Secondary Lymphoedema of the Breast
“The lady, aged 46, came to me after breast cancer treatment, which included lumpectomy, lymph node dissection, chemotherapy and radiotherapy. She developed Lymphoedema of her right breast soon after radiotherapy and was in a lot of pain, also due to scar tissue and cording. After the first treatment with MLD and DEEP OSCILLATION® Naomi found relief from the pain and discomfort and her breast no longer felt hard and heavy. She found the treatment itself very relaxing and soothing. Naomi's oedema is now managed with regular MLD with DEEP OSCILLATION®, compression, skin care and exercises.”
Secondary Lymphoedema of the Arm and Cording
“The lady, aged 47, had a right and left breast lumpectomy in 2012. Although the biopsy result was negative on the right breast she had sentinel node removal on the left breast, which followed with six cycles of chemotherapy. This lady had a family history of breast cancer from maternal side. I started treating her with lymphatic drainage combined with oscillation therapy to minimise the development of secondary Lymphoedema of the left arm. In October 2013, she was diagnosed with right breast cancer. Immediately she had an axillary clearance followed by radiotherapy and chemotherapy. Unfortunately the second intervention left her with the problem of cording (an accumulation of protein particles in the tissue, which makes the skin hard, red, painful and very sensitive to touch). She restarted her lymphatic drainage treatment. The cording in the right armpit around the scar tissue was very tender, swollen and causing restriction of the arm movements. I started treating this lovely lady with DEEP OSCILLATION® therapy via the HIVAMAT® 200. On the first 2 sessions I tried to work only on the proximal side of the cording, at the end of each treatment she felt relieved and had more flexibility of the arm. On her 3rd visit I started working closer to the cording and eventually on the scar tissue. She had altogether 6 treatments with me, which improved her arm movements and she started doing everyday tasks without any restrictions”
Severe Fibrosis of Lower Arm, Hand and Fingers
“The lady, aged 59, was treated for left breast cancer with mastectomy, axillary node clearance and adjuvant chemotherapy. Nine months following completion of her chemotherapy, she started to develop problems with her left hand and fingers. She noticed difficulty in bending her fingers and ‘firmness’ in the skin on her hand. This progressed until her hand, fingers and lower arm became fibrotic/sclerotic and there was very little movement in the wrist and fingers. Lymphoedema assessment revealed no oedema, slight inflammation, and severe fibrosis. Referral to several other specialties revealed no cause for the changes in her arm. She worked in a bank and because of her limited hand mobility, was no longer able to work. A course of short stretch compression bandaging combined with manual lymphatic drainage was commenced, but after 2 weeks there was very little change in her symptoms. A chance conversation with a Physiotherapist in Australia led to her purchasing a DEEP OSCILLATION® Personal from PhysioPod®. She used this 3 times a day on her arm, hand and fingers, and within 3 weeks her symptoms had started to improve. After 2 months she was able to use her hand and fingers and the fibrosis had almost resolved. This led to a significant improvement in her ability to carry out her self-care needs, but she was still unable to return to work. She continues with her regimen faithfully every day and takes the unit with her when she travels to her family holiday home in Ireland.”
Treatment of Cording with MLD and DEEP OSCILLATION®
“I have treated several patients suffering from cording after breast cancer surgery. This lady, aged 47, was suffering with arm and hand swelling and had been recommended to see me by a mutual friend who was also having treatment for secondary Lymphoedema. The lady was still undergoing chemotherapy but was particularly struggling with restricted arm movements due to cording. After MLD to the neck, unaffected axilla, chest and proximal affected arm, the HIVAMAT® 200 was brought into play and I carried out treatment along the route of the cording. Even after the first treatment, there was an improvement in the thickness of the cording and movement of the affected arm was much freer. I saw the client a few times, until she was happy that the cording had resolved. This is just one example of the power of the HIVAMAT® 200 and I continue to use it within my practice on a regular basis.”
Mechanisms of Deep Oscillation
Deep oscillation refers to an electromechanical therapy method in which electrostatic attraction and friction, produced by the use of a glove or hand-held applicator, create resonance vibrations in treated tissue. These have a gentle and deep-acting effect on all tissue components to an 8 cm depth
Because of the non-invasive, non-traumatic nature of this modality, there are very early possibilities of application: following injury and from Day One post operatively, in acute pain and in wound healing, also.
Since 1991 deep oscillation has been an adjuvant treatment modality from Day One post operatively after mastectomy. © Photo: Tápanez Hernández
Impact of Deep Oscillation on the Lymphatic System
Oedema and haematomas occur as a result of bleeding as well as destruction or damage of lymphatic capillaries by trauma (mechanical, surgical etc.). In the acute inflammatory phase of wound debridement, there is also increased phagocytosis and a generally higher need for transport of extracellular protein, blood cells and other particles (exudation). This results in an enormous interstitial increase in the lymphatic load. As a result, post-traumatic oedema develops by overloading the lymph transport system (high volume insufficiency) and backing up in the interstitial space, in spite of increase in the lymphatic flow rate.
Increased resorption of subcutaneous oedema by deep oscillation has been shown in several clinical studies. This can be explained by two hypotheses. One would be that mechanical stimulation at the level of the interstitial ground substance produces mixing of materials to be transported with the lymph, enhances its distribution and thus increases the surface area for resorption. Another would be that mechanical impulses generate deforming forces that act on the collagenous fibre structures of the interstitial space, and these apply tensile forces to the endothelial layer of the initial lymphatic vessels (lymph capillaries and pre-collectors) via anchor filaments. In this way they could open junctions in the endothelial layer for inflow of fluid, and assist the interstitial drainage mechanism.
- Post-traumatic oedema formation: Bleeding, increased transport demands, high volume insufficiency, backing-up in interstitial space.
- Deep oscillation assists resorption of oedema: Mixing materials for transport with the lymph, distribution, increasing surface area, tension on endothelial layer of initial lymph vessels (lymphatic capillaries and pre-collectors) via collagenous fibre structures in the interstitial space, opening junctions for fluid inflow, assistance of the interstitial drainage mechanism.
- Transport of lymph together with materials such as various extracellular proteins, blood cells and other particulate material.
- Valves can already be found in the pre-collectors at intervals of 2-3 mm. Transport of lymph is the exclusive function of lymph collectors and the lymph ducts connected with them.
- The lymphatic system contributes to homeostasis by influencing the volume of extracellular fluid, the interstitial protein concentration and the tissue pressure.
In this article "Mechanisms of Deep Oscillation" Dr Jens Reinhold explains well-established clinical effects of deep oscillation and models underlying physiological mechanisms of action, each with references to the relevant literature.