Leitch Csd 5300 Manual Lymphatic Drainage

Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs).

We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis.

Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation. Manual lymphatic drainage techniques (MLDTs) are unique manual therapy interventions that may be incorporated by medical practitioners as well as allied health clinicians into rehabilitation paradigms for the treatment of somatic dysfunctions and pathologies –. The theoretical bases for using such modes of manual therapy are founded on the following concepts: 1) stimulating the lymphatic system via an increase in lymph circulation, 2) expediting the removal of biochemical wastes from body tissues, 3) enhancing body fluid dynamics, thereby facilitating edema reduction, and 4) decreasing sympathetic nervous system responses while increasing parasympathetic nervous tone yielding a non-stressed body-framework state.

The physiological and biomechanical effects of MLDTs on lymphatic system dynamics in treating ill or injured patients have long been of interest to osteopathic, allied health, complementary, and alternative medicine practitioners, although it was not until the 19 th century that researchers began to theorize concepts regarding direct influences of human movement and manual inerventions, predominantely massage, on the lymphatic system. Subsequent clinical scientists focused their efforts on advancing investigations on the biodynamic properties of the lymphatic system from which treatment interventions were developed for therapeutic purposes,.Andrew Taylor Still, DO, proposed the initial principles of MLDTs with the advent of osteopathic manipulative techniques in the late 1800s. Still's appreciation for the complexities of lymphatic system functionality influenced many of the ensuing pracitioners who evolved this body of work. Elmer D Barber, DO, a student at Still's American School of Osteopathy, was the first author to publish works on manual lymphatic pump techniques for the spleen, in 1898.

Another pupil of Still's philosophies, Earl Miller, DO, instituted the manual thoracic pump technique in 1920. Emil Vodder, PhD, was an additional clinical scientist who contributed to the development and advancement of MLDTs,. Vodder focused his clinical research on gaining further insight into the treatment of various pathologies by manipulating the lymphatic system,. In his work with individuals afflicted by various health ailments, Vodder reported successful treatment results using his manual lymph drainage technique throughout the 1930s,.

Vodder's treatment approach was similar to popular modes of Scandinavian massage therapies for that time period but it differed in that heavy pressure was discouraged and a light touch was substituted,. This has led to the advent of the current Vodder Method, which is used by various healthcare professionals in treating several edematous conditions,. Numerous other medical and allied health professionals, such as Bruno Chikly, MD, DO, have contributed to progressing the art and science of MLDTs, most notably with managing post-lymphadenectomy lymphoedema.In contrast, the currently proposed criteria for successful management of most acute or chronic edematous conditions in allopathic-based orthopaedic sports medicine and rehabilitation have traditionally implemented cryotherapy, elevation, compressive dressings, suitable range-of-motion exercises, and applicable therapeutic modalities,.

This commonly prescribed standard of care for injury to musculoskeletal tissues is often supplemented with bouts of oral anti-inflammatory analgesic medications,. These medications typically constitute non-steroidal anti-inflammatory drugs, which have been the subject of increasing scrutiny and caution with the recent discovery of occasionally fatal side-effects.Evidence-based practice is a common agenda in medical and allied health sciences, which serves to optimize rendering of health care services through the investigation of treatment interventions that yield positive patient outcomes for establishing clinical practice guidelines,. Use of MLDTs to improve functionality and maintain homeostasis of the lymphatic system is a topic that warrants critical appraisal for determining efficacy in sports medicine and rehabilitation. Hence, it is the purpose of this systematic review to present manual therapy clinicians with a synopsis of the history, theory, and application of MLDTs as well as to discuss current evidence that scrutinizes its efficacy in sports medicine. MethodsThe elements of our clinical question were refined in a stepwise process employing the Participant, Intervention, Comparison, Outcome (PICO) model (McMaster University, UK) (Figure ). Manual lymph drainage is defined by MedlinePlus (United States National Library of Medicine) as “a light massage therapy technique that involves moving the skin in particular directions based on the structure of the lymphatic system. This helps encourage drainage of the fluid and waste through the appropriate channels.” This broad definition was used when surveying the relevant literature for our systematic review.

