Define "gentle" when doing LE massage

Del14

Define "gentle" when doing LE massage

lisa-e

Jo, can you have your PT evaluate your massage technique?  

 Regarding gauntlets - I don't wear one because my hand and wrist swell if I do.  It doesn't matter if I wear the gauntlet over or under the sleeve.   I think it is because the compression where the gauntlet overlaps the sleeve is just too much.   

 lisa-e

otter

JO, I don't know who said it (Binney, perhaps), but someone here characterized the "touch" of MLD as "kitty pats." Whenever I would go back to my LE therapist for a follow-up, I would always be surprised at the lightness of her touch as she did MLD on my chest and arm.

What I did not know until I saw something Binney sent me about lymphatic drainage was how superficial the relevant lymphatic vessels are. When I studied anatomy, I learned that nearly every artery/vein team has an accompanying lymphatic vessel that runs right alongside them. So, I figured the massage had to be fairly firm to move fluid along those vessels, which can be pretty deep under the skin.

But the lymphatics that are a problem with LE lie just underneath the skin. They are very tiny, and there are lots of them (sort of a meshwork). So, to move fluid into and through them, we only need to press a tiny bit with the pads of our fingers. (The technique can vary, depending on the therapist.) Yes, you have to move the skin ... but not very much. And you should not be pressing hard at all, unless you're massaging to break up fibrosis, which is a whole different situation that I don't know anything about.

Remember:  kitty pats. Soft, whispery pushes (or pulls?) along the skin.

Feels kind of good, eh?

otter 

Binney4

Kira and I have been discussing how hard it is to be both gentle and slow when we're either in a hurry or worried about flare-ups. We just naturally want to wring those suckers out! But MLD takes a whole different mind set that can be hard to come up with. If it's any comfort, Vodder therapists have to take courses every two years to up-date their skills, and one of the main things they have to relearn is GENTLE!!

Another good description to help you keep it in mind is that the international symbol for lymphedema is a butterfly, and the massage is as gentle as butterfly kisses. (Awwwww! Is that cute, or what?!)

I'm bad at this. If I see that the fluid is building up I get panicky and mad and way too vigorous. It helps to plan a quiet time, play some restful music, light a candle, relax and...ahhhhh!

Be well,
Binney

kira66715

It is hard not to try and DRIVE that darn fluid out. I actually bought a book on Amazon by Foeldi on MLD--it's a bit hard to understand, but he's adamant that the strokes be SLOW--and gentle. Different people teach different strokes: sweeps, stationary circles, pull/release--the key is to just move the skin, gently. Hard to do when frustrated.

JoAnn Rovig has on line videos, she uses the sweep stoke--they're helpful to review MLD.

http://www.nwlymphedemacenter.org/ 

If I'm frustrated and mashing, I go back to sweeps, hard to do them too hard. I'm currently frustrated with my ##$% inner wrist, and it's hard not to want to push the fluid out.

Kira 

kira66715

Jo, I love that book--the first one that actually drew pictures and explained. The videos are interesting, although she takes a while to get to the point, but if you just look at MLD for upper extremity, parts 1 and 2, it's only about a 12 minute committment.

It is an adventure, and we're constantly learning.

Kira

kira66715

Jo,

  JoAnn Rovig is opinionated, and not everyone agrees with her: I personally still clear the neck/chest/inguinals, although I don't have obvious issues other than my hand/wrist. I don't spend a ton of time there, but I do it. I'd review it with your LE therapist. I feel like clearing the neck/watersheds/trunk can't hurt. If I'm really rushed for time, I may skip the inguinals.

I found the videos to be so helpful, and I re-watched it again the other day, and it was a good refresher.

Kira

kira66715

Jo, she is a character! She's also proud that she's flown without compression garments, yet says she wants to set a good example????

What I figure, is that we learn something from her, and take what works, and kind of discard but recognize the part that doesn't make sense.

One thing she said that made a big impact on me, is that when we learn how to control our LE, we get our power back.

And, it's a moving target--at least for me.

I completely agree with you: if it didn't feel right, then you added back the trunk clearing (and some sites just say to clear our necks and upper chests)--as we figure out what works for us, we gain some control over this.

I appreciated her videos, but I also realize that her opinions are a bit controversial. Yeah, we should all have surgery--elective, for a lipoma--on our LE arm, and let them run an IV in that arm as well. That's an example--of someone who's completely ignoring reasonable risk reduction!

Kira

kira66715

Jo, 

Well, I still remember taking care of a little girl who had osteomyelitis of leg--6 weeks of trying to keep an IV in a toddler, and the presumption was that the bacteria got into her bloodstream and ended up in the bone.

Same argument for why some people need antibiotics for a dental cleaning, so the bacteria that get into the blood won't end up on their heart valves.

Likely, you'll never know, and with cellulitis and LE, it can just sort of happen spontaneously. It's very scary--if it can happen without an obvious source, how do you prevent it? That's when prophylactic antibiotics and using hibiclens come in. I hope it NEVER happens to you again.

Kira