Pathology Perspectives
quadrant of the body where the
lymphatic system is impaired. Pressure
must be no deeper than that used
for typical application of lotion: this
means bodywork should not evoke
redness or pain. The whole quadrant
includes not just the extremity but the
trunk, anterior, and posterior as well.
It's safer working on the rest of the
body, but some experts recommend
caution here as well, at least until
the client has a chance to see what
changes massage brings about.
Therapists trained in lymphatic
drainage learn the detailed anatomy of
the lymph system, including where the
watersheds are. These are the places
where ISF enters the network of vessels
that carry it to groups of lymph nodes.
Because the lymph system is open—that
is, the vessels can accept fluid all along
their length—lymphatic flow can be
rerouted to alter the watershed system.
Lymphatic work has a good success rate,
especially when combined with careful
exercise, skin care, and compression
garments, but it is a specialized
field and should not be undertaken
without appropriate education.
Some of the complications of
lymphedema include depression, poor
self-image, and social isolation. Massage
is well suited to address all of these, and
can then lead to better self-care and
an improved prognosis. The prospects
for helping people with lymphedema
are exciting, and they present a great
way for massage therapists and massage
therapy to be welcomed in medical
settings. I urge interested practitioners
to pursue this work through the
many avenues that are available. Then
report back to me: write a case report
about your experience to share your
wisdom with your colleagues!
A special thanks to Helen, Lisa, and
Kate, who generously contributed their
wisdom to this piece.
Ruth Werner is a writer and educator
approved by the National Certification Board
for Therapeutic Massage & Bodywork as a
provider of continuing education. She wrote
A Massage Therapist's Guide to Pathology
(Lippincott Williams & Wilkins, 2012), now in its
fifth edition, which is used in massage schools
worldwide. Contact her at www.ruthwerner.
com or wernerworkshops@ruthwerner.com.
I worked with
postoperative
patients for
two years in a
medical day
spa. There are
many things to
consider, such
as whether
the person
has recently
undergone
surgery;
whether they
have a chronic
condition; the
level of local
inflammation
and bruising
related to
surgery;
development
of scar tissue
and how that
may affect
lymph flow …
the list is long.
Kate Zulaski
Resources
Difference Between. "Difference Between Edema And Lymphedema." Accessed December 2012.
www.differencebetween.net/science/health/difference-between-lymphedema-and-edema.
Lymphedema People. "Leg Lymphedema." Accessed December 2012.
www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema.
Lopez, Martin M. et al. "Manual Lymphatic Drainage Therapy in Patients with Breast Cancer Related Lymphedema."
BMC Cancer 11 (2011). www.ncbi.nlm.nih.gov/pmc/articles/PMC3065438.
Medscape. "Lymphedema." Accessed December 2012. http://emedicine.medscape.com/article/191350-overview.
Park, J. et al. "Quality of Life, Upper Extremity Function and the Effect of Lymphedema Treatment in Breast Cancer
Related Lymphedema Patients." Annals of Rehabilitation Medicine 36, no. 2 (2012): 240–47.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3358681.
Premkumar, K. "Edema and Lymphedema: Are They Different? Implications For Bodyworkers." Massage &
Bodywork (December/January 2005): 46–52. www.massageandbodywork.com/Articles/DecJan2005/edema.html.
www.abmp.com. See what benefits await you. 45
