Acute cardiovascular responses to a session of Manual Lymphatic Drainage

Impacto da drenagem linfática manual nos sintomas relacionados ao edema de membros inferiores de gestantes

RESUMO O objetivo deste artigo é analisar os efeitos da drenagem linfática manual sobre os sintomas de sensação de peso, dor, edema e formigamento nos membros inferiores de gestantes, assim como na redução da perimetria. A amostra foi composta por 23 voluntárias, e foram realizados 35 atendimentos. Foram incluídas gestantes com idade gestacional acima de 26 semanas, que apresentavam sensação de peso, dor, edema e formigamento nos membros inferiores, com autorização escrita do médico obstetra para que fossem submetidas a drenagem linfática manual utilizando o método Leduc. Foram excluídas gestantes que apresentaram pressão arterial superior a 140/100mmHg no momento da realização da drenagem linfática manual, lesão de continuidade da epiderme, doenças dermatológicas, linfáticas e cardíacas, infecções e varizes volumosas e/ou sintomáticas. As avaliações foram realizadas imediatamente após a aplicação da drenagem linfática manual e duas horas depois, por meio de questionário estruturado pelas pesquisadoras. Diferenças estatisticamente significativas foram encontradas antes, imediatamente após e após duas horas da intervenção no que se refere à melhora da dor (p=0,001*), do formigamento (p=0,01*), da sensação de peso (p=0,000*) e do inchaço (p=0,000*). Em relação à perimetria antes e após o tratamento, houve diminuição na maioria das mensurações realizadas. A técnica de drenagem linfática manual tem papel fundamental na melhora da qualidade de vida da gestante devido ao relaxamento e bem-estar proporcionado, componentes considerados essenciais para redução da ansiedade e com benefícios que podem perdurar até o parto.

Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy

BACKGROUND

Lymphedema arises due to a malfunction of the lymphatic system, leading to extensive tissue swelling. Complete decongestive therapy (CDT), which is a physical therapy lasting for 3 weeks and includes manual lymphatic drainages (MLD), leads to fluid mobilization and increases in plasma volume. Here, we investigated hemodynamic responses induced by these fluid shifts due to CDT and MLD.

METHODS

Hemodynamic parameters were assessed continuously during a sit-to-stand test (5 min baseline, 5 min of standing, and 5 min of recovery). This intervention was repeated on days 1, 2, 7, 14, and 21 of CDT, before and after MLD. Volume regulatory hormones were assessed in plasma samples.

RESULTS

A total number of 13 patients took part in this investigation. Resting diastolic blood pressure significantly decreased over three weeks of CDT (p = 0.048). No changes in baseline values were shown due to MLD. However, MLD led to a significant decrease in heart rate during orthostatic loading over all epochs on therapy day 14, as well as day 21. Volume regulatory hormones did not show changes over lymphedema therapy.

CONCLUSION

We did not observe any signs of orthostatic hypotension at rest, as well as during to CDT, indicating that lymphedema patients do not display an elevated risk of orthostatic intolerance. Although baseline hemodynamics were not affected, MLD has shown to have potential beneficial effects on hemodynamic responses to a sit-to-stand test in patients undergoing lymphedema therapy.

Investigation of the Less Known Effects of Manual Lymphatic Drainage: A Narrative Review

Introduction: Manual lymphatic drainage (MLD), one of the components of complex decongestive physiotherapy, which is accepted as the gold standard in the treatment of lymphedema, is used for therapeutic purposes in many diseases. The most well-known feature of MLD is that it helps to reduce edema. In addition to reducing edema, MLD has many effects, such as increasing venous flow, reducing fatigue, and raising the pain threshold. To the best of our knowledge, there is no study examining the effects of MLD other than its effects on edema in detail. The aim of this study is to compile effects of MLD and to provide a better understanding of the effects of MLD. Methods: A literature search was conducted in Medline, Embase, and the Cochrane Library in July 2019, to identify different effects of MLD. The articles were chosen by, first, reading the abstract and subsequently data were analyzed by reading the entire text through full-text resources. To undertake the study, we have collected information published about different effects of MLD over the last 30 years (1989-2019). According to our results, 20 studies met inclusion criteria. Conclusions: This study suggests that MLD can be used in symptomatic treatment of various diseases (multiple sclerosis, Parkinson's disease) considering the effects of MLD on the systems.

Acute Cardiovascular Responses to the Application of Manual Lymphatic Drainage in Different Body Regions

Background: The purpose of this study was to investigate acute cardiovascular responses to manual lymphatic drainage (MLD) on different parts of the body. Materials and Methods: Thirty healthy individuals (10 women and 20 men) participated in the study voluntarily. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiration frequency, and oxygen saturation were measured before and after MLD was applied to different regions of the body (neck, abdomen, anastomosis, arm, and leg). HR, SBP, and DBP were measured with a sphygmomanometer (OMRON, USA) and oxygen saturation was measured with a pulse oximeter. Results: Increase in DBP was seen after abdominal drainage (p = 0.038); reduction in SBP (p = 0.002) and DBP (p = 0.004) after neck drainage; reduction in SBP (p < 0.001) and HR (p = 0.004) after arm drainage; and reduction in SBP and DBP after leg drainage. There was no change in the oxygen saturation levels of participants after MLD (p > 0.05). Conclusions: In healthy subjects, the effects of MLD were found to vary according to the region of application. This study signals that the cardiovascular effects of MLD treatment vary in different regions of the body.