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Lymphland International Lymphedema Online
| Bruno Chikly, M.D., D.O. (hon.) Developer, Lymph Drainage Therapy Bruno Chikly, MD, DO (hon.), is a graduate of the Medical School at Saint Antoine Hospital in France, where his internship in general medicine included training in endocrinology, surgery, neurology and psychiatry. Dr. Chikly also earned the United States equivalent of a master's degree in psychology from Paris XIII University. His doctoral thesis, which addressed the lymphatic system, its historical evolution and the manual lymphatic drainage technique, was awarded a Medal of Medical Faculty of Paris VI, a prestigious acknowledgment for in-depth work and scientific presentation. He extensively studied osteopathic techniques and other hands-on modalities, both in Europe and the United States, including Manual Lymphatic Therapies, CranioSacral Therapy, Visceral Manipulation, Mechanical Link, Muscle Energy, Myofascial Release, Neuromuscular Therapy, SomatoEmotional Release, Orthobionomy, Chi Nei Tsang, Zero Balancing , Reflexology, Polarity Therapy, and Homeopathic and Oriental medicines. He is also a long-time practitioner of Aikido. Dr. Chikly co-created a school of Manual Lymphatic Therapy in Europe. This resulted in the creation of the Lymph Drainage Therapy curriculum in the United States in collaboration with The International Alliance of Healthcare Educators (IAHE). Lymph Drainage Therapy workshops have been taught in Belgium, Brazil, Canada, China, France, Germany, Israel, Singapore, Switzerland, Tunisia and the United States. Dr. Chikly is a member of the International Society of Lymphology (ISL) and an associate member of the American Academy of Osteopathy (AAO) and the Cranial Academy. He recently received an honorary doctorate in osteopathy from the European School of Osteopathy. He is on the advisory board of the Journal of Bodywork and Movement Therapies (Churchill Livingstone) and is listed in the millennium edition of Marquis' Who's Who in the World. In his definitive text, "Silent Waves: Theory and Practice of Lymph Drainage Therapy," 2nd Edition, Dr. Chikly addresses the applications for lymphedema, chronic pain and inflammation. "Silent Waves" is carried by Stanford University Medical Library and is the first comprehensive book on the lymphatic system and lymphedema in North America. (ISBN: 0-9700530-290, Hardcover , over 400 pages, approximately 270 illustrations and photos, and 50 pages of medical references. © 2001, 2002 International Health & Healing Inc. Publishing, Scottsdale, Arizona.) Dr. Chikly, is an international seminar leader, lecturer and writer. He has spoken to most North American professional medical and health-related groups and to many lymphedema support groups. He lives in Arizona with is wife and teaching partner Alaya Chikly, CMT. She is curriculum director of Heart Centered Therapy (HCT). Please note: Dr. Chikly regrets that he cannot respond to requests for specific medical information of any sort outside of a regular professional relationship. Bruno Chickly, MD, is bringing a special touch to lymph drainage. His original technique, called lymph drainage therapy (LDT), achieves many of the same outcomes as traditional lymph drainage (LD), but in a more therapeutic manner. The difference lies in the LDT practitioner’s ability to get in touch with the patient’ s lymphatic system and natural rhythms. According to Dr. Chikly, that “tuning in” with the patient’s body makes LDT unique. Traditional LD employs a “pumping” action that Dr. Chikly says breaks the contact between the hand and lymph. Dr. Chikly’s technique is more like a massage. The practitioner keeps his or her hands flat on the patient, using the palms and fingers to create steady, gentle, wave-like, motions that emulate alpha brain waves. “I wanted to develop a (system of) touch for lymph drainage in order to…monitor the lymph exactly in its direction and flow,” Dr. Chikly explained. Constant contact with the patient enables the LDT practitioner to gain a feel for the direction, rhythm and flow of the lymph. “You have systematic feedback with the hands. Each movement is efficient because you are able to tune with the rhythm of the liquid,” said Dr. Chikly. “Not only is it more efficient, but more gratifying because you can gain more information about the quality of the lymph and the exact pressure needed.” One of the strengths of LDT, Dr. Chikly believes, lies in the practitioner’s connection with the water in the patient’s body. “When you touch water in the lymph, you are touching over 50-75 percent of the body. Water goes in and out of the cells, also people react very quickly to that.” The LDT practitioner must posses a strong knowledge of lymph gland anatomy and an ability to tune into the unique, natural body rhythms, pressure and flow of each patient. According to Dr. Chikly, there are numerous applications for LDT, among them deep cleansing and regeneration of tissues; stimulation of fluid circulation to improve conditions such as edema, lymphedema, and skin dehydration; stimulation of the immune system; stimulation of the parasympathetic system to relieve headaches and pain; and antispastic action (spasm relief). Deep relaxation and rhythmic techniques help in stress conditions, loss of vitality and insomnia. How does LDT relieve these complications? It activates liquid circulation, stimulates the immune system and regulates the autonomic nervous system. “When you do that, you can get rid of swelling,” Dr. Chikly explained. “When you drain the toxins, you regenerate the tissue, which would be beneficial for patients who are about to undergo surgery. Generally they experience less swelling, scarring and chance of infection.” LDT also has been found effective in cellulite reduction. “Cellulite is a pocket of fat, water, and toxins trapped in collagen fibers. With LDT, we work to loosen those fibers, making the lymph drainage techniques we perform next much more efficient.” The LDT process stimulates the immune system and thereby prevents infection. Healing occurs more quickly because the toxins have been drained. It can even benefit neuromuscular conditions. “In France, some people have been using LDT with muscular dystrophy patients, and it’s been helpful,” Dr. Chikly added. Dr. Chikly, a native of France, will be teaching LDT at various points in the U.S. for the International Alliance of Healthcare Educators. He is a graduate of the medical school at Saint Antione Hospital in France, where he received a medal from the medical faculty of Paris. He also holds a degree in psychology at the master’s level. His LDT technique evolved out of a decade of study in lymph drainage, Oriental medicine, acupuncture, osteopathy, cranio-sacral therapy, visceral manipulation, reflexology, and Swedish massage. Dr. Chikly said LD is a routine form of treatment in European hospitals. While he realizes that it will be much more challenging to convince insurers and facilities in this country to embrace this technique, he believes the demand for LDT in the U.S. will grow. LDT has practical applications for physicians, chiropractors, physical, occupational and massage therapists, and aestheticians, Dr. Chikly noted. He hopes one day to see lay people learn LDT to practice in their homes, as a wellness regimen. “I want people to touch each other in the family circle. Everyone needs detoxification and rejuvenation.” The doctor and his wife Alaya reside in Arizona when not touring and teaching ---- Articles from Dr. Chikly ======================================================================== Dr Chikly's Lymph Drainage Therapy Bruno Chikly, M.D., Laureat of the Medical Faculty of Paris, Member of the International Society of Lymphology (I.S.L.) is