Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study

Crisóstomo, Rute; Candeias, M.S.; Armada-da-Silva, Paulo

doi:10.1016/j.physio.2015.12.005

Cited by 10 publications

(16 citation statements)

References 33 publications

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“…Conservative CVD treatment might include intermittent pneumatic compression [116], compression stockings and bandages [77,117,118], and muscle pump activation using electrical muscle stimulation [77,119], transcutaneous electrical nerve stimulation [119], or active and passive movements [103,119]. In this regard, MLD maneuvers may be an alternative treatment to enhance venous flow [21][22][23]. Nevertheless, this intervention needs specialized professionals and could be an expensive health care treatment.…”

Section: Conservative Treatment Of Cvdmentioning

confidence: 99%

“…Nevertheless, based on research [21][22][23], the hands of the physical therapist must do the maneuvers producing a low pressures form of skin stretching. The pressure applied by the hands onto the skin and underlying soft tissues should be carefully adjusted to remain soft and just enough to stretch the skin for at least 4 s. When both legs are treated, the whole session take approximately 40-45 min [17,18,21].…”

Section: The Techniquementioning

confidence: 99%

“…One study concluded that 5 to 15 minutes of MLD does not change cardiac output in patients with heart failure despite the near 100% increase in venous return after 5 minutes of MLD [128]. Nevertheless, recent studies reveal that in real-time the blood flow in superficial and deep veins increase, despite the presence or absence of venous pathology [22,145].…”

Section: Physiological Effects In Venous Hemodynamicmentioning

confidence: 99%

“…Current concepts regarding MLD indicate that each maneuver should take around 4 s from beginning to end [22,23,129]. MLD techniques, which are based on manual stretching of the skin and underlying soft tissues, increase venous blood flow along the superficial veins, as has already been suggested [144], but also along the deep venous system, which course beneath the deep fascia.…”

Section: Physiological Effects In Venous Hemodynamicmentioning

confidence: 99%

“…MLD must take into account venous anatomy and venous blood flow direction just like the lymphatic anatomy and the lymph flow directions, particularly when applied to larger body segments (like the course of GSV), such as the thigh, to be more effective in increasing venous flow [23,128,129,145,148].…”

Section: Physiological Effects In Venous Hemodynamicmentioning

confidence: 99%

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Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Crisóstomo¹,

Armada-da-Silva²

2017

Clinical Physical Therapy

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Chronic venous disease (CVD) is a chronic condition that is associated with venous hypertension, vein's valves damage, venous obstruction, and calf muscle pump impairment. This blood circulatory condition is also characterized by important inflammatory changes affecting the skin, the subcutaneous tissue and the muscles, which are probably triggered by blood stasis and venous edema. With disease progression, severe ulcerative skin damage might occur, which when present represent the more severe stage of this condition. CVD has a significant economic, social and health impact, mostly due to raised morbidity and chronicity.The treatment of patients with CVD might focus on both the symptoms and secondary changes of the disease, such as edema, skin and subcutaneous changes or ulcers.Usually, initial treatment of CVD patients involves a non-invasive, conservative treatment to reduce symptoms, treat secondary changes, and help prevent the development of secondary complications and the progression of the disease. Complementary, some interventional or surgical treatments can be undertaken.There are several conservative treatments to treat and prevent complications associated with CVD that have been described in the literature, like manual lymphatic drainage (MLD) and compression, physical exercise, intermittent pneumatic pressure, kinesio taping, electrical muscle stimulation, transcutaneous electrical nerve stimulation, hydrotherapy, and health education. Most of these techniques are complementary to compression therapy or pharmacological treatment. This chapter will address the role of physical therapists in the management of CVD. The chapter will begin by reviewing the basic physiopathology of CVD, including the role of calf muscle pump. The CEAP classification system and the chronic venous severity score will be presented, as these are main tools for clinical assessment of CVD severity. In the remainder of the chapter will address the physiological effects and recommendations for treating CVD of MLD, based on our clinical experience and own research.

