Treatment of lymphatic injury with breast cancer lymph node dissection (BrLND) must include territory-based restoration of the physio-mechanical function of the lymphatic system, and restoration of fluid homeostasis, so as to mitigate protracted changes to solid phase lymphedema.
Physio-mechanical function is optimized by superficial AND subfascial lymphatic treatment. Superficial and subfascial treatment allows increased fluid flow into initial lymphatic (ILs) and powerfully reduces both superficial edema back-flow and subfascial overload.
Subfascial treatment reduces lymphostasis in joint/muscle complexes and reduces occlusion pressure on perforating lymph vessels linking subfascial and superficial systems.
Superficial treatment exerts radial tension on anchoring filaments attached to endothelial cells of the initial lymphatics (ILs). Radial tension is proportional to diameter of IL lumen dilation and widening of junctions between endothelial cells through which lymph fluid enters the lymphatic system.
Territory-based fluid homeostasis is assisted by removal nitric oxide, which disables contractility of collector vessels, and by transition of pro- to anti-inflammatory cytokines. Transition failure leads to inflammation, proteolytic activity and deposition of adipose tissue.
Purpose of the study is to demonstrate treatment leverage in using integrated manual therapy skills to affect positive outcomes in physio-mechanics of ILs, fluid homeostasis, fluid volume reduction and mitigation of solid phase lymphedema.
Method: 24 month Retrospective BrLND case study of clinical lymphedema to evaluate subfascial neuro-musculo-skeletal approach, integrated with superficial MLD, on the physio-mechanical functioning of the local lymphatic system.
Subfascial treatment includes myofascial trigger point release work, joint mobilization and neural tension mobilization to reduce lymphostasis and occlusion pressure on perforating lymphatic vessels. Superficial treatment includes muscle bending techniques and manual lymphatic drainage to exert radial tension on anchoring filaments attached to endothelial cells of ILs.
Surveillance of limb volume was performed with circumferential measurements using a tape measure to provide a scale for volume reduction; L-Dex bioImpedence measurements provided surveillance of lymph homeostasis and fluid consistency.
Fluid to solid ratio was superimposed on a graph using these two measurement systems.
Conclusion: Integrated treatment interventions positively affected the functioning of the locally impacted lymphatic system, resulting in volume reduction and fluid homeostasis, reduced inflammation, reduced proteolytic activity, reduced deposition of adipose tissue and optimizing physio-mechanical functioning of the local lymphatic system so as to mitigate protracted solid phase lymphedema.