We have many manual lymphatic drainage students who wish to practice MLD techniques post-abdominoplasty procedure.
On April 5, 2022, the Journal of American Society of Plastic Surgeons published an article called: Changes in the Pattern of Superficial Lymphatic Drainage of the Abdomen after Abdominoplastyhttps://pubmed.ncbi.nlm.nih.gov/35383695/
This published research states: "A significant change in lymphatic drainage pathway occurred in the infraumbilical region after abdominoplasty. The axillary drainage path was predominant after the operation, in contrast to the inguinal path observed in the preoperative period."
There is a LOT to learn to accurately and efficiently applied MLD techniques with the lastest research, proven methods and adverse complications, such as this one. We teach about this and much more in our manual lymphatic drainage classes. For the latest, evidence-based methods in manual lymphatic drainage training, please register with us at: https://ceinstitute.com/collections/lymphatics
Greater research studies are showing the efficacy of bolstering clients with swelling, particularly during the practice of manual lymphatic drainage (MLD).
Manual lymphatic drainage utilizes light-pressure manual manipulation of the skin and underlying tissues to promote the movement of lymphatic fluid, usually from one area to another towards lymphatic node regions. MLD is not to be confused with a traditional massage, especially given the pressure and work directions can be quite different in MLD.
To learn more, specifically in how to apply manual lymphatic drainage, please register for one of our MLD classes at: https://ceinstitute.com/collections/lymphatics. Home study classes are immediately available 24/7, until your course access expires.
In this training video, we will show you the order in which to bolster extremities (both arms and legs) during MLD practice:
Manual Lymphatic Drainage is NOT A MASSAGE. In massage therapy, we primarily work with muscle and other soft tissue structures. In Manual Lymphatic Drainage, we primarily work with FLUID.
While the lymphatic and cardiovascular systems both transport fluid throughout the body, the lymphatic system is thought to be a “less robust” system than the cardiovascular system, in-part, because the lymphatic system does NOT have a PUMP. The cardiovascular system's pump is our human heart and cardiac muscle.
In manual lymphatic drainage, we are trying to absorb and propel a milky white and often colorless fluid that bathes the tissues and drains through the lymphatic system into the bloodstream. It contains: water, proteins, cells, toxins, fats, waste, bacteria, viruses, etc.[i]
“The only difference between lymph and interstitial fluid is its location. If the milky white fluid is found in the spaces between body tissues, it is called interstitial fluid. If it is found in the lymphatic system, it is called lymph.”
Here is an instructor demonstration of belly pumping, which is thought to promote stagnant lymph to propel superiorly towards the subclavian veins to be "dumped" in the cardiovascular system for appropriate filtering and/or elimination:
Plastic surgeons often refers patients for post-surgical manual lymphatic drainage to relieve pain and swelling, or they may prescribe deep tissue massage for new muscular contracture over an implant or filler, or more.
Even with a doctor’s written prescription and direction, shifting or migration of fillers and implants could happen or be blamed on the therapist's manual therapy, and shifting could have already occurred, hence the referral.
It's important for massage therapists to remember that working over fillers or implants is contraindicated. Shifting and migration could occur with the manual therapy, and it is not worth the risk to try to achieve the benefit, especially given the lack of certainty with both. Therapists, clients and doctors cannot always control shifting and migration issues within the human body. This is one of many reasons why working over foreign materials implanted in the body is a massage and bodywork contraindication.
Please click HERE if you would like to read our article on Massage Magazine's website.
Establishing consistent opening rituals could prove to be beneficial, especially in group practice. Spending one minute or more with anything that feels familiar at the start of any session could feel comforting when an old client quickly reconnects with familiar touch. Many clients could instantly relax when they recognize what they are feeling and receiving.
In this article, we focused mostly on opening rituals, and added in a few common closing rituals as well. We provided sample and common rituals for the following massage therapy and soft tissue bodywork applications:
Abhyanga & Ayurvedic Massage
Deep Tissue Massage
Hot Stone Massage
Lomi Lomi Massage
Manual Lymphatic Drainage
Sports Event Massage
Trigger Point Therapy
Here is a list of common closing rituals that can be commonly practiced amongst all modalities:
Thank the client for their time.
Express wishful thoughts silently or aloud for the client.
Apply a hold with static placement of their hands on the client’s body.
Ask the client to take some deep breaths.
Perform body brushing techniques.
Use a towel to remove massage medium from the client’s skin.
Assist a client off the treatment table with select services or customers.
Turn up any dim lighting so the client has greater visibility and acclimation back to reality.
Of course, no one has to follow these lists and practitioners can make up their own opening and closing practices as well! What's most important is allowing your client to feel comfortable and instantly relax in your work area.
You can read this article in full at Massage Magazine by clicking HERE.
Evidence-based massage practice applies a hands-on researched protocol to a client. The objective is to simulate hands-on applications with methods and protocols found to be beneficial in research or provide therapeutic outcomes, similar to what was achieved in the research study.
