Manual lymph drainage

Lymph drainage on the knee

The manual lymph drainage (ML od. MLD) is a form of physical therapies and part of the complex physical decongestive (KPE) for the treatment of lymphedema . Their areas of application are broad. It is primarily used as edema and decongestion therapy for edematous areas of the body, such as the trunk and extremities ( arms and legs ), which can arise after trauma or surgery . This therapy is particularly often prescribed after tumor treatment or lymph node removal.

description

ML is the appropriate therapy for the treatment of lymphostatic edema, which is characterized by insufficient transport capacity of the lymph vessels with normal lymphatic load (also low volume insufficiency ). This includes congenital (primary) and secondary lymphedema. The classic indication is secondary lymphedema of the arm after breast cancer surgery.

The effect of ML is based on interstitial pressure build-up, stretching, intermittent pressure and suction.

The four basic handles according to Emil Vodder used for this are: standing circle, pump handle, scoop handle and twist handle. They are adapted to the different body regions. The lymphatic system is to be activated by various grip techniques, in particular by improving the pumping capacity of the lymph vessels, more precisely the lymphangions. The frequency of the lymphangiones is around 10–12 contractions per minute under rest conditions; this can be increased to up to 20. The therapist creates a stimulus for the tissue through the handles with their changing pressure (pressure phase with transverse and longitudinal stretching of the skin or zero phase - only skin contact is maintained). The smooth (involuntary) muscle cells of the Lymphangione respond to this stimulus with increased pumping frequency. Frequent repetition of the handles is followed by an increased flow rate.

Other effects besides de-edema are the sympatholytic (patients become calm, stimulation of the gastrointestinal tract), the pain-relieving (mechanism of the gate control theory ) and the tone-lowering effect on the skeletal muscles. The direction of pressure results from the lymph vessels that can be reached by manual lymphatic drainage and must always aim towards the extremity root (arm, leg) or generally towards the terminus (terminal of the lymphatic system in the union of the subclavian vein and the internal jugular vein in the area of ​​the collarbone ). This directs the lymph to the central large lymphatic strains. In addition, the therapist can move protein-rich edema fluid through the superficial lymphatic system, which covers the body like a network, via the so-called watersheds from a congested area of ​​the body to a healthy area. Manual lymph drainage does not increase blood flow as in classic massage .

Further indications are all orthopedic and traumatological diseases that are associated with swelling (e.g. dislocations, strains, sprains, torn muscle fibers). Manual lymphatic drainage is also used for burns , whiplash , Sudeck's disease , migraines and similar clinical pictures.

In scar treatment, ML aims to improve the mobility of the scar and the formation of new lymphatic vessels in the severed tissue. It should also help to decongest the tissue in the fight against pain , also before and after operations (e.g. after knee or total hip replacement). Sometimes pain medication can be reduced and the healing process is faster.

In the case of pronounced lymphatic diseases (congestion), this therapy is supplemented with compression bandages made from compression bandages or with custom-made compression stockings . Together with these measures as well as skin care and special exercise therapy, manual lymph drainage is summarized under the term complex physical decongestion therapy (KPE).

In the 1960s, this therapy, which was largely developed by Emil Vodder, established itself and has been taught at German massage and physiotherapy schools since then. The therapists are mainly masseurs and physiotherapists . Use is only permitted for specialist staff with the corresponding additional training in manual lymphatic drainage at an approved training institute. The additional training lasts four weeks (around 180 teaching units) and is specified in the guidelines of the guild health insurance fund . Lymph drainage is widespread in Germany and Austria. It is used less often in the United States.

In addition to manual lymphatic drainage, intermittent pneumatic compression therapy (IPK), also called apparatus intermittent compression (AIK), can be used in the interval between ML appointments. In the case of IPK, the limb is mechanically decongested with a pressure cuff, the indication for this must be narrowed down.

