Issue link: https://www.massageandbodyworkdigital.com/i/621015
• Place both hands on the surface of the abdomen on either side of the umbilicus and apply a firm but gentle rhythmic pumping action toward the thorax (Image 4). Repeat this procedure four or five times. • Apply a pumping, rhythmic compression on the soles of the feet and palms of the hands. • Rhythmically rock the body, beginning at the feet, and passively move the joints throughout the massage session (Image 5). Massage protocol (Total time: 30 minutes) • The massage application consists of a combination of short, light, pumping, gliding strokes, beginning close to the torso at the node clusters and directed toward the torso. • The strokes methodically move distally (Image 6). The stroke does not slip, but rather drags the tissue to bind. The phase of applying pressure and drag must be longer than the phase of pressure and drag release. The releasing phase cannot be too short, because the lymph needs time to drain from the distal segment. Therefore, the optimum duration of the pressure and drag phase is 6–7 seconds; for the release phase, it is about 5 seconds. • This pattern is followed by long, surface, gliding strokes and kneading with a bit more pressure to influence deeper lymph vessels. The direction is toward the drainage points. • Repeat in each body segment and limb. Repeat generalized pumping protocol (Total time: 10 minutes) To end the session, repeat the same steps as in the opening pumping protocol. CONCLUSION This is an example of how to justify massage adapted to specifically target fluid movement when research evidence is inconclusive or does not exist. Each step of the suggested protocol is based on mimicking normal function. Obviously, all fluid is moved—not just lymph. Also, the connective tissue structures and nervous system are stimulated as well. Regardless of how specific an outcome we intend, massage is just too general and broad in approach and effects to make a specific type of claim. However, by using critical thinking and offering full disclosure during the client's informed consent process, you can safely and ethically offer an adapted massage that is safe for your client's lymphatic issues. Notes 1. Giampietro Vairo et al., "Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach," The Journal of Manual & Manipulative Therapy 17, no. 3 (2009): e80–e89. 2. T. W. Huang et al., "Effects of Manual Lymphatic Drainage on Breast Cancer-Related Lymphedema: A Systematic Review and Meta- Analysis of Randomized Controlled Trials," World Journal of Surgical Oncology 14 (2013). 3. M. M. Stuiver et al., "Conservative Interventions for Preventing Clinically Detectable Upper-Limb Lymphoedema in Patients Who Are At Risk of Developing Lymphoedema After Breast Cancer Therapy," Cochrane Database of Systematic Reviews (February 2015), accessed December 2015, www.ncbi.nlm.nih.gov/pubmed/25677413. 4. J. Ezzo et al., "Manual Lymphatic Drainage for Lymphedema Following Breast Cancer Treatment," Cochrane Database of Systematic Reviews (May 2015), accessed December 2015, www.ncbi.nlm.nih.gov/pubmed/25994425. Sandy Fritz is the owner and head educator of the Health Enrichment Center School of Therapeutic Massage in Lapeer, Michigan. In massage practice for more than 35 years and actively involved in the global advancement of massage therapy, Fritz is passionate about training the next generation of instructors and leaders. She is the author of Mosby's Fundamentals of Therapeutic Massage (Mosby, 2012) and Mosby's Essential Sciences for Therapeutic Massage (Mosby, 2012) and many other textbooks published by Elsevier. Visit www.sandyfritz.info for more details. CAN MASSAGE TARGE TING LYMPHATIC FUNCTION BE JUSTIFIED? If massage does indeed affect the movement of fluid (including lymph) in the body, then somehow massage would need to mimic the natural mechanism of fluid and lymph movement.