Lymphatic Facilitation for Athletic Injuries. Director of Instruction Discoverypoint School of Massage Seattle WA

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1 Lymphatic Facilitation for Athletic Injuries Pat Archer ATC, LMP Director of Instruction Discoverypoint School of Massage Seattle WA

2 Lymphatic Facilitation A specific lymphatic technique proven as an easy and effective method of enhancing edema removal. Developed by Dale Perry, LMT, CLT, for use in cases of traumatic edema. Abbreviated from Manual Lymph Drainage (Vodder), and Comprehensive Decongestive Therapy (Casley-Smith)

3 What we already know IMMUNITY & FLUID RETURN OPEN SYSTEM; BEGIN ENTWINED IN CARDIOVASCULAR CAPILLARIES PICKS UP INTERSTITIAL FLUID = LYMPH LYMPH NODE BEDS RECEIVE REGIONAL FLOW FLOW IS SLOW AND IN GENERAL DIRECTION OF HEART SUBCLAVIAN VEINS

4 Fluid Return Obligatory load = 10% Filtrate Proteins can only be removed via lymphatics Edema is dysfunction in filtration & resorption Resorption into veins cannot be increased Edema uptake CAN

5 3 Types of Edema CIRCULATORY= Systemic cardiovascular dysfunction or capillary exchange problems; Congestive heart failure, Hypertension, Obesity LYMPHEDEMA = Local or systemic failure of lymphatic system Primary: Congenital or genetic Secondary: Damage via surgery, radiation, trauma TRAUMATIC = Local edema secondary to prolonged exertion or soft tissue injury: Surgery, Sprains, Strains, Hematomas

6 Lymph Vessel Network Initial Vessels (capillaries) Collecting Capillaries Primay Vessels (Lymphangia) Collecting Trunks Deep Lymphatic Ducts

7 LYMPH VESSEL NETWORK Initial vessels are sub-epidermal Flow into collecting capillaries in upper dermis Primary vessel = Lymphangia; superficial & deep

8 THE INITIAL LYMPHATIC VESSEL Over-lapping epithelial cells; Lumen 4-6x cardio vascular capillaries Anchor filaments holds in place & pulls vessel open No valves in either of the lymph capillaries Tissue stretch opens vessel for edema uptake; Edema uptake only occurs w/ pressure differential

9 Anastomosis Collecting capillaries between lymphangia Allow 2-way lymph flow to move lymph between lymphangia Located along the watersheds

10 Increased filling of angions rate & strength of contraction LYMPHANGIA One-way valves divide vessel into angions Spiral mm. in wall with ANS contractile rate 4-10x per minute Aerobic activity rate 20x/ min. LF that 30x / min.

11 REGIONAL LYMPH FLOW Lymphotome A specific region of tissue with a network of vessels that create a predetermined pathway to a specific catchment Watersheds non-structural boundaries that divide body into regions that direct flow to a specific catchment

12 Summary of Key Points Obligatory Load = 10% of total capillary filtrate; fluid + proteins. Proteins in interstitium must be removed by lymphatic system. Entire system works on syphon principle. Negative pressure inside system is required for edema uptake. Edema uptake (initial vessels) is not the same as lymph flow.

13 Keys to Edema Uptake Edema uptake is increased by: syphon effect leads to negative intralymphatic pressure interstitial pressure from edema & manual techniques Mild stretch of tissue opens initial vessel fully

14 Keys to Lymph Flow Lymph flow is based on contractile rate of lymphangia Skeletal mm contraction, arterial pulse. and deep breathing influence flow through deep vessels, trunks & ducts in edema uptake leads to in rate and strength of contraction in the lymphangia Lymph flow follows a pre-determined pathway to a specific catchment. Watersheds separate these regions Catchment slow down lymph flow significantly

15 Importance of Lymphatic Facilitation R.I.C.E. does not stimulate edema uptake (no protein removal) LF removes proteins to limit secondary edema Limiting secondary edema limits adhesions & improves recovery Improves pain-free ROM in all stages of healing

16 QUESTIONS

17 Absolute Contraindications Congestive heart failure Kidney dysfunction Active TB Current thrombosis or embolism Active infection Lymphedema

18 Relative Contraindications Malignancy Phlebitis & open wounds History of thrombosis or emoblism Monitor closely with HYPOTENSION Hyperactive thyroid

19 LF STROKES Light slow rhythmic Light pressure = slide your eyelid over eye TISSUE STRETCH (no sliding) & QUICK RELEASE (snaps back into place) STATIONARY CIRCLE (S/C)- L-shape of Across flow + With flow; Used to clear the neck, catchments, and site specific work LONG STROKE (L/S) - stretch the skin and slide up the extremity; Used to clear lymphotomes

20 3 STAGES OF LF TREATMENTS START THE SYPHON: Clearing the neck with lateral and terminus strokes CLEAR THE WAY: Empty catchments and proximal lymphotomes SITE SPECIFIC WORK: Begin in the periphery of edema, closest to catchment

21 OPENING: LATERAL NECK Flat fingers over the strip of skin just under the ear Stretch the tissue horizontally ACROSS the neck, then DOWN toward the terminus Release the tissue so it snaps back into place

22 Empty Terminus

23 BI-LATERAL CLEARING OF AXILLA

24 Compression Pumps & Lo-press Wraps Standard 4-chamber compression pumps typically use distal to proximal pressures of: mmhg. (1-2) Compression of 30 mmhg inhibits edema uptake and lymph flow (2-4) Research shows significant increase in venous return with lower pressures: mmhg. (2-4) 1. Hooker DN. Intermittent compression devices. In: Prentice WE. Therapeutic Modalities for Physical Therapists, 2nd ed. McGraw-Hill Casley-Smith JR. Modern Treatment of Lymphoedema. Adelaide Australia. Lympoedema Association of Australia, Johansson K, Lie E. et al. A randomized study comparing manual lymph drainage with sequential pneumaitc compression for treatment of postoperative arm lymphedema. Lymphology 1998; 31:56-64.

25 Lo-press vs Elastic Wrap Resting Pressure = No muscular contractions; at rest. Working Pressure = During muscle contraction. Regular elastic wraps have HIGH RESTING & LOW WORKING compression. Lo-press wraps offer LOW RESTING & HIGH WORKING compression.

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27 Major Watersheds of the Body