Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach

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.

Therapeutic Ultrasound Decreases Mechano-Growth Factor Messenger Ribonucleic Acid Expression After Muscle Contusion Injury

OBJECTIVE

To examine the influence of nonthermal ultrasound on mechano-growth factor (MGF) messenger ribonucleic acid (mRNA) expression after blunt trauma.

DESIGN

A 2x4 factorial multivariate analysis of variance design.

SETTING

University research laboratory.

ANIMALS

Thirty-six 3- to 4-month-old male Wistar rats (mean weight, 280.8+/-21.5g). Thirty-two received a bilateral contusion injury to the gastrocnemius via a drop mass technique. Four were control animals.

INTERVENTION

Ultrasound treatment (frequency, 3MHz; intensity, 0.3W/cm(2); continuous duty cycle) was started 24 hours postinjury and delivered for 5 minutes daily on 4 consecutive days. Treatment was on the left hindlimb and the contralateral right hindlimb was the nonultrasound control.

MAIN OUTCOME MEASURES

Muscle mass (in grams) and MGF mRNA expression as measured via real-time reverse transcriptase polymerase chain reaction.

RESULTS

Ultrasound had no effect on muscle mass (F(1,28)=2.723, P=.110, 1-beta=.357, eta(2)=.089). Ultrasound treatments decreased MGF mRNA expression in the treated limb compared with the nontreated hindlimb (F(1,28)=6.605, P=.016, 1-beta=.699, eta(2)=.191).

CONCLUSIONS

The nonthermal ultrasound treatments resulted in decreased MGF mRNA expression after blunt trauma to the gastrocnemius muscles.

Reliability and validity of a novel muscle contusion device

CONTEXT

Many models have been employed to replicate skeletal muscle injury associated with trauma; however, most are restricted to 1 level of severity.

OBJECTIVE

To create and validate an injury-producing device that could generate multiple levels of injury severity.

DESIGN

Validation study.

PATIENTS OR OTHER PARTICIPANTS

Twenty-six male Wistar rats, 3 to 4 months old.

INTERVENTION(S)

A contusion device was developed and its ability to deliver consistent impacts was validated alone and in the presence of an experimental animal. A free-falling mass (267 g) was adjusted to the desired height (40, 50, 60, or 70 cm) and then dropped.

MAIN OUTCOME MEASURE(S)

Peak load, peak displacement, impulse, energy, and velocity peak were measured. Injury severity was determined using magnetic resonance imaging.

RESULTS

Outcome measures observed from the device alone were different by height (F(18,136) = 21.807, P < .001, 1-beta = 1.0). Outcomes using the experimental animals were also dependent on height (F(14,102) = 68.679, P < .001, 1-beta = 1.0). Linear regression analyses indicated that height accounted for 17% to 89% of the variance.

CONCLUSIONS

Mild to moderate and moderate to severe injuries can be replicated with this device, which will be useful in evaluating clinical treatments on acute muscle injury.

Magnetic resonance imaging of acute injury in rats and the effects of buprenorphine on limb volume

The purposes of this study were to determine 1) whether magnetic resonance imaging (MRI)-based T2 mapping and measurements of limb volume can differentiate injured and uninjured tissue after blunt trauma to rat hindlimbs and 2) whether administration of buprenorphine influences these assessments. Male Wistar rats (age, 3 to 4 mo) underwent blunt contusion injury to the posterior aspect of the hindlimb; MRI was conducted at 6, 12, 24, 48, 72, and 96 h after injury. The imaging results showed that administration of buprenorphine had no effect on the T2 value {area under the receiver operating characteristic [ROC] curve: with drug, 0.869 [95% confidence interval (CI), 0.78 to 0.96]; without drug, 0.809 [95% CI, 0.72 to 0.90]} but did influence limb volume [area under the ROC curve; without drug, 0.954 (95% CI, 0.92 to 0.99); with drug, 0.713 (95% CI, 0.61 to 0.82)]. When using MRI to determine the extent of injury or to track injury over time, calculated limb volumes may lose sensitivity to detect injury, due to the intrinsic increase in volume from morphine-derived drugs. During administration of morphine derivatives, T2 maps may provide more accurate assessments of muscle tissue injury both initially after injury and over time.