Manual lymph drainage techniques reviewed included the Vodder Method and various lymphatic pumps, which demonstrate anatomical and physiological rationale supported by empirical evidence. Specialized concepts such as reflexology, craniosacral technique, and manual lymphatic mapping were not included due to the scarcity of reliable and valid evidence supporting these interventions. Search StrategyA comprehensive survey of recent scientific articles in suitable peer-reviewed journals published between 1998 and 2008 was conducted. A series of literature searches used PubMed, PEDro, CINAHL, the Cochrane Library and SPORTDiscus electronic databases.

The keywords consistently used were lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We screened the titles of all retrieved hits and identified potentially relevant articles by analyzing associated abstracts.

Entire articles were obtained if we deemed the research study satisfied inclusion criteria. Additional publications were identified through manual searches of cited references for related articles retrieved. Inclusion CriteriaInclusion criteria consisted of scientific publications that were complete articles with sufficient detail to extract the focal attributes of the research studies.

Articles were eligible for inclusion in the critical appraisal if they were categorized as systematic reviews, randomized controlled trials (RCTs), or cohort studies. Due to limited applicable original research studies, pragmatic pilot and case studies pertinent to musculoskeletal health as well as innovative animal-model experiments were also included. Patients enrolled in the research studies had to have suffered from medically diagnosed musculoskeletal ailments, which included bone fracture, acute ankle sprain, fibromyalgia, orthopaedic trauma, and Bell's palsy. Healthy humans participating in research studies that experimentally induced acute skeletal muscle damage following standardized exercise were also included. Furthermore, all research studies included in this systematic review used reliable measurement tools employed in the biomedical, health, and rehabilitation sciences.

Data Extraction and Critical AppraisalThe following data were extracted from selected publications to assess the efficacy and effectiveness of MLDTs in sports medicine and rehabilitation as well as to analyze treatment protocols employed in retrieved research studies: experimental design; sampled population size; patients/participants treated; control group; mode of MLDT; MLDT regimen; clinician administering treatment; concomitant interventions; outcome measures. Methodological quality of all scientific articles was critically appraised in this review as delineated per the levels of evidence (May 2001) categorized by the Centre for Evidence-Based Medicine (CEBM) (Oxford, UK),. Where applicable, selected RCT articles were further scrutinized with a validity score (PEDro scale). QUORUM statement flow diagram illustrating the results of our literature search strategy.Diverse modes of MLDTs and outcome measurement tools were noted in the research studies. Three relevant human-subject research studies were selected for critical appraisal. One research study was classified as a RCT; it experimentally induced acute skeletal muscle damage after a standardized exercise protocol.

The control group in this experiment received no treatment. Another RCT evaluated MLDT intervention following radial wrist fracture. In this instance, the MLDT group's contralateral extremity served as an internal non-treatment control and differences in bilateral limb volume were compared against a group who received the standard of care for a similar injury. A prospective randomized controlled nonconsecutive clinical trial was also identified assessing acute ankle sprains. In this research study, comparisons were made to a control group of participants who had sustained a similar injury and received the standard of care.The RCTs, obtained a score of 6 or higher as scrutinized by the PEDro scale.

All of the research studies lost two points as the result of not blinding the participants receiving and the therapists administering the MLDT treatments. However, it is inherent in manual therapy investigations that blinding is compromised because the patient perceives the intervention during treatment.

Manual Lymphatic Drainage Massage

Likewise, it is difficult for a manual therapist to administer a sham or placebo intervention without being cognizant of such during treatment. The validity scoring of the RCTs per the PEDro scare are listed in Table. ∗This item is not used to calculate the validity (PEDro) score.A pilot study evaluating the effect of MLDTs on fibromyalgia was also included. Furthermore, two multimodal case studies were chosen pertaining to traumatic musculoskeletal injury and neuromuscular pathology. Three patient animal-model experiments – were also included as they represented innovative basic science investigations in the theoretical domain of proposed MLDT biomechanisms. The characteristics of the retrieved articles are listed in Table. A summary of the selected literature reviewed is presented in Table.