a graduate of the medical school at Saint Antoine Hospital in France, where his internship in general medicine included training in endocrinology, surgery, neurology and psychiatry. Dr. Chikly also holds a degree in psychology at the master's level. Further areas of training and education consist of 10-years of study in Oriental medicine, including acupuncture and osteopathy, including CranioSacral Therapy, Visceral Manipulation, Spinal release, Mechanical link, Muscle energy among others. His doctoral thesis addressing the lymphatic system, its historical evolution and the manual lymphatic drainage technique was awarded the Medal of the Medical Faculty of Paris, VI, a prestigious acknowledgment for in-depth work and scientific presentation. He is a member of the International Society of Lymphology (ISL). Lymph Drainage Therapy workshops on the body and face, along with self- drainage techniques, currently are taught in France, Belgium, Switzerland, Sweden, Israel, Tunisia, Canada, Brazil and the United States. For more information on workshops, call the International Alliance of Healthcare Educators at 1-800-233-5880, extension 9320. Table of contents: Introduction History of Lymph Discovery and Lymphatic Drainage The Water Element and the Liquids of the Body. Circulation, Blood and Lymphatic Vessels (Physiology) Lymph Vessels, Lymph Nodes Lymph Circulation Comparison Lymph system / Blood system Composition of Lymph Functions of the Lymphatic System Indications and Applications of Lymph Drainage Annex: Dr Chikly's resume Introduction LYMPH DRAINAGE THERAPY TM A NEW CONCEPTION OF LYMPHATIC DRAINAGE Lymphatic Drainage is a specialized massage technique designed to activate and cleanse the human fluid system. Because the lymphatic system itself is responsible for optimum functioning of the water circulation and immune system, Lymphatic & Energetic Drainage is a key to maximizing our ability to rejuvenate and to establish resistance to stress and disease. Lymphatic drainage was initially developed in Europe in 1932 by Dr. E Vodder. By the late 60's it established the credibility necessary to be taken seriously by the medical profession. Dr. Johannes Askonk, a prominent German physician, then successfully tested 20,000 patients in hospitals in order to verify its credibility, measure its efficiency and find its indications and counter-indications. Today this technique is widely spread throughout Europe and is so highly recognized in the medical field that doctors now commonly prescribe these treatments which are used in hospitals and reimbursed by Social Security. This work is facilitated by physiotherapists, chiropractors, nurses and bodyworkers. Concisely we can say that the three main actions of lymphatic drainage are: 1) Stimulation of body fluid circulation. It activates lymph function and lymph circulation. Indirectly stimulate the blood circulation of the Body (enhance blood capillaries resorption, increase pulsation of capillaries, activate venous circulation, . . .). 2) Stimulation of the immune system: the passage of lymph in the lymph nodes stimulate the immune system (the humoral as much as well as the cellular immunity). The stimulation of lymph circulation activate antigen/antibody presentation and immune reactions. 3) Nervous system: stimulate the parasympathetic nervous system (relaxation effect, antispastic effects -- muscle tonus -- , etc). The constant stimulation of the C-fiber mechanoreceptors has inhibitory effects (analgesi -anti-pain-action). Lymphatic & Energetic Drainage is an original method of Lymphatic Drainage developed by a French physician, Dr. Bruno CHIKLY. Today, lymphatic drainage has reached a new level of effectiveness and efficiency. The enhancements we have made to the original Vodder technique is by incorporating the most advanced scientific data on lymphology with whole-body healing values and direct listening techniques. As in CranioSacral Therapy, we can easily develop and teach the skills to identify the very specific rhythm, then direction and quality of the lymphatic flow. Dr. Chikly was the first in the world to make this breakthrough. The method, Lymph Drainage Therapy (LDT), offers patients a myriad of benefits. Advance practitioner can really assess their patients (lymphatic mapping), monitor their work and check the result of their work at the end of the session. If needed (lymphedema, surgery, obstruction), they can finally find the best alternate pathways to reroute the lymph flow to a healthy area of the body. The manual maneuvers employed are very subtle (e.g. cranio-sacral movements). The work is done with flat hands using all fingers to simulate aquatic, wave-like movements, which enables the practitioner to deeply listen to the rhythm of the body fluids. A heightened awareness opens one's ability to attune to the exact pressure and rhythm necessary to enter into the flow of the lympathic system. The Lymph : an "Elixir of Life" Lymph in its flow actually takes away the toxins, the germs, and the large molecules that the venous system can't regain. It can, in particular, remove "trapped proteins" and fat molecules in the tissues. Finally as it passes through the lymphatic nodes, small centers of filtration, it also manages our immune defenses. Lymph leaves the waste and germs in the lymphatic nodes, and transports lymphocytes, specialized white corpuscles that produce antibodies. It is easy to understand, therefore, its importance for the strength of our immune system, the state of our tissues and our general well-being. However, the lymphatic flow can stagnate or even stop for many reasons such as fatigue, stress, emotional shock, lack of physical activity, certain food additives, etc. . . If the lymphatic circulation slows down, the supplying and regeneration of cells is poorly carried out. Consequently, toxins accumulate, hastening the aging process and opening the gates to various physical problems. We use our hands to aid in Nature's work assisting the recirculation of the lymphatic flow.The wave-like movements of the fingers restimulate the contractile movements of the lympatic channels. History of Lymph discovery and Lymphatic Drainage It is most likely that throughout history the medical field was unable to recognize the lymphatic system because of the transparency of the lymph and the difficulty to even see the lymphatic vessels when dissections were done. The ancient peoples of China, Sumeria, Babylon, Egypt, and India may have had vague ideas of the lymph circulation of the body. As we know it today, they were far from understanding the lymphatic system as a specific entity. The Greeks witnessed some lymph vessels, primarily the ones in the intestines because they carry a more visible milky-like lymph (chyliferous vessels) and probably the "thoracic duct", the largest lymphatic vessel. Even though Hippocrates (460-377 B.C.), describes a lymphatic temperament, we really have to wait until the anatomists of the l7th century before the first substantial scientific discoveries concerning the lymphatic system were made. In 1622, Gaspard Asselli (1581-1626), an Italian physician, discovered the "milky veins" of a dog after digestion. This is documented as the first historical discovery of the lymphatic vessels. We can note that shortly afterwards in England, 1628, William Harvey published his discoveries about the systemic blood circulation. In 1650-51, John Pecquet (1622-1674) from Dieppe, France, described, the lymphatic duct, the largest lymphatic vessel of the body", and its unique beginning in the "Cysterna Chyli" or "Pecquet's cystern". Olauf Rudbeck (1630-1708) was a scientific genius from Sweden (Uppsala). He was the first anatomist to see and consider the lymphatic as a complete and specific system in the human body that could