Define "gentle" when doing LE massage

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 

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 

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

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