Lymphoedema Support Group get into Yoga

A fun day with willing participants!

See the LSGSA Facebook page for more photos.

I was able to share my love of Yoga with Lymphoedema people and friends during Lymphoedema Awareness Month.

Thanks Monique a everyone who put in all the behind the scenes effort to make it such a successful meeting.

The following link will open a pdf of the presentation and teh exercises we did on the day

LSGSA Ex & Yoga

Who’s training you???

Vodder logo 2015

Since becoming an accredited Instructor with Vodder Schools International I have received numerous emails and questions from people wanting to know about ‘other’ training programs.

I can’t comment on the content or quality of any other courses but there are some facts that prospective students should be aware of.

Recognition of your qualification
If you are planning to treat people with lymphoedema then you should only consider courses which are recognised for entry to the National Lymphoedema Practitioner Register (NLPR). The NLPR is an assessed register which means that everyone on it has undergraduate and postgraduate qualifications suitable for lymphoedema management.

The NLPR is managed by the  Australasian Lymphology Association which is the peak body for lymphoedema therapists in Australia and New Zealand. You can read more about the ALA and the NLPR at lymphoedema.org.au

ALA Home page

 

Benefits of listing on the NLPR are:

  • Access to client services. Some institutions such as DVA now require the therapist to be a member of the NLPR in order to provide rebates. Most garment schemes also have this requirement.
  • Validity of your services. Because the register is assessed it is used and trusted and by health professionals who want to refer patients

What technique is being taught?
There are two primary techniques used for lymphatic drainage.

  • Lymphatic effleurage. Performed with a flat stroking movement. It acts like squeezing a tooth paste tube. You clear the fluid inside the lymph vessels by applying a light pressure along the lymph pathway.
  • Manual lymph drainage (MLD) which is a very precise movement of the skin in a circular direction. This triggers a reflex in the lymph vessels which increase their pumping activity. It is like turning on the vacuum cleaner, the increased movement in the vessels will ‘suck’ the fluid from the extracellular space into the distal end of the lymph vessel. This increased lymph motoricity has been shown to last for several days after the treatment.

"Stationary Circles" The foundation technique in MLD. The skin is stretched in a circular pattern with and increasing pressure and then passively returned to a zero phase. This precise pressure (imagine the weight of a couple of coins resting on the skin) and movement of the skin is what activates the lymph vessels to pump harder.“Stationary Circles” The foundation technique in MLD. The skin is stretched in a circular pattern with an increasing pressure and then passively returned to a zero phase. This precise pressure (imagine the weight of a couple of coins resting on the skin) and movement of the skin is what activates the lymph vessels to pump harder.

What other conditions will I be able to treat?
People with lymphoedema often have complex needs – frozen shoulders, knee and hip replacements, carpal tunnel etc. Any increased inflammation in the body will exacerbate lymphoedema, and the symptoms of these conditions seem to be exacerbated in the lymphoedema limb. Only the Dr Vodder course provides training in drainage of all deeper structures such as joint capsules, skeletal-muscular attachments and trigger points.

And what most people don’t realise is that you can use these same techniques to treat everything you might have previously treated with deep remedial techniques. With MLD you will get a better result faster without pain for the client and without stressing out your own body. Sounds too good to be true right? Have a look at some of the case studies on the Facebook Page

Quality in training is a key component of the Vodder School philosophy    

and I am proud to be accredited by them to teach this important technique. The courses offered by Vodder Schools International meet and exceed the Australian Lymphology Association (ALA) Training Guidelines for Lymphoedema
Akademie logo_vodder_big_01

The Vodder School also offers a review class to keep therapists current with clinical practice and research on an international level. Practical trainers accredited by the school (like me) undergo an intensive 4 – 8 week training program at each level and must pass stringent practical and theory exams. Instructors must also renew their accreditation annually.

This ensures that every instructor is completely up to date with latest research and clinical practice and to maintain a high standard of technical expertise. Lymphoedema assessment and theory is taught by internationally recognised academic and medical experts in their field. In Australia this is often Professor Neil Piller.

A biography of all instructors can be viewed at vodderschool.com.
Rotary

Systematic Review on MLD for BCRL

Cochrane_Logo

The Cochrane Library of Systematic Reviews has accepted only 4 reviews on management of lymphoedema – mainly because one of the Cochrane criterion is to include only randomised controlled trials and many studies on lymphoedema are cohort studies (one group all receiving the same treatment) and not RCT’s (two or more groups receiving comparative treatments, usually with one group acting as a control and receiving no treatment at all).

Systematic Reviews (SR) are very different to Literature Reviews. In a Literature Review it is possible for a single author to ‘cherry pick’ the included articles to support a particular point of view. In a Systematic Review the authors must accept and include all the published papers which meet the stated criteria for the review. This reduces the possibility that the authors have biased the review in favour of their own opinions. Additionally an SR must have at least two authors and will commonly have a whole team performing the review.