be compared to the venous circulation. He can be referred to as the first man who truly discovered the lymphatic system, and understood it as a whole system. Alexander of Winiwarter (1848-1910), a surgeon from Belgium, was the first physician to introduce an effective protocol using manual techniques (heavy pressure) in hospitals for draining lymphedemas. F.P. Millard, Canadian osteopath, founder and president of the International Lymphatic Society, editor of a quarterly journal published by the Lymphatic Research Society, proposed a new osteopathic technique of "diagnosing various disease by palpating lymphatic glands." In Applied Anatomy of the Lymphatics, 1922, he used the term "lymphatic drainage," and suggested different lymphatic drainage techniques to affect the lymphatic flow. Emil Vodder (1896-1986), a Danish massage practitioner, and doctor in philosophy (1928), had further intuition, an inspired insight, to drain the lymph of one of his patients that suffered from chronic sinusitis and diffuse acne. This took place between 1932 and 1936 in Cannes, French Riviera, in his physiotherapeutical institute. He further developed, for the first time, a precise manual technique for lymph drainage. Initially, he began to reveal and demonstrate this technique in cosmetogical congresses throughout Europe (beginning with Paris, 1936). Emil and Astrid Vodder, his wife, gave the denomination Manual Lymph Drainage to the technique: it is like "draining the marsh" (of chronic sinusitis). Because he was not an M.D. or a physical therapist, but a massage therapist, he had a difficult time to authenticate his new technique. At that time his work was not accepted by the scientists because they were afraid that the bacteria and toxins would spread from the lymph nodes and vessels throughout the body. It was not until1967 that the German physician, Johannes Asdonk, scientifically tested the technique in his clinic on 20,000 patients and established its medical effects, its indications and its countra-indications. Today in Europe, the technique is commonly used in hospitals, this work is prescribed by M.D.'s and is reimbursed by national insurance. Bruno Chikly, M.D., France, was the first to recognize the specific rhythm of the lymphatic flow and teach how to attune with it manually (Lymph Drainage Therapy). The Water element and the liquids in the Body I) THE LIQUID ENVIRONMENT OF THE ORGANISM Life is unthinkable without water. It is the most abundant element of living beings. We have learned that through evolution animals left the water to become mammals. They developed a respiratory tract, and from there it seems we became a "dry" species. Yet the gasses that we breath are transported in water, and communication throughout the cells is also done through water. It is then interesting to realize that our own cells in fact never left the water! Coming in contact with lymph is to connect with the liquid dimension of the organism. Many civilizations have symbolically associated the water element with different aspects of life: the subconscious, the moon, woman, emotion, the inner child, purity, love. Like our own subconscious or our inner child, we can easily deny or overlook our own water element. Our society specifically doesn't acknowledge the water element nor does it encourage awareness of the more subtle aspects of ourselves. Through Lymph Drainage Therapy we will try to come in contact again with these dimensions of our body and look towards integrating more sides of ourselves. Circulation, blood and lymphatic VeSSELs The lymphatic system belongs to the circulatory apparatus which provides one way for the blood to leave the heart, the arterial system, and two ways for it to return: the venous and lymphatic pathways. The LYMPHatic system is THEREFORE Another PAthway BACK TO THE HEART, PARALLEL TO THE VEINAL SYSTEM. Lymph is an intermediary liquid, between the blood and tissues. It is, therefore, the real interior environment in which the cells are immersed. This is where these cells both receive their nutritive substances and reject any damaging toxins. Part of the constituents of the blood will go out of the blood capillaries to join the surrounding tissues, passing through the interstitial environment (interstitium), the "interstices between each cell". The liquid that is filtered from the blood capillaries, will further be reabsorbed accordingly: From 80 to 98% by the small veins emerging from the blood capillaries. From 2 to approximately 20% by the small initial lymphatic capillaries. If the body did not "reuse" the 2 to 20% of the liquid, a large part of which the venous system cannot recover, the body would probably develop systemic edemas (swellings) because of the protein loss, and ultimately the organism would probably die in 24 to 48 hours. In effect the lymphatic system fine tunes the drainage of the interstitium (connective tissue) and thus constitutes a sort of "overflow", which evacuates the water and excess substances in the interstitial environment. The initial lymph capillaries which originates in almost every tissue of the organism, are at their beginning "feather fine". They will slowly increase in size moving into big lymphatic collectors, and will eventually join the major venous circulation, just before reaching the heart, behind the clavicles. So remember the lymph circulation ends in the systemic blood circulation just before the heart. The lymphatic system meanwhile transports large proteins, foreign bodies and pathogenic agents (germs, toxins etc.) in its pathway through the lymphatic nodes which acts as an active purification center. The nodes break down and destroy those particles, so they can eventually be flushed out of the body through the eliminatory tract. Lymph vessels, lymph nodes. I) Location of the lymphatic system: The lymphatic system is present everywhere in the organism except where there is no vascularisation: The epithelial tissues (spleen, bone marrow, epidermis etc.). The cartilaginous tissues The cornea and the lens of the eye The placenta The labyrinth of the inner ear The central nervous system (?) II) Organization of the Lymphatic pathways: Lymph is the liquid contained in the lymphatic vessels. Remember that before entering the initial lymph capillaries, this liquid is called the "interstitial liquid" (in the "interstice" between the cells) or the pre-lymphatic liquid. 1. The Pre-lymphatic pathways: The interstitial liquid flows in the interstitium (interstitial tissue) through non- organized pathways, sometimes called the "tissue canals". They are like the spontaneous waterways that water naturally carves out in a field in rainy weather. They are unorganized and unstructured pathways, that are different from real vessels which are closed units. This interstitial liquid is slowly "draining" to the lymphatic capillaries. The state of the connective tissue can be jelly-like (jel.) or more liquid, in a soluble state (sol.).The property of the connective to become more jel. or sol. is called thyxotrophy. It determines the amount of fluid trapped in the ground substance (Jel.) or free to circulate (sol.). L.D.T. specific maneuvers will help the natural drainage of the pre-lymphatic pathways and slowly transform the "jel." constitution of the loose connective tissue in a more "sol." state. 