Indications

• Lymphedema
• Phlebo-lymphostatic edema
• Post-traumatic / post-operative edema
• Lipedema / lipolymphedema
• Cyclic idiopathic edema
• Musculoskeletal disorders in rheumatic diseases
• Scleroderma
• Sudeck's disease

Contraindications

Contraindications (contraindications) must be carefully observed. A distinction is made between absolute and relative contraindications: the absolute include untreated malignancies, recent thrombosis or thromboembolism, acute septic inflammation and decompensated heart failure (NYHA III or IV). Relative contraindications are, for example, chronic inflammation, past thrombosis, hypotension, thyroid dysfunction, pregnancy or bronchial asthma. In these cases, the ML can be modified somewhat or applied under observance of certain precautionary measures.

Contraindications are in particular:

• Pronounced heart failure , usually stages 3 and 4 (cardiac edema)
• decompensated heart failure
• increased body temperature from 37.5 degrees Celsius
• inflammatory processes of unknown origin (pathogenic germs)
• acute, deep vein thrombosis ( phlebothrombosis ), but also acute thrombophlebitis
• Erysipelas (wound rose) in general
• acute, febrile or bacterial inflammation
• cardiac edema

literature

• Ulrich Herpertz: Edema and Lymph Drainage Diagnosis and Therapy Textbook of Oedematology , 5th edition, Schattauer Verlag Stuttgart 2014, ISBN 978-3-7945-6743-0
• G. Bringezu, O. Schreiner: Textbook of decongestive therapy. Springer, Berlin 2001.
  • Volume 1: Basics, description and evaluation of the procedures. ISBN 3-540-64985-9 .
  • Volume 2: Treatment Concepts for Practice. ISBN 3-540-66927-2 .
• M. Földi, E. Földi, S. Kubik: Textbook of lymphology. 5th edition. Urban and Fischer, Stuttgart 2005, ISBN 3-437-45322-X .
• P. Hutzschenreuter, H. Brünner: Lymph vessel regeneration after surgical interventions with manual lymph drainage according to Dr. Vodder. In: Up close. 3/2003.
• H. Weissleder, C. Schuchhardt: Diseases of the lymphatic system. 4th edition. Viavital-Verlag, Essen 2006, ISBN 3-934371-36-1 .
• H. Weissleder: Lymphedema Therapy: Importance of the Apparatus Intermittent Compression-Literature Review. In: Lymphology in Research and Practice. 7 (1) 2003.
• H. Wittlinger, AM Dieter: Manual lymph drainage according to Dr. Vodder Thieme, Stuttgart 2009. ISBN 978-3-13-140071-0 .
• F. Zsusmann, M. Moog-Egan: Physiotherapy for pain problems . In: Frans van den Berg (Ed.): Applied Physiology. Volume 4, Thieme, Stuttgart 2003, ISBN 3-13-131111-8 .42

Web links

Wiktionary: Lymph drainage  - explanations of meanings, word origins, synonyms, translations

Individual evidence

1. ↑ Földi, Wittlinger: On the therapeutic influence of acute experimental lymphostatic edema by means of massage . In: Angiologica 8: 31-42, 1971.
2. ↑ Olszewski et al. In: Weissleder, Schuchhardt: Diseases of the lymphatic system. 2006.
3. ↑ Cf. Földi, Kubik: Textbook of Lymphology. 2005, p. 205.
4. ↑ Bringezu, Schreiner: Textbook of Entauungstherapie. 2001.
5. ↑ Zsusmann, Moog-Egan: physiotherapy for pain problems. 2003.
6. ↑ Schuchhardt 2006
7. ↑ Hutzschenreuter, Brünner: Lymph vessel regeneration after surgical interventions. 2003.
8. ↑ Kerstin Protz, Joachim Dissemond, Knut Kröger: Compression therapy. An overview for the practice. Springer Verlag, Berlin 2016, ISBN 978-3-662-49743-2 , page 95.
9. ↑ Weissleder: Lymphedema therapy: importance of apparatus-based intermittent compression. 2003.

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