Sometimes a researched protocol which show what is not appropriate in massage therapy or bodywork practice. Studies often exclude subjects with various disqualifications which create various parameters for the student. Sometimes these exclusions are born from massage contraindications which are important to follow. from participating due to various constraints or contraindications. This is why the entire study must be read and considered prior to real-time application or practice for evidence-based massage therapy practice.
To view our evidence-based massage article in full, published @MassageMag, please click HERE!
by Selena Belisle, Founder/Instructor, CE Institute LLC
One of my favorite goats named Creamy has developed caprine arthritis encephalitis which is also known as CAE. Creamy was delivered to us with an original herd of approximately 100 goats. She is of unknown age but is likely over five years old, and she has a lovely cream colored coat which contributed to her name.
We were told that CAE did not exist within the herd when it was acquired, despite there appearing to be visual scars on the animals that indicated otherwise. CAE is a devastating disease which usually results in culling the herd, and termination of infected animals.
Creamy has been with us for a couple years without any signs of CAE. Then, during her last pregnancy and delivery, things went awry. She was pregnant with two calves which is fairly normal for a goat. She delivered one calf, and then didn't deliver the second calf until five days later.
CAE Symptoms Develop
Immediately after delivery, Creamy started showing significant symptoms of CAE. They were gradual and became worse with each day, until she was walking on three legs only within about 2-weeks. She was separated from the herd, kept dry with a sawdust bed, provided anti-inflammatories and other medicine to no avail.
Her right front knee was excessively swollen, and I thought I may be able to manually manipulate the fluid away from the knee joint, but despite Creamy being an incredibly patient and mild mannered goat, she wouldn't allow me to touch her knee for very light manual lymphatic drainage techniques. At one point, during her medical care, her knee was shaved which provided better access to directly manipulate the skin with MLD, but unfortunately she was not having it, and I did not press the matter to avoid distressing the animal.
Creamy's Weight Loss
It took about 2-weeks of non weight-bearing on Creamy's right front leg before her right shoulder atrophied. The atrophy was slight but clear between her right and left shoulder. Creamy also lost weight which is normal for goats after delivering their calves, so it's unknown if Creamy's weight loss was from her delivery or CAE or likely both.
Goat with CAE Gets Even Dirtier
Like all farm animals, goats can be fairly dirty and Creamy was no exception. Unfortunately this situation worsened when another animal peed on her which was weird given she was fairly isolated. I found half her head and a rear back quarter soaked in urine. It might have been possible that she hobbled to one of the horse stalls and laid down in the urine too. Unfortunately we'll never know how it happened, but it was important for me to remove it and get her clean.
Making the Decision to Provide a Caprine Spa Session to an Ill Goat
I asked Creamy's more experienced care givers if it would be acceptable to wash Creamy and we were all at a loss. This was a no win situation where the animal's coat would have either remained soaked in urine for a good amount of time, or risked health issues from being wet in the cold.
We ultimately agreed that I if I worked quickly to clean Creamy and dry her, it could be successful. Luckily, I was able to clean Creamy in local spots only with multiple, inexpensive disposable washcloths within about 30-minutes, then quickly dry her within another half hour, so her health was not compromised with her quick and efficient, one-hour caprine spa session.
Goat Spa Session
Our barn is in northern Vermont where it is very cold in the Winter, so washing an ill animal during sub-zero temperatures (end of February) in a moderately heated barn was undesirable. Nevertheless, I wanted this goat to feel clean while ill, so I did it. I purchased:
From Dollar Tree at $1.25 each:
Extra large puppy pads
Heated radiator ($50)
Hair dryer ($10)
Set of towels ($10)
Oatmeal gentle dog wash ($5)
Creamy received similar to what most ICU patients would receive as a sponge bath with the following steps:
I collect a clean pail of tepid water
I dunked an individual disposable washcloth into the tepid water
I rinsed Creamy with the disposable washcloth
I repeated this process over and over with clean cloths, until all urine was removed from her coat
I did not use the oatmeal cleanser on Creamy. The disposable washcloths seemed to have some type of gentle cleanser on them which satisfied the cleansing and rinsing process with individual cloths.
Once Creamy was clean in the two areas that were soiled of urine, I then used a hair dryer to dry the areas that were cleaned. It was important to get Creamy as dry as possible to prevent pneumonia or other illness in the dead of Winter with this severely compromised goat.
Spa Session Tired Goat with CAE
Creamy was fairly tired when I finished her mini-spa session. She was standing on three legs the entire time, leaning into me. I also believe the hair dryer noise was likely unnerving to her, but she accepted it without much issue. It's almost like she was aware that it was necessary, and the warm heat of the hair dryer might have even felt good to her. It's hard to say given the goats cannot speak and you have to take their physical cues as communication.
A Satisfied Clean Goat
Creamy jumped up onto her three legs to greet me the next time I entered the barn after her spa session. It's like she wanted to show me that she was doing much better. Please keep in mind that Creamy has been receiving round-the-clock medical care from her care givers, so I will never know if her improvement was from her spa session or medical care or both. But there was no mistaking that she was happy to see me again, and excited to get another rub down.