2. Lymphatic capillaries (or initial lymphatics): Lymphatic capillaries, made of a single layer of flat cells, are 4 to 6 times bigger than the blood capillaries. They are fragile vessels, one cell thick, with collagen fibers connecting them to the surrounding environment. They form a tight "spider net" covering most of the body organs. Unlike the closed-loop of the blood circulation the lymphatic circulation is a one- way structure beginning with the lymph capillaries. In the embryo, the lymphatic capillaries develop within the pre-lymphatic pathways. The lymph vessels "grow" specifically within the surrounding interstitial tissue and inherently stay firmly connected by its many microfibrils called the "anchoring filaments" (Leak fibers, or Casley-Smith fibers, first observed in 1935 by Pullinger and Florey). These fibers are attached from the tissue to the lymph capillary cells. They help the lymph capillaries to widely open if there is too much fluid pressure in the connective tissue, or, for example, when we move the tissue manually with the external maneuvers of Lymph Drainage Therapy. After the pre lymphatic liquid enters the lymph capillary the flat cells of the wall of the lymph capillary close, working as flap valves, and the liquid becomes lymph. As the connections between the lymph capillary cells are very loose, some fluid (mainly water and small molecular weight solutes) can usually escape through the minuscule spaces between the cells. Proteins (macro molecules) on the contrary, never get out of the lymph vessels, they are too large. In this way proteins eventually become more and more concentrated as they travel through the lymphatic apparatus. The concentration of the interstitial liquid and the lymph is therefore slightly different at the beginning. The initial capillaries form a very tight, web-like network without valves everywhere under the dermo-epidermic junction. The lymph collected in these capillaries gathers in the pre-collectors. We can note that at the main lines between territories, where the lymph circulation divides into two opposite directions (medial center line, "belt" line), we can find a specific network of vessels or minute "anastomosis" ("watersheds"). This structure will be used in advance levels to drain the lymph flow in a specific direction or another. 3. Pre-collectors: They have the same structure as the lymph capillaries, but are larger vessels that have additionally, conjunctive and elastic layers. They slowly acquire valves to help them carry the lymph to the big collectors. These valves consist of two parts ("bicuspid" valves) and are located between two lymphangions (or muscular units). Lymphangions and valves give the lymphatic vessels the characteristic appearance of a pearl necklace, sometime called "monoliform" shape. 4. Lymph collectors: These are large vessels that carry the lymph to the lymph nodes. The superficial collectors, above the fascias, drain about 70% of the lymph of the body. They are very often located throughout fatty tissues. The biggest collector of the body is the "thoracic duct" that usually terminates in the left brachio-cephalic vein. 5. Lymph trunks/lymph ducts (thoracic duct): They are the biggest lymph collectors of the body. 6. Lymph Nodes: LYMPH PASSES THROUGH THE LYMPHATIC NODES WHICH are LINKED TO THE IMMUNE SYSTEM. The Greek word "ganglion" (node) means little tumor. For a longer time, this word referred to different anatomical structures of the lymphatic system or to the nervous system. The first precise microscopic studies of the nodes were not done until the 19th Century. Nodes are covered by a dense connective tissue, the capsule. These densifications extend into the nodes and are called trabeculae. The collectors conjunct in large numbers in the convex region of the nodes. We call these vessels the "afferent" lymph vessels. Lymph usually leaves the node through one, sometimes two or three vessels, from the concave region of the node. They are the "efferent" vessels. This region of the node contains a slight depression and is called "the hilum" of the node. Nodes usually have the shape of a bean (kidney-shape), but may have all kinds of different shapes, some being round, oval, oblong. A normal, healthy size can range from 1 to 25 mm (from the head of a pin to the size of a cherry pit). The nodes are formed in the embryo during the second month of the intra-uterine life. They grow and achieve maturity in puberty. We can count from 400 up to 1,000 nodes in the human body. More than one-half are located in the abdomen alone. Many nodes are also located in the region of the neck (the cervical region). The main groups of nodes can be found in the major articulation folds of the body, excluding the crease of the wrists. By putting yourself in the embryo position you are able to protect them, except for the ones in the malleolar region, the mythologic weak point of Achilles. Lymph nodes are part of the lymphoid system. This system is comprised of the various organs that are part of the immune system. We separate the primary and secondary lymphoid organs. The primary lymphoid organs include bone marrow and thymus. The secondary lymphoid organs include lymph nodes, spleen, appendix, tonsils, adenoids, M.A.L.T. (mucosals associated lymphoid tissue present in the small and large intestines, the oral cavities. . . .). Their function is to defend the body against aggressive agents entering the body or to destroy accumulated wastes. Lymph nodes have various specific functions: They are filtration and purification stations for the lymph circulation. They capture and destroy toxins of the body. During inflammation the lymph nodes can become enlarged and painful. When they trap cancer cells in order to destroy nodes can be sources of secondary growth localization (metastasis) for the cancer They concentrate the lymph, reabsorbing about 40% of the liquids present in the lymph. They produce lymphocytes and monocytes. The production of lymphocytes is increased when the flow of lymph is increased through the nodes. It indicates manual techniques like L.D.T. increase the production of lymphocytes. Lymph nodes" offer 100 times more resistance to lymph flow than the whole rest of the system put together" (Casley-Smith). Lymph circulation There are approximately 6 to 10 liters of lymph in the body, compared to 3.5 to 5 liters of blood. About 1.5 to 2 liters of lymph per day circulate throughout the whole body. Efficient activation of the lymphatic circulation can increase this number to 10-30 liters per day. The lymphatic muscular units contract in humans at a rate of about 10 cm/min or 3 in/min (Olszewski & Engeset 1979). The overall pulse rate in lymph can be 1 to 30/min. =========================================================== CDP Treatment of Lymphedema While all treatments for lymphedema should be tailored to the patient, CDP treatment includes at least two phases which are equivalent in all therapies. These two phases may need to be repeated after about 4-6 months. 1- Phase I decongestive: acute phase This usually takes two to four weeks of treatment, until a plateau of decongestion has been reached. For cases of simple lymphedema, it may take 5 to 25 sessions. 1- Patient education: contraindications, precautions, complications, self- bandaging, diet, etc. 2- Skin Care / skin precautions. 3- Hands-on modality: MLT / LDT (once or twice a day, possibly as often as 5 to 7 days a week in some clinics). 4- Medical compression: bandaging. 5- Psychological and stress management, if needed. Compliance: Home Maintenance Program: 1- Self-education of the patient. 2- Hygiene and precautions. 3- Self drainage, twice daily. 4- Self bandaging (facilitate with a "companion"). 5- Exercises under compression twice daily / breathing / moderate exercise. 6- Diet / weight loss if needed. Lymph Drainage: once or twice a day. Rest, then walk or exercise for 15-45 min. During the first phase of acute decompression the bandages are kept on the limb(s) at all times except during the LDT / MLT sessions. Note: Other Modalities That May Be Considered: - Elevation (early stages only) - Medication - Ultrasound - Laser - Heat/Microwaves - Cold - Pneumatic Pump compression - Electricity - Hyperbaric chambers - Mercury bath (rarely used anymore) 2- Phase II: Rehabilitation / Maintenance / Preservation Phase After the plateau of decompression, we can switch from bandages to compression garments during the day. The protocol is similar to that of phase I, but the home program maintenance is much more extensive. 