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Section: Conservative Treatment Of Cvdmentioning

confidence: 99%

Section: The Techniquementioning

confidence: 99%

Section: Physiological Effects In Venous Hemodynamicmentioning

confidence: 99%

Section: Physiological Effects In Venous Hemodynamicmentioning

confidence: 99%

Section: Physiological Effects In Venous Hemodynamicmentioning

confidence: 99%

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Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Crisóstomo¹,

Armada-da-Silva²

2017

Clinical Physical Therapy

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CEST MRI quantification procedures for breast cancer treatment‐related lymphedema therapy evaluation

Crescenzi

Donahue

Mahany

et al. 2019

Magnetic Resonance in Med

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PurposeTo quantify chemical exchange saturation transfer contrast in upper extremities of participants with lymphedema before and after standardized lymphatic mobilization therapy using correction procedures for B0 and B1 heterogeneity, and T1 relaxation.MethodsFemales with (n = 12) and without (n = 17) breast cancer treatment‐related lymphedema (BCRL) matched for age and body mass index were scanned at 3.0T MRI. B1 efficiency and T1 were calculated in series with chemical exchange saturation transfer in bilateral axilla (B1 amplitude = 2µT, Δω = ±5.5 ppm, slices = 9, spatial resolution = 1.8 × 1.47 × 5.5 mm3). B1 dispersion measurements (B1 = 1‐3 µT; increment = 0.5 µT) were performed in controls (n = 6 arms in 3 subjects). BCRL participants were scanned pre‐ and post‐manual lymphatic drainage (MLD) therapy. Chemical exchange saturation transfer amide proton transfer (APT) and nuclear Overhauser effect (NOE) metrics corrected for B1 efficiency were calculated, including proton transfer ratio (PTR'), magnetization transfer ratio asymmetry , and apparent exchange‐dependent relaxation (AREX'). Nonparametric tests were used to evaluate relationships between metrics in BCRL participants pre‐ versus post‐MLD (two‐sided P < 0.05 required for significance).ResultsB1 dispersion experiments showed nonlinear dependence of Z‐values on B1 efficiency in the upper extremities; PTR' showed < 1% mean fractional difference between subject‐specific and group‐level correction procedures. PTR'APT significantly correlated with T1 (Spearman's rho = 0.57, P < 0.001) and body mass index (Spearman's rho = −0.37, P = 0.029) in controls and with lymphedema stage (Spearman's rho = 0.48, P = 0.017) in BCRL participants. Following MLD therapy, PTR'APT significantly increased in the affected arm of BCRL participants (pre‐ vs. post‐MLD: 0.41 ± 0.05 vs. 0.43 ± 0.03, P = 0.02), consistent with treatment effects from mobilized lymphatic fluid.ConclusionChemical exchange saturation transfer metrics, following appropriate correction procedures, respond to lymphatic mobilization therapies and may have potential for evaluating treatments in participants with secondary lymphedema.

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Manual lymphatic drainage and quality of life in patients with lymphoedema and mixed oedema: a systematic review of randomised controlled trials

et al. 2018

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PurposeTo assess the impact of manual lymphatic drainage (MLD) on the health-related quality of life (HRQoL) of adults with lymphoedema or mixed oedema, through a systematic review of randomised controlled trials (RCTs).MethodsMEDLINE, EMBASE, PsycINFO, CENTRAL, the Cochrane Database of Systematic Reviews and ClinicalTrials.gov were searched to identify RCTs evaluating HRQoL after a MLD intervention compared to non-MLD interventions (PROSPERO 2016:CRD42016042255). We extracted the effect of the interventions on the HRQoL (primary outcome) as well as data on volume and functional changes, and adverse events when available (secondary outcomes).ResultsEight studies were eligible. The studies were heterogeneous in the aetiology of oedema, schemes of MLD applied, additional treatments offered with MLD, length of follow-up, instruments used to assess HRQoL and interventions offered to the control group. Five studies included patients with breast cancer-related arm lymphoedema; one study reported increased HRQoL among patients randomised to the MLD group. The two RCTs that involved patients with leg mixed oedema due to chronic venous insufficiency did not find between-group differences in the overall HRQoL. One trial included patients with hand oedema from systemic sclerosis and showed higher HRQoL in the group that received MLD. No studies reported reductions in HRQoL, or severe adverse events after MLD. The small numbers of patients analysed in all studies may have resulted in lack of power to detect between-group differences in HRQoL.ConclusionsThe effect of MLD on the HRQoL of patients with chronic oedema is unclear.Electronic supplementary materialThe online version of this article (10.1007/s11136-018-1796-5) contains supplementary material, which is available to authorized users.

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Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study

Cited by 10 publications

References 33 publications

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

CEST MRI quantification procedures for breast cancer treatment‐related lymphedema therapy evaluation

Manual lymphatic drainage and quality of life in patients with lymphoedema and mixed oedema: a systematic review of randomised controlled trials

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