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News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
June, 2002, Vol. 02, Issue 06
Traditional Massage Therapy in the Treatment and Management of Lymphedema
By Joachim Zuther, MT, PT
Editor's note: Joachim Zuther is the founder and director of the Academy of Lymphatic Studies in Sebastian, Florida. Mr. Zuther received his massage therapy degree in 1982 and his physical therapist degree in 1984, both from the School for Physical Therapy and Massage in Ulm, Germany.He is also certified in manual lymph drainage and is the director of the Lymphedema Association of North America (LANA).
Lymphedema is a common condition caused by a reduction in the transport capacity of the lymphatic system. The lymphatic system in the affected area is unable to respond to an increase in lymphatic loads. Massage therapy increases the amount of lymphatic load and can have negative effects on lymphedema if applied incorrectly.
This article discusses the differences between massage therapy and the techniques known as manual lymph drainage (Vodder Technique) and the proper application of massage therapy when lymphedema is present.
Lymphedema is defined as high-protein edema - an accumulation of water and protein in the tissues, caused by a decrease in the transport capacity of the lymphatic system. Lymphedema may be mild, moderate or severe; most often, it affects the extremities, but can also be present in other parts of the body.
Lymphedema can be classified as primary or secondary. In primary lymphedema, transport capacity is reduced as the result of a congenital malformation in the lymphatic system.6 Primary lymphedema may be present at birth, but more often develops later in life, with or without obvious cause. Secondary lymphedema is more common, and is caused by surgical interventions involving the lymphatic system. Lymph node dissections, radiation therapy, or incisions that disrupt the natural pathways of the lymphatic system affect the ability of the lymphatics to drain lymphatic loads out of the affected extremity. Secondary lymphedema may arise immediately after surgery or years later.
What Are Lymphatic Loads?
The lymphatic system is not a closed circulatory system; it works according to the one-way principle. Its main purpose is to drain from the interstitium substances that cannot be absorbed by the venous end of the blood capillaries. These substances, called lymphatic loads, consist of water, protein, cells and fat.5
What Is the Transport Capacity of the Lymphatic System?
Transport capacity is the highest possible lymph flow per unit of time.4 The relation of the physiological resting lymph flow to the transport capacity of a healthy lymphatic system is approximately 1:10.7 This means that the lymphatic system is able to transport 10 times the volume of the normal amount of lymphatic loads. When primary or secondary lymphedema is present, the transport capacity of the lymphatic system falls below the physiological level of water and protein load (mechanical insufficiency).
Massage Therapy vs. Manual Lymph Drainage (MLD)
The term massage means "to knead" (Gr: massain) and is used to describe forms of "classical" or "Swedish" massage.10 The word is often misused to describe the techniques of manual lymph drainage, which is a gentle, manual treatment technique used in combination with compression therapy, skin care and decongestive exercises. The techniques of MLD are used to effectively treat primary and secondary lymphedema1 and postsurgical and posttraumatic swelling. Migraine headache, chronic venous insufficiencies and edema of other genesis present additional indications. MLD also has a detoxifying effect.
If applied correctly, MLD increases the activity of lymph vessels and moves interstitial fluid; it exerts little pressure on the skin3 and does not cause any increase in local arterial blood flow.
Effects of Massage Therapy on the Skin
The basic strokes used in massage (e.g., petrissage, effleurage, tapotement, vibration and friction) are generally applied with more pressure than manual lymph drainage techniques. The effects of massage strokes are not limited to suprafascial tissues (e.g., the skin), but also cause reactions in subfascial areas such as muscles, tendons and ligaments. Massage strokes can increase local arterial blood flow and venous and lymphatic return, and can also loosen subcutaneous adhesions.
Many massage therapy publications list edema as one of the indications for these techniques.8 This statement, while correct, is often misleading if the distinction between edema and lymphedema is not established. Edema is suprafascial tissues can be caused by various problems, including inflammation or impaired venous return (valvular insufficiency, pregnancy, or prolonged sitting and/or standing). With edema, the lymphatic system remains intact but is overloaded. This condition, called dynamic insufficiency, results in the accumulation of water in the tissues. Massage therapy may be beneficial for some forms of edema, but is contraindicated for others. It should not be applied without prior consultation with a physician.
On the other hand, lymphedema is always caused by mechanical insufficiency of the lymphatic system; water and protein accumulates in the tissues. As discussed earlier, in the case of mechanical insufficiency, the transport capacity of the lymphatic system falls below the physiological level of water and protein load and is not able to appropriately respond to an increase in lymphatic loads.
Negative Effects of Massage Therapy on Lymphedema
Most massage strokes cause an increase in arterial blood flow (active hyperemia) in skin areas where such techniques are applied. Active hyperemia is accompanied by an increase in blood capillary pressure and subsequent increase in ultrafiltration of water in the area of the blood capillaries. This process results in more water accumulating in the interstitial spaces. Water represents a lymphatic load. Due to mechanical insufficiency, the lymphatic system will not be able to manage this additional water load. If massage therapy to lymphedemateous tissues, an increase in swelling may result.
Additionally, superficial lymphatics are extremely vulnerable to external pressure. Traditional massage techniques can cause focal damage to anchoring filaments and the endothelial lining of lymph vessels.2 This possible damage to lymphatics, and the potential increase in arterial blood flow, must be avoided.
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