1- MLT / LDT is replaced by self drainage twice daily. The therapist is seen much less often. 2- The bandages are replaced during the day by compression garments (sleeves or stockings) and/or other equipment (Reid sleeve, Legacy, etc.) 3- Phase III: Repetition of Acute Decongestion as in Phase I Phase I treatments may be repeated within 6 months (Kasseroller, 1998). ManageMENT of lymphedema, Non-operative Treatment, ISL Consensus document This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema. It is based upon modifications suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain, discussed at the 1999 XVII ICL in Chennai, India, considered at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany, and derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina. The document attempts to amalgamate the broad spectrum of protocols advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a "Consensus" of the international community. In the treatment of "classical" lymphedema of the limbs (that is, peripherallymphedema), improvement in swelling can usually be achieved by non- operative therapy. Because lymphedema is a chronic, generally incurable ailment, it requires, as do other chronic disorders, lifelong care and attention along with psychosocial support. The continued need for therapy does not mean a priori that treatment is unsatisfactory, although often it is less than ideal. For example, patients with diabetes mellitus continue to need drugs (insulin) or special diet (low calorie, low sugar) in order to maintain metabolic homeostasis. Similarly, patients with chronic venous insufficiency require lifelong external compression therapy to minimize edema, lipodermatosclerosis and skin ulceration. The compliance and commitment of the patient is also essential to an improved outcome. Failure to control lymphedema may lead to repeated infections (cellulitis/lymphangitis), progressive elephantine trophic changes in the skin, sometimes crippling invalidism and on rare occasions, the development of a highly lethal angiosarcoma (Stewart-Treves syndrome). Therapy of peripheral lymphedema is divided into conservative (non-operative) and operative methods. Applicable to both methods is an understanding that meticulous skin hygiene and care (cleansing, low pH lotions, emollients) is of utmost importance to the success of virtually all treatment approaches. Basic range of motion exercises of the extremities, especially combined with external limb compression, and limb elevation is also helpful to virtually all patients undergoing treatment. Non-operative Treatment Physical therapy Combined physical therapy (CPT) (also known as Complete or Complex Decongestive Therapy (CDT) or Complex Decongestive Physiotherapy (CDP) among others) is backed by longstanding experience and generally involves a two- stage treatment program that can be applied to both children and adults. The first phase consists of skin care, light manual massage (manual lymph drainage), range of motion exercise and compression typically applied with multi-layered bandage- wrapping. Phase 2 (initiated promptly after Phase 1) aims to conserve and optimize the results obtained in Phase 1. It consists of compression by a low- stretch elastic stocking or sleeve, skin care, continued "remedial" exercise, and repeated light massage as needed. Prerequisites of successful combined physiotherapy are the availability of physicians (i.e., clinical lymphologists), nurses, and therapists highly trained and educated in this method, acceptance of health insurers to underwrite the cost of treatment, and a biomaterials industry willing to provide high quality products. Compressive bandages, when applied incorrectly, can be harmful and/or useless. Accordingly, such multilayer wrapping should be carried out only by professionally trained personnel. Newer manufactured devices to assist in compression (i.e. pull on, velcro-assisted, quilted, etc.) may relieve some patients of the bandaging burden and perhaps facilitate compliance with the full treatment program. Some clinics find that patient self-care and risk reduction strategies help maintain edema reduction. CPT may also be of use for palliation as, for example, to control secondary lymphedema from tumor-blocked lymphatics. Treatment is typically performed in conjunction with chemo- or radiotherapy directed specifically at producing tumor regression. Theoretically, massage and mechanical compression could promote metastasis in this setting by mobilizing dormant tumor cells, although only diffuse carcinomatous infiltrates which have already spread to lymph collectors as tumor thrombi might be mobilized by such treatment. Because the long-term prognosis for such an advanced patient is already dismal, any reduction in morbid swelling is nonetheless decidedly palliative. Massage alone. Performed as an isolated technique, classical massage or effleurage usually has limited benefit. Moreover, if performed overly vigorously, massage may damage lymphatic vessels. Source: From "Consensus Document of the International Society of Lymphology, The Diagnosis and Treatment of Peripheral Lymphedema, Lymphology, 2003 June, 36, (2): 84-91. Reproduced here by kind permission" =========================================================== Hyaluronan The term hyaluronan (HA) has lately substituted the terms hyaluronic acid and hyaluronate Only one kind of hyaluronan exists, in the classical form of glycosaminoglycan. The highest concentration of HA is found in the soft connective tissue, about half of it in the dermis and epidermis, and also in the vitreous body of the eye, in hyaline cartilage, in synovial joint fluid, blood vessels and in the umbilical cord. Until recently however, HA was considered to be an inert space filler that bind water molecules and fulfilled mainly a mechanical roles in the human tissues. - Under gradual shear stress, hyaluronan acts as a lubricant - Under sudden loading, hyaluronan acts as a shock absorber - Hyaluronan acts as a filter, hindering the movement of potentially damaging cells and molecules Recently, HA has been also demonstrated to 1- Facilitate cell adhesion (hyaluronan interact specifically with cell receptors such as CD 44, RHAMM, ICAM-1). Cell anchored hyaluronan meshworks can prevent cells, particles and large molecules from approaching closely to the cell membrane. 