may be used to soften hardened tissue. Specific education in manual lymphatic drainage is needed to use this technique. The most comprehensive instruction is taught in courses that culminate in certification as a lymphedema therapist by the Lymphology Association of North America. At the end of the Phase-I treatment, the patient is fitted with a compression garment. Without the continued use of the compression garment, the treatment results from Phase I and the long-term effects of Phase II will be significantly limited. 5 In Phase II, the patient assumes responsibility for maintaining skin health, including appropriate cleansing and moisturizing all affected areas, to help prevent infection over his or her lifetime. Considerations for bodyworkers Massage therapists should ascertain with all clients if they have a history of cancer, radiation therapy, surgery, or other potential causes of lymphedema. This is essential even if the client does not have any symptoms of lymphedema, as vigorous massage is one of the risk factors for triggering it. If your client has edema, it may or may not be lymphedema. Find out if lymphedema has been diagnosed. If the client has lymphedema, special attention should be given to the superficial lymphatic vessels. Massage that is too aggressive or pressure that is too heavy can cause complications. Even if your client is not undergoing CDT, you may wish to refer her to a therapist certified in manual lymphatic drainage. The website of the Lymphology Association of North America (www.clt-lana.org) has a search function to find certified therapists by zip code.
The compression garment is worn during the day, and the garment fit should be checked at least every six months (sooner if the patient is having difficulties). The patient continues with her or her exercise program, usually while wearing the compression garment. Psychosocial considerations Because lymphedema is disfiguring and sometimes disabling and painful, individuals with lymphedema can experience mental, physical, and sexual problems. They may benefit from individual or group counseling that includes emotional support and provides information about the role of diet and exercise and advice for selecting comfortable and flattering clothes. Classical massage or effleurage, if performed overly vigorously, may damage lymphatic vessels. 9 The usual technique of asking the client if the pressure being used is comfortable may not be adequate when you are working with someone who is at risk for lymphedema. His or her feedback may not be an indication of what is appropriate. If you are working with a client who is at risk for lymphedema, avoid deep massage and do not apply any techniques that redden the skin. Increasing circulation to the skin or causing inflammation characteristic of the friction of the hands could damage the lymphatic system. 10 You should also avoid any stretches that could cause microtrauma.
PART 3: FIBROMYALGIA
Muscular pains and fatigue are the hallmarks of fibromyalgia, a common but misunderstood disorder affecting approximately five million Americans, 80 to 90 percent of whom are women between the ages of 35 and 60. 1 Fibromyalgia is a rheumatic condition and not a form of arthritis, as often thought. It does not cause inflammation or damage to the joints, as does arthritis. Rheumatic diseases are characterized by inflammation and loss of function of one or more connecting or supporting structures of the body. Fibromyalgia is a syndrome, not a disease. The distinction is that a disease is a medical condition that has one or more specific causes and has recognizable signs and symptoms, whereas a syndrome is a condition characterized by a collection of Physiology Although no consistent pattern fits all patients with fibromyalgia, studies have found that many patients have abnormalities of hormonal, metabolic, and brain chemical activity. For example, studies have shown that some patients with fibromyalgia have lower levels of serotonin. 3 Serotonin, an important neurotransmitter found in the brain, gut, and other areas, plays important roles in mood, pain modulation, and promotion of deep sleep. Abnormalities in serotonin production and distribution have been linked to many disorders, including depression and irritable bowel syndrome, which are common in fibromyalgia. Individuals with fibromyalgia can also have abnormal levels of a chemical in their spinal fluid called substance P , a neurotransmitter that helps send signals of pain and sensation to the brain. Research has shown a threefold increase in the level of substance P in the spinal fluid of patients with fibromyalgia, compared to that of healthy individuals. 4 Scientists believe that this substance may amplify the pain these individuals experience. Studying the Symptoms The symptoms of fibromyalgia vary among individuals, and also wax and wane in intensity over days and weeks. Flares of symptoms occur with increased exertion, systemic infections, soft-tissue injuries, lack of sleep, cold exposure, and psychological stressors. In addition to suffering from fatigue and
symptoms and medical problems that occur together but can’t be pinned down to an identifiable, single cause. The cause of fibromyalgia is unknown, but scientists believe there may be genetic factors or a traumatic personal history, or a combination of the two, which make some people react strongly to stress or pain. For example, an emotionally stressful event, an injury, or a viral infection can trigger the onset of the syndrome. Fibromyalgia is a chronic condition with no known cure. Most patients with fibromyalgia report that chronic pain and fatigue have adversely affected the quality of their life and their ability to be competitively employed. 2 role of substance P is among the areas of research being pursued by scientists to find the cause of fibromyalgia. A deficiency in growth hormone, which is secreted in the pituitary gland, occurs in about 30 percent of fibromyalgia patients. 5 Defective growth hormone secretion in these patients appears to be due to excess somatostatin, a hormone that inhibits the release of growth hormone. For some reason, these fibromyalgia patients have too much somatostatin in their bodies, preventing the release of growth hormone. 5,6 Researchers have also found that fibromyalgia patients produce less cortisol in response to stress than do healthy people, possibly as a result of a defect in the hypothalamic-pituitary- adrenal axis, which controls cortisol production. 7 Lower levels of cortisol produces symptoms common in fibromyalgia, including fatigue, weakness, muscle pain, depression, and sleep disturbances.
widespread, generalized pain, individuals have multiple tender points that are painful when pressed. These occur in certain areas, including the back of the head, upper back and neck, upper chest, elbows, hips, and knees (see figure 3).
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Book Code: MTX1323
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