The Effectiveness of Manual Lymphatic Drainage in Patients With Orthopedic Injuries

Abstract

Clinical Scenario: Managing edema after trauma or injury is a primary concern for health care professionals, as it is theorized that delaying the removal of edema will increase secondary injury and result in a longer recovery period. The inflammatory process generates a series of events, starting with bleeding and ultimately leading to fluid accumulation in intercellular spaces and the formation of edema. Once edema is formed, the lymphatic system plays a tremendous role in removing excess interstitial fluid and returning the fluid to the circulatory system. Therefore, rehabilitation specialists ought to use therapies that enhance the uptake of edema via the lymphatic system to manage edema; however, the modalities commonly used are ice, compression, and elevation. Modalities such as these may be effective at preventing swelling but present limited evidence to suggest that the function of the lymphatic system is enhanced. Manual lymphatic drainage (MLD) is a manual therapy technique that assists the lymphatic system function by promoting variations in interstitial pressures by applying light pressure using different hand movements. Focused Clinical Question: Does MLD improve patient-and disease-oriented outcomes for patients with orthopedic injuries?

Kinesiotaping for postoperative oedema – what is the evidence? A systematic review

“…Considering extremity surgery, manual lymphatic drainage is broadly accepted for the treatment of postoperative and posttraumatic oedema [31][32][33] as well as oedema caused by other pathologies [2,29,30], even though corresponding evidence is conflicting [3,4,34,35]. The application of pneumatic compression was also established as treatment option [36][37][38], although again with limited evidence base [38][39][40][41].…”

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

“…The evidence of MLD for the treatment of edema (related to cancer or traumatic during sport activity, or other orthopedic injuries) [25,26,133] and in improving functional status (related to total knee arthroplasty) [24] is unclear but has been considered somehow effective, but more research is needed. Nevertheless, MLD might have an important role in CVD by improving HRQL, symptoms [134,135], and range of motion [24] when edema/lymphedema is present.…”

Posttraumatic Oedema in Lower Limbs. Advances in Understanding Etiopathogenesis and Treatment. Review Article

“…Brak jed nak do tychczas prze ko nu ją cych ba dań na du żych gru pach pa cjentów, stąd li te ra tu ra nie za le ca tej tech ni ki do po wszechne go sto so wa nia [26]. W przy pad ku chę ci za sto so wania tej me to dy lecz ni czej na le ży pa mię tać, że pod stawą po wo dze nia jest sys te ma tycz na opie ka wy kwa lifi ko wa ne go fi zjo te ra peu ty, ma su ją ce go naj pierw proksy mal ne czę ści koń czy ny, a na stęp nie od cin ki dy stalne, by unik nąć nie kon tro lo wa ne go wzro stu ci śnie nia w tkan kach mięk kich [27,28].…”

“…Con clusive results of studies enrolling large groups of patients have not been provided to date; hence, this technique is not recommended for common use in the literature [26]. If this treatment is being considered, it needs to be borne in mind that the success of the therapy depends on regular care by a qualified physiotherapist, who massages the proximal, and then distal, parts of the limb to prevent uncontrolled increase of pressure within the soft tissues [27,28].…”