EFFECT OF THIGH MANUAL LYMPHATIC DRAINAGE, LOWER LIMB, ELEVATION AND REST ON VENOUS VOLUME - A PILOT STUDY

A.M. da Costa Proença¹, R.S. dos Santos Crisóstomo¹, J.P. Sabina dos Santos Valente¹, S. Soares Saraiva¹

Background: Manual Lymphatic Drainage (MLD) is a physiotherapist technique that increase venous return and function in patients with disabilities where the venous return is compromised. Nevertheless the effect of this technique applied distally to the body region that is treated, for example in venous ulcers, is unknown.

Purpose: To compare the effect of thigh Manual Lymphatic Drainage (MLD), lower limb elevation and rest, on venous return and venous refill in leg in healthy subjects.

Methods: Six healthy subjects participated in the study (mean age 21.00 ±0.26 years old). Participants were assessed in supine position with photoplethysmography BITalino, with probe at 10cm below medial malleolus, in four intervention moments: with leg elevation (60sec), in rest supine position (120sec), and randomly where than applied two MLD manoeuvres, reabsorption (120sec) and call-up (120sec), to assess venous blood variation. After each of the four intervention moments the participant stay with the foot hanging out during 120 sec, to ensure the maximal venous refill volume. Data were recorded on the Brainanswer platform and the mean of venous blood volume (VV) in each intervention and the mean of venous blood refill (VR) in each moment of foot hanging out, where calculated.

Results: The VR after the four moments of intervention were significantly different (p<0.01): the highest VR was after leg elevation (16.15±9.99), than after rest (11.83±8.99), after reabsorption manoeuvre (5.19-0.74;16.51) and  the lowest VR was after call-up manoeuvre (-2.56±-15.23;6.44).  The VV during Reabsorption manoeuvre was lower than during lower limb elevation (p=0.027) and the VV during both reabsorption and call-up manoeuvres were lower than during rest (p<0.01 and p=0.027, respectively). During elevation and during rest the VV was similar; during the both MLD manoeuvres the VV was also similar (p>0.05).

Conclusion(s): It seems like MLD manoeuvres on the thigh (at distance) has a greater increase on the leg venous return (by decreasing venous blood volume in the leg and by reducing the venous refill volume in the leg int the moment of foot hanging out) when compared with elevation of the lower limb and compared to rest, in healthy subjects.

Implications: The results observed in this study are a starting point for other studies that are looking to research treatment modalities for conditions where the local application of MLD is not recommended and a good venous return is essential.

Funding, acknowledgements: none

Keywords: Manual Lymphatic Drainage, Photoplethysmography, Physiotherapy

Topic: Cardiorespiratory

Did this work require ethics approval? Yes

Institution: Instituto Politécnico de Castelo Branco (IPCB)

Committee: Comissão de ética do Instituto Politécnico de Castelo Branco (IPCB)

Ethics number: (148/CE-ESALD/2019)