues and our general well-being.

• However, the lymphatic flow can stagnate or even stop for manyreasons such as fatigue, stress, emotional shock, lack of physicalactivity, certain food additives, etc. . . If the lymphatic circulation

slows down, the supplying and regeneration of cells is poorly carriedout. Consequently, toxins accumulate, hastening the aging processand opening the gates to various physical problems.

• We use our hands to aid in Nature's work assisting the recirculationof the lymphatic flow.The wave-like movements of the fingersrestimulate the contractile movements of the lympatic channels.



• History of Lymph discovery and Lymphatic Drainage

• It is most likely that throughout history the medical field was unableto recognize the lymphatic system because of the transparency of the lymph and the difficulty to even see the lymphatic vessels whendissections were done. The ancient peoples of China, Sumeria,Babylon, Egypt, and India may have had vague ideas of the lymphcirculation of the body. As we know it today, they were far from

understanding the lymphatic system as a specific entity.• The Greeks witnessed some lymph vessels, primarily the ones in

the intestines because they carry a more visible milky-like lymph(chyliferous vessels) and probably the "thoracic duct", the largestlymphatic vessel. Even though Hippocrates (460-377 B.C.),describes a lymphatic temperament, we really have to wait until the

anatomists of the l7th century before the first substantial scientificdiscoveries concerning the lymphatic system were made.

• In 1622, Gaspard Asselli (1581-1626), an Italian physician,discovered the "milky veins" of a dog after digestion. This isdocumented as the first historical discovery of the lymphatic vessels.



LYMPHEDEMA

PATHOPHYSIOLOGY AND TREATMENT



•Lymphedema, a protein rich swellingwhich usually affects the extremities, is a

very common condition worldwide.

Complete Decongestive Physiotherapy isdone successfully in Europe for decades

in the treatment of primary and secondary

Lymphedema and is now becoming widely

recognized in the U.S.



• One of the main reasons for the

development of lymphedema are surgical

interventions in combination with lymph

node dissections, such as mastectomy or lumpectomy due to breast cancer, which is

the number one cause for this disease in

the U.S.



Anatomy and Physiology of the Lymphatic System

• Unlike the blood system the lymphatic system worksaccording to the one way principle, its main purpose is to

transport "waste materials" from the interstitial tissuesback into the blood system.

• These materials, also called lymphatic loads, consist of protein, water, cells and fat, are drained by the variousvascular structures of the lymphatic system and filtered

by a large number of regional and central lymph nodesbefore they enter the venous system. Part of thesewaste materials are also cell products and cell residuesincluding foreign materials.

• Lymph capillaries collect lymphatic loads from the

interstitial areas and gradually join together into bigger lymph vessels, so-called precollectors which then draininto collectors.

• Collectors: One segment of a lymph collector is calledlymph angion. Contractions of smooth muscles situatedin each lymph angion, generate the propulsive force of the lymph flow.



• The pumping is aided by a large number of valveslocated inside the collectors which allow the lymph flowin only one direction. After passing a large number of lymph nodes, where foreign substances like bacteria arefiltered out and necessary immune reactions areactivated, the lymph fluid empties into the venoussystem, mainly via the thoracic duct.

• The thoracic duct is the largest lymph vessel of the body.Under physiological conditions approximately 1-2 liters of

lymph fluid drain in 24 hours via the thoracic duct into theleft venous angle, formed by the left internal jugular andthe left subclavian vein.

• Starling's equilibrium: The amount of water and proteintransported via the lymphatic system is depending on

forces being active in the area of the blood capillaries.• Starling's equilibrium describes the balance of capillary

filtration and capillary reabsorption. The transport of fluidthrough the membrane of blood capillaries depends onfour variables:



The transport of fluid through the membrane of

blood capillaries depends on four variables:

1. blood capillary pressure (BCP)

2. colloidosmotic pressure (COP) of theplasma proteins

3. colloidosmotic pressure (COP) of the

proteins located in the interstitial tissue

4. tissue pressure (TP)



• Ultrafiltration: – blood capillary pressure > COP of plasma proteins

• Reabsorption: –

blood capillary pressure < COP of plasma proteins• Under physiological conditions 10-15% of the ultrafiltrate

remains in the interstitial tissues and is then drained bythe lymphatic system.

• Shifting of Starling's equilibrium towards an increase in

ultrafiltration, e.g. increased blood capillary pressure(inflammation, venous hypertension) or decreasedcolloidosmotic pressure (hypoproteinemia), can causean increased amount of water and proteins, thus creatinga higher burden on the lymphatic system.

•

A healthy lymphatic system is, for some time, able toprevent the onset of edema, under normal conditions thetransport capacity (TC) of the lymphatic system isapproximately 10 times higher than the physiologicalamount of the lymphatic loads (LL) of water and protein=> functional reserve (FR) of the lymphatic system.





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16 Lymphedema