2- Modulate acute and chronic tissue inflammation processes both in animals and human beings. HA has a half-life of about a day. It is principally degraded in the lymph nodes. As much as 80-90% of HA is transported in afferent lymphatics vessels to the lymph nodes for final degradation. Only about 15 % is transported to the blood circulation to be catatabolized in the liver endothelium. In both cases, macrophage-like cells intertwined with the endothelial cells degrade hyaluronan. In lymphedematous tissue, especially when lymph nodes has been removed, the concentration of HA increase in the regional tissues. HA is usually "trapped" in lymphedematous tissues. One of the earliest known properties of HA is to bind water and increase edematous state in tissue. Local breakdown of HA (rather than in the nodes) produce also components that induce inflammation (release cytokines from macrophages), influence collagen and fibrin production and help induce fibrotic processes in lymphedema. In the future, we will hear probably more and more about the role of HA in edema general chapter on management of lymphedema While Lymph Drainage Therapy is appropriate therapy for many diseases, in a book like this lymphedema inevitably stands out. It is the condition in connection with which the most scientific research has been done on the therapeutic use of lymphatic drainage; it is particularly difficult to comprehend and challenging to treat; and while it is unfortunately very widespread, understanding of it and education and training about it are gravely deficient on the part of the general public, practitioners and physicians alike. My own training in medical school unfortunately taught me very little about the condition, its diagnosis and treatment. Furthermore, the condition is characterized by its disabling and far-reaching effects. Not only can lymphedema disable the patient, but it tends to get worse over time if untreated and can lead to serious and recurring complications. It seems appropriate to devote a large section of this book to lymphedema and its treatment, especially its multifaceted, conservative treatment called complex decongestive physiotherapy (CDP). This term refers to a combination of modalities, including manual and compressive therapies, which is usually the first treatment to consider in lymphedema. Lymphedema it tends to respond to this kind of appropriate conservative treatment. CDP is safe, non invasive, effective and cost effective, but must be applied by trained and skilled practitioners. In some syndromes where high output lymphatic transport failure is longstanding, a gradual functional deterioration of the draining lymphatics may supervene and thereby reduce overall transport capacity. A reduced lymphatic circulatory capacity then develops in the face of increased blood capillary filtration. Examples include recurring infection, thermal burns, and repeated allergic reactions. These latter conditions are associated with "safety valve insufficiency" of the lymphatic system and can be considered a mixed form of edema/lymphedema and as such are particularly troublesome to treat. Main Actions of Lymphatic Drainage 1) Liquid/blood: Activates lymph function and lymph circulation. Indirectly stimulates the liquid circulation of the body (enhance blood capillaries resorption, increase pulsation of capillaries, activate venous circulation, . . .). 2) Immune system: the passage of lymph in the lymph nodes stimulates the immune system (the humoral as much as well as the cellular immunity). The stimulation of lymph circulation activates antigen/antibody reactions. 3) Nervous system: stimulates the parasympathetic nervous system (relaxation effect) inhibits various (analgesic action -- anti-pain --, antispastic effects -- muscle tonus -- , etc). Indications and applications of Lymph Drainage Therapy Don't forget that by law any disease must be diagnosed by an M.D. All the necessary studies have not been done yet, nor have all applications of Lymphatic Drainage been discovered. There is an unending list of indications that still need to be explored. The following are the most common disorders treated, and some are various ailments that showed response in therapists' daily practice. They are not all scientifically proven indications of lymphatic drainage. They are only reference points for those that don't have experiences of the lymph drainage. Every case has to be considered specifically. Angiology (Blood vessels) / Cardiology / Phlebology (veins) / Lymphology: Edema (swelling or "dropsy") is an excessive accumulation of fluid (hydro- colloid) in the interstitium. Lymphedema is an edema that is a result of impaired removal of lymph from the interstitium. It is an accumulation of protein-rich fluid in the tissues that may develop into fibrosis. Yet it is a poorly understood disease in medicine. a) Lymphostatic edema (high protein edemas): is one of the main medical indications of lymphatic drainage. Lymphostatic edema = deficit in lymphatic transport capacity. In lymphostatic edemas the lymphatic vessels themselves are not properly working. It is a decreased ability to remove fluid from the extracellular compartment. Theses edemas are also described as Low Output Failure or low volume mechanical insufficiency). There are various lymphostatic edemas: Primary lymphedema (congenital origin) Secondary lymphedema (anatomical obliteration): Post-surgery lymphedema: post-mastectomy lymphedema, post-hysterectomy lymphedema, post-prostatectomy, post-biopsy, etc. Metastatic lymphedema Post-infectious, (parasites / filariasis, tuberculosis, etc.) Post-radiations lymphedemas Post-trauma, burns Post-medications, silica dust, etc. CVI: post-phlebitic, etc. b) Lymphodynamic edema = overproduction of lymph or High Output Failure, is when normal or increase in capacity of normal lymphatics is overwhelmed by an excessive burden of intercellular fluid. The lymph vessels are functioning correctly (are still "dynamic") but they can't handle the excessive stagnant liquid in the connective tissue. The excess fluid present in the connective tissue is a burden beyond the transportation capacity of the lymphatic system. For example: defective kidney or heart function, blockage in the venous system, low protein edema, etc. Edemas of different origins can be also treated, for example: "dermatologic" edemas, e.g. chronic eczema; pediatric edemas; Traumatic edemas: torn muscles, sprain articulation, joint dislocations, knee edemas after meniscus and ligament lesions, tendinitis, tendinosynovitis, fracture (before, in and after the cast), haematomas, "ski thumb" injury. . . . Reduction of edema helps an early, less painful mobilization or prepares the patient's tissue before applying plaster; post- infectious edemas (ORL, odontologic ,etc.); pre-menstrual edemas, cyclic- idiopathic edema; gynecologic edemas; "neurologic" edemas (neuralgia, facial paresia, multiple sclerosis, etc.) Edemas associated with Rhumatism or Auto-Immune diseases: arthrosis, polyarthric, PSH, etc.: Nephrologic edema (nephrotic edema), Lipedema Edemas of veno-lymphatic conditions: we can drain from the first early stages of venous diseases to varicose veins, post thrombotic leg edema, hypodermitis to the late chronicle complications like venous ulcer. Always keep in mind the terrible contra-indication of acute phlebitis; arteritic ulcer, and other type of ulcer (diabetes mellitus ulcer); arterial hypertension (high blood pressure); arteritis, intermittent claudication (intermittent limping); Raynaud's disease Dentistry, orthodontic: tooth pain; post-tooth extraction (for the pain, the edema, the haematoma, the scar, etc.); tooth realignment; root canal, orthodontic surgery; gingivopathy (gums disease); parodontitis Dermatology (skin): acne vulgaris; rosacea; seborrhea; chronic and allergic eczema (avoid the area at the beginning to avoid inflammatory or allergic reactions); Peri-oral dermatitis (from cortisone treatments); chloasma; some pigmentation spots. Esthetic: wrinkles (lymph drainage hydrates the skin, nurtures wrinkles, removes toxins, regenerates skin tissue, tonifies skin, relaxes facial muscles. . . .); skin complexion; erythrosis; telangiectasia; hematosis; "bags" under the eyes; hair loss; adiposis, cellulite; breasts ptosis (sagging breasts.) Gastro-enterology (Stomach): chronic constipation; irritable bowel syndrome, chronic colitis; ulcerative colitis, Crohn's disease; enteropathy, coeliac disease; diverticulosis; food intoxication; chronic gastritis, stress ulcers; chronic pancreatic insufficiency, chronic pancreatitis General: stress; fatigue; chronic fatigue syndrome (CFS), Epstein Barr syndrome; chronic fatigue syndrome (CFS). A very common disorder, yet not clearly defined. It has worn various names: HHV6 syndrome (Human Herpes Virus 6); epidemic neuromyasthenia, Iceland disease, chronic mononucleosis, chronic teast syndrome, myalgic