Eating During Massage
Creamy is a hearty goat and she continued to eat despite being ill. Sometimes when I went to the barn to massage Creamy, she would eat the hay that was left for her. Prior to her spa session, she would be lying down and she would not get up when I entered which was sad to see, given during previous visits without CAE, Creamy would patiently follow me around with the rest of the herd until it was her turn for attention. Some of the goats demanded immediate and nonstop attention, but Creamy was patient and different. Very loveable. I also do not know if Creamy was eating before I arrived for her rub down, or if she started eating while I massage her, but she did eat during her massage and she seemed to enjoy it.
Creamy's Rub Down
Massaging Creamy was simple bodywork, and similar to what she's been receiving from me for two years now. I applied a circular effleurage/friction technique. The goat herd seems to favor this style of massage over anything else such as traditional straight effleurage or petrissage.
I usually wear either vinyl or nitrile gloves when physically working with the goat herd. This herd has the common orf virus which can be transmissable to humans; however, the herd did not have any active outbreaks during this Winter 2022 visit.
The goats favorite circular therapy technique is bilateral alternating massage with both hands on their lower mandible or hips. The more mild manner goats enjoy their mandible massaged, and all of the goats enjoy the alternating bilateral circulatory massage of their hips. They'll either stay in place until you stop, or start leaning into you for more pressure. Then when you do stop, they'll usually follow you around for more.
It is important to note that I am NOT an expert in animal care nor caprine livestock, despite being a born and raised Vermonter. I have bottle fed over 100 calves from this goat herd, and massaged them all. But, my real health care experience is massage therapy practice for over three decades, and I have provided spa services for the past 27 years - for humans (although some humans have equally behaved like animals if not worse). Today, I teach CE hours for the massage, nursing and cosmetology fields as an expert instructor of multiple modalities for human health and cosmetology care.
I am often asked about bodywork techniques including MLD for animals, especially given equestrian massage has been a nonstop growing industry for years. While I have multiple horses available to work with including beautiful clydesdales, I prefer to work most with the goat herd and their kids. These goats are the most affectionate, loving animals and a true pleasure to work on.
Our school received approval this morning from the Florida Board of NURSING to teach CE hours! YAY!
Right now we have only approved our MLD training for FL Board of Nursing credit, but if you would like Florida Nursing CE credit for any of our other subjects, pls kindly send us an email so we can follow-up!
Ablative lasers vaporize the top layers of damaged skin. They are usually more aggressive than nonablative lasers that leave the skin intact.
An article in the Seminars in Plastic Surgery reports: “Although ablative lasers result in far more down time and a more difficult recovery process, they remain the lasers that produce the most dramatic outcomes.”[i]
Skin must be whole and intact to provide most hands-on bodywork, including MLD.
Because ablative laser treatment destroys the outer layer of skin, bodywork and all hands-on services including massage and MLD are contraindicated until the skin has healed.
Practicing MLD is a wonderful nonpharmacological benefit for clients who have pain or swelling; however, practitioners should be thoroughly trained in all treatment precautions and contraindications prior to practicing. To learn more, please register for manual lymphatic drainage training with us at: https://ceinstitute.com/collections/lymphatics
[i] Preissig, Jason, et al. “Current Laser Resurfacing Technologies: A Review That Delves beneath the Surface.” Seminars in Plastic Surgery, Thieme Medical Publishers, Aug. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580982/#:~:text=Ablative%20lasers%20vaporize%20tissue%20and,produce%20the%20most%20dramatic%20outcomes.
Manual lymphatic drainage (MLD) is used to reduce swelling, which can result in pain relief, increased range of motion, physical function restoration and more. It is often performed post-surgery to help prevent secondary injury and increase healing times and outcomes. The two most common post-surgical MLD treatment requests are for cosmetic and orthopedic surgeries.
MLD practitioners must have post-surgical MLD training when working with post-surgical clients. They must also communicate with the surgeon to ascertain each MLD client's specific requirements for their post-surgical treatment and healing processes. The following are some suggested questions a MLD practitioner can ask a surgeon when providing post-surgical MLD.
Practitioners can request this information in the form of a treatment prescription if desired. It is always best to request treatment directions in writing:
Would an increase of circulation be harmful to this client?
When can I start MLD appointments for this client?
Does the client have any surgical drains, implants, injectables or joint replacements?
Does the client have any areas I should not touch? If yes, where?
Can I work around the client’s stitches and if yes, how far of a distance should be maintained between my hand and the client‘s stitches (Practitioners can add: I will use only the weight of my hand to manipulate the skin to create drainage).
Do you want me to wear gloves when working on the client’s skin, or are well sanitized hands acceptable? Follow-up: If I must wear gloves, when would it be acceptable to use well sanitized bare hands?
Is there anything that could happen with the client where or when I should not administer MLD? (Practitioner can add: I do not work with active bleeding, fevers or any sign of infection).
How long of an appointment and how frequently can MLD be provided?
Are there any special directions that should be followed or considerations to be made?
Practitioners should add any other questions that seem appropriate and useful.
Practicing MLD is a wonderful nonpharmacological benefit for clients seeking a reduction of swelling and pain after surgical procedures. To learn more, please register for training with us at: https://ceinstitute.com/collections/lymphatics