In this review, although the search found 834 articles on MLD, the authors excluded 805 – either because the title itself or the abstract (a short synopsis of the whole paper) indicated they were not suitable for inclusion. Then, when the remaining 29 papers were closely evaluated only six met the strict inclusion criteria that had been set at the commencement of the review. It is important to realise when you are reading an SR that whilst it will give you the best available evidence for the intervention under review, it is not representative of all the available peer reviewed literature that has been published on the subject.

You can read the full article at
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003475.pub2/full
but unless you are academically trained you might go cross-eyed trying to follow the complicated process by which the reviewers have come to their conclusions!

At a minimum I suggest you read:

  • The first 6 pages
  • Page 11
  • And look at the ‘Forest Plots’ starting on page 15.

Forest plots graphically compare the results of the trials. The green square indicates the weighting given to each included trial and the thin line through it indicates the range of results for individual trials. The black diamond summarizes this for all trials in the graph. In this review most of the forest plot comparisons are of only one trial at a time so the black diamond is pretty much the same width as the line. If the thin line or the black diamond crosses the vertical line then the results are less definitive than when  all the data is on one side only.

From the forest plots in this review you can see that:

  1. MLD + compression therapy was better then SLD (self massage) + compression in reducing excess limb volume but not better than a compression pump + compression.
  2. MLD + compression sleeve was only slightly better than SLD + compression sleeve in reducing total limb volume.
  3. A greater % change in lymphoedema volume was achieved using MLD than using SLD or a pump.

You might also like to read the results on subjective symptoms reported on page 18. I value self-reported symptoms very highly in my clinic. After all, it is about how the person experiences their conditions that really matters, not how many mls reduction is achieved (although the two are often closely linked).

It is good to read the authors Discussion (pages 19 – 21)  but if you are already too mind boggled by now you can cut to the Conclusion (page 22).

The main points that I have taken from this review are;

  • Performing MLD  in the reduction phase of treatment may have the greatest benefit in earlier stages of lymphoedema than in later stages. This reinforces my personal view that we need to advocate for earlier intervention.
  • Skipping bandaging and going straight to a sleeve is not as effective as persisting with the initial phase of short stretch bandaging.
  • Off the shelf sleeves are not as effective as custom made sleeves.

One big issue that I have with most trials on MLD is the lack of description of the technique used – not all MLD is equal. And again in this review you can’t tell if the ‘MLD’ used in any trial was the Dr Vodder technique or lymphatic effleurage. I am yet to see anywhere a trial that compares these two forms of lymphatic drainage but I do believe that they are not the same and will not produce the same results.

Until authors of original research – and that includes authors of reviews of original research – more explicitly describe the MLD techniques used, I believe we do not yet have a clear picture of the effectiveness of Dr Vodder’s MLD.

The Original Dr Vodder Method of Manual Lymph Drainage (MLD)

This specialised technique uses precise movements of the skin to activate the lymph vessels which respond by pumping harder and faster. By this action MLD has a profound effect on lymphatic transport, literally suctioning the tissues like a vacuum cleaner, removing wastes, excess fluid and moving immune elements more effectively to where they are needed.

Rotary
“Rotary” technique. Performed on large open areas to actively promote the flow of lymph in the underlying vessels

The technique also has an incredibly calming affect on the sympathetic nervous system, that’s the part of the nervous system that responds to stress. Research has shown that this stress response reduces significantly within 5 minutes of commencing MLD. And not just for the client, MLD practitioners also get the benefit while performing the treatment!

"Soldiers" Activating deep pathways along the spine
“Soldiers” Activating deep pathways along the spine

Unlike lymphatic effleurage which simply empties the lymph vessels in the direction of the lymph nodes, MLD initiates a lasting response in the vessels which continue to ‘pump’ more effectively for up to 3 days after the treatment has ceased.

"Stationary Circles" The foundation technique in MLD. The skin is stretched in a circular pattern with and increasing pressure and then passively returned to a zero phase. This precise pressure (imagine the weight of a couple of coins resting on the skin) and movement of the skin is what activates the lymph vessels to pump harder.
“Stationary Circles” The foundation technique in MLD. The skin is stretched in a circular pattern with an increasing pressure and then passively returned to a zero phase. This precise pressure (imagine the weight of a couple of coins resting on the skin) and movement of the skin is what activates the lymph vessels to pump harder.
"Thumb Circles" These smaller movement are repeated numerous times in the same are where they actively change the consistency of the connective tissue, changing congested, gel like states back into free flowing, fluid states.
“Thumb Circles” These smaller movement are repeated numerous times in the same area where they actively change the consistency of the connective tissue, changing congested, gel like states back into free flowing, fluid states.

To find courses for this technique in Australasia visit www.movinglympn.com

For courses worldwide go to www.vodderschool.com