encephalomyelitis, etc.; autonomic dystonia; chronic pain; sleeping disorders; snoring; detoxification (fasting, dieting, tobacco, substance dependency); toxic chemical poisoning; jetlag (pressure in airplane), edemas within the plane; alcohol hangover Gerontology (older people): L.D.T. is a very good technique to use with elderly people, because of its profound effects on tissue regeneration and oxygenation, deep cleansing of the body, as well as its immune system stimulation, stress release, and health maintenance. You can apply L.D.T. for almost every indication with elderly people because of its gentleness and harmlessness. L.D.T. be used as a home family practice. Just be careful of the reaction of your patient in the 3-4 initial treatments. Give shorter sessions and evaluate; cerebral degeneration, memory loss... Gynecology: Menstruation; PMS, painful or haemorragic menstruation; breast pain or swollen breasts (from menstruation, oestro-progestatif pill, pregnancy); pregnancy; "stretch marks (belly, breasts): "striata gravidarium" "cutis striata lymphostatica". About 50% of them can usually be alleviated. It is a very long process and the results will be better if the drainage begins in early stages; swollen legs; varicose veins; breast feeding; breasts' soreness, cracks or fissures in the puerperal period (prevention or treatment; help scaring process, anti- infectious); fibrocystic mastopathy (cysts formation in the breast); Infertility Infectious disease: (also check Dermatology, General, Ophtalmology, Pneumology) You can apply it to Pediatric (children) or Gerontology (elderly people). (Be cautious to do short sessions first to avoid inflammatory reactions); chronic amygdalitis, pharyngitis, tonsillitis, laryngitis, rhinitis, otitis, syringitis; chronic sinusitis frontalis: do neck, face, especially nose and cheeks, you can finish with Intra-oral treatment if there is no sign of fever at all (be careful of meningitis with fever. Don't work with lymph drainage, and especially not inside the mouth); chronic sinusitis maxillaris; allergic nasal catarrh; HIV positive, AIDS: Be very careful, check with an M.D. The reactions can be different depending of the state of the disease. Improve quality of life, can stimulate immune system in previous states. Recent studies suggest that as many as 2 billions of lymphocytes (CD 4) are produced every day to replace the losses induced by the virus. Neurology (Nerves): headaches; migraine; post trauma symptoms: headaches, vertigo. . . .; cerebrovascular accident (stroke), hemiplegia, chronic ischemic syndrome, apoplexia, various encephalopathies. . . . concussion (commotio cerebri, commotio spinalis); spinal injuries; cerebral spastic infantile (cerebral palsy, Little's disease); neuralgia facial, intercostal neuralgia, herpes zoster neuralgia, etc.; trigeminal neuralgia; facial paralysis; Parkinson disease, choreic disorders: sometime diminution of the trembling. . .; multiple sclerosis (MS): If the disease cannot be cured with Lymph Drainage, some patients really appreciate the results of the technique especially for their legs. It seems after some studies that the crisis becomes shorter and the remissions of M.S. longer with Lymph Drainage. The action of the drainage might work on the auto-aggressive T lymphocytes that cross the blood-brain barrier in M.S.; vertigo; memory disorder; peripheral nerve disorders/cranial nerve disorders: facial nerve paralysis, trigeminal neuralgia, Bell's Palsy. . . ; myopathy, muscular dystrophy or atrophy; spinal poliomyelitis (edemas); epilepsy Ophtalmology: Visual acuity: many clients said their sight became much better after the sessions; scotoma; chronic dacryocystitis (infection of the lachrymal sac), blepharitis (inflammation of the eyelid margins); chronic glaucoma; chronic edema of the eyelids; retina detachment Orthopedy (Bones-Surgery): trauma; hematoma; sprain; dislocation, luxation; ligaments and meniscus pathologies; fracture; post fracture or post-sprain symptoms: pain, discomfort etc. Osteopathic/Chiropractic: (Also check Orthopedy, Rheumatology, Sport); neck pain, whiplash; lower back pain, lumbago, lumbalgia. . . ; sciatica: there are many different etiologies (origins) of sciatica. It is not the best indication of Lymphatic Drainage, but in some cases it really helped patients. Maybe it is the anti- edematous action around the "nerve" and the anti-pain action that makes it work. Otorhinolaringology - ORL (Nose-Throat-Ear): peridontal disease; tinnitis: tinkling, ringing or buzzing in the ear; vertigo; Meniere's disease; asialie- hyposialie; Sjrogren's syndrome (dry eyes and mouth syndrome): tremor Pediatrics (Children): All quoted diseases can be applied to children. Be especially careful not to enhance fever in a child. Pneumology (Lungs) Allergology: chronic bronchitis, emphysemal bronchitis; bronchial asthma; emphysema; post-pleuritic disorders; silicosis: pneumoconiosis resulting from inhalation of silica (quartz) dust; cystic fibrosis: (mucoviscidosis); hay fever Rheumatology (Bones-Articulation), musculoskeletal and connective tissue disorder: Lymph drainage can effectively alleviate the edemas of many rheumatologic ailments after signs of acute inflammation have disappeared; arthrosis (neck, shoulders, hips, knees. . . .), polyarthrosis deformans; rheumatoid arthritis, juvenile rheumatoid arthritis, polyarthritis; ankylosing spondylitis (ankylopoietic spondylarthritis); gout, chondrocalcinosis (pseudogout); psoriasic arthritis: psoriasis associated with arthritis; allergic arthropathies, endocrine arthropathies, diabetic arthropathies, etc; lupus erythematosus; scleroderma; polymyositis and dermatomyositis; osteoporosis; lumbago, lumbalgia; Sudeck's atrophy (traumatic osteoporosis, algoneurodystrophy or "shoulder-arm" syndrome); fibrositis syndrome: bursitis, tendinitis, tenosynovitis, tendoperiostosis, etc; tennis elbow (lateral humeral epicondylitis), etc.; carpal tunnel syndrome; Dupuytren's contracture; spasmodic torticollis; noctural paraesthetic brachialgia; fibromyalgia syndrome (FS): it is today maybe the third most common rheumatic disease. Sport: To improve the conditions of muscles before and after a sport event (waste and acid lactic in the tissue); muscles spasms; Sport trauma: any edemas, haematomas (be sure that any bleeding has stopped); sprains, dislocations, etc.; muscles cramps or pain; ligament and meniscal lesions; fractures (under cast, after the cast); scars/fibrosis Surgery: Pre-surgery: prepare the tissue for the intervention, drain the tissue clear the lymph ways before the post-surgery edema; post-surgery: scars-fibrosis (help scaring process, anti-pain, anti-infectious, etc. . .) Some effects against hypertrophic or keloides scars; for any surgery taking off major lymph nodes (post- mastectomy, post-prostatectomy, post-hysterectomy, post-ovariectomy, post- nephrectomy, ORL surgery, tumor removal. . .); post-plebitis and post thrombotic surgery; post-trauma surgery; limb amputation; prosthetic surgery; skin transplant; burns; oral surgery, face surgery, face-lifting, ear lifting. . .; vein stripping Veterinarian Lymph drainage can also be applied to animals. Source: From "Consensus Document of the International Society of Lymphology, The Diagnosis and Treatment of Peripheral Lymphedema, Lymphology, 2003 June, 36, (2): 84-91. Reproduced here by kind permission of Dr. Chikly. =========================================================== The Abdominal and Pelvic Brain, Byron Robinson, M. D., 1907 Thoracic Duct The thoracic duct is in general 1/6 of an inch in diameter and 18 inches in length with non-uniform caliber and sinuous course with minimum caliber at its middle portion. It is especially dilated at the distal end (receptaculum lymphatics) and at the proximal end is an elongated ampulla (which I shall term its cervical dilatation). The thoracic duct may bifurcate, forming two or several branches, a network, and reunite in its course. Its valves are the most limited in number and dimensions of any portion of the tractus lymphaticus. (1) Receptaculum Lymphatica (Distal Dilatation). In general the dimensions of the receptaculum lymphatics is 1/5 of an inch in diameter and 2 1/2 inches in length. It is an oblong formed sac or dilatation at the distal end of the thoracic duct. (2) Cisterna Lymphatica Cervicis (Proximal Dilatation). The "cervical dilatation" or cisterna lymphatica cervicis is a spindle or oblong formed swelling of the duct located at its terminal end. It, as well as other dilations, has been termed an ampulla. (3) Isthmus Medius (Middle Isthmus). The thoracic duct possesses a minimum caliber at its medial portion, hence I shall term this the middle isthmus. It is the chief constriction or isthmus of the thoracic duct. Source: Large extracts taken from Massage Today, Jan. 2004, Vol. 4 , Numb. 1, Page 1, 20-21. Reproduced here by kind permission =========================================================== Massage Therapists and Breast Care: Easing the Controversy By Bruno Chikly, M.D., D.O. (hon.) Breast care is often the subject of ardent controversies due to legal, ethical and physical problems associated with it. Because of this, many practitioners are reserved when it comes to working on this area of the body. It is my hope that the information and guidelines provided here will work to ease the debate. I have taught and provided therapeutic breast care for many years using techniques that work through the lymphatic system. While I understand the reason for the controversy, I know that respectful, nonstimulating and effective techniques exist for the care of the breast. As with any type of manual therapy, however, they must be practiced in a very specific and controlled environment by qualified therapists with a clear understanding of boundaries. Within this context and a therapist's scope of practice, breast care can be safely and efficiently applied to alleviate numerous breast pathologies. Guidelines for Therapeutic Breast Care Through my experience treating the delicate tissues of the breast, I developed some general guidelines for application that, when observed, may eliminate most of the controversy. 1. Before using any technique on the breast, therapists should review and be clear on the rules and/or laws that govern their licensure in the city/state/country where they practice. 2. Obviously, all contraindications and precautions must be respected related to the specific pathology and technique being used. 3. Heavy pressure should not be applied to the breast tissue. All that prevents breast tissue from sagging (mastoptosis) are some of the minute elastic fibers of the superficial skin and a few suspensory ligaments (Cooper's ligament), which are actually comprised more of irregular layers of connective tissue fibers than of real organized ligaments. (See Dissection of the Human Lymphatic System, video 2, Chikly.) Petrissage (kneading) may therefore hurt or destroy the few existing local suspensory ligaments and elastic fibers. Women with breast implants present another area of caution. Pressing the breasts strongly could exacerbate some leaking. 4. Though manipulation of the breast tissues can be stimulating, there are a number of techniques available today that are gentle, noninvasive and nonstimulating for the breast. My position is that very efficient work can be accomplished without ever using stimulating touch. Remember, breasts are created to nurture and support the growth of a newborn. As such, they need to be touched in the most respectful and gentle manner. Going a step further, I would even suggest that a therapist's speech and thought processes be gentle during a breast treatment. 5. Prior to any session, therapists should clearly explain what the session will entail and what the objectives and intent are. I recommend that they always have the client sign a release giving them permission to do the breast work. This form should explain why and how this technique is applied. It should also state that a client can stop the massage for any reason at any time during the treatment process and the decision will be respected, no questions asked. 6. It is important for therapists to remain aware of the trust that the client has placed in them to provide breast care. Proper draping should be used at all times to provide the client maximum comfort and security. 7. I always recommend self-application techniques (Self-Lymphatic Breast Care [SLBC]) to clients as a way to enhance the effects achieved during the session. The protocol is also an excellent option for clients who may not feel comfortable having the technique applied by a practitioner. Study of the body's lymphatic system shows that breast tissue contains an abundance of lymph vessels. Unlike other areas of the body, however, the breast lacks sources of external compression, such as muscles or strong overlying fascia, that promote natural lymphatic drainage. As a result, fluid has a tendency to stagnate, which may lead to breast pathologies (mastopathy).This is where gentle, nonstimulating techniques can be applied to aid fluid recirculation. Of the many modalities I have studied and practiced throughout my career, I am amazed at the applications and efficiency of Lymph Drainage Therapy in treating most breast pathologies. Lymph Drainage Therapy (LDT) is a gentle, nonstimulating technique that has very few contraindications. It is distinctive in that it teaches practitioners how to attune to the precise rhythm, direction, depth and quality of the lymph flow. LDT is particularly good for treating the delicate breast tissue because it requires extremely specific and light pressure. Breast care is an important area of health that is often neglected due to the stigmas surrounding the treatment of this part of the body. The multiple applications and benefits of Lymph Drainage Therapy for mastopathies are simply too important, not to be implemented. Armed with knowledge and a clear understanding of boundaries, we can hopefully eliminate the controversy surrounding this legitimate and necessary therapeutic application. BRUNO CHIKLY, M.D., D.O.(hon.) Laureat of the Medical Faculty of Paris, Associate Member of the American Academy of Osteopathy and the Cranial Academy, Member of the International Society of Lymphology (I.S.L.), Member of the National Lymphedema Network (N.L.N.), Director of Lymph Drainage Therapy seminars +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Information about Dr. Chikly's book: In his definitive text, "Silent Waves: Theory and Practice of Lymph Drainage Therapy," Dr. Chikly addresses the applications for lymphedema, chronic pain and inflammation. "Silent Waves" is carried by Stanford University Medical Library and is the first comprehensive book on the lymphatic system and lymphedema in North America. (ISBN: 0-9700530-5-3, Hardcover). A book review is at: http://www.upledger.com/therapies/waveldt.htm Ordering is available from: http://iahe.com/controller/IaheProductDisplay?productCode=SW Several other articles that may be of interest are: http://iahe.com/controller/ArticleDisplay?id=10093 http://iahe.com/controller/ArticleDisplay?id=10057 http://iahe.com/controller/ArticleDisplay?id=10037 http://iahe.com/controller/ArticleDisplay?id=10357 Our Certification program details: http://iahe.com/controller/IaheCourseDisplay?id=188&courseCode=LLCC Kathy Woll The Upledger Institute Permission gained to publish these articles by Dr. Chikly. Source: Dr. Bruno Chikly ======================================================================= Last page update 2/28/09 |
