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Manual lymphatic drainage fails to reduce swelling after surgery

PainSci » bibliography » Pichonnaz et al 2016
Tags: massage, bad news, manual therapy, treatment

Three articles on PainSci cite Pichonnaz 2016: 1. Does Massage Therapy Work?2. Why Drink Water After Massage?3. Does Massage Increase Circulation?

PainSci commentary on Pichonnaz 2016: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a test of manual lymphatic drainage (MLD), a gentle massage-like technique that allegedly reduces swelling by stimulating the natural mechanisms that drain excess fluids from between cells. Testing MLD is fairly easy and interesting, because it’s supposed to have such an objective, measurable effect.

So how did five doses of MLD work on 30 patients who’d just had knee surgery (total knee arthroplasty)? Compared to 30 others who got a placebo.

It didn’t work! No difference. MLD bombed this straightforward test. Alas.

It did reduce pain quite a bit right in the early stages, which is a nice demonstration of something we already know — gentle touch is quite soothing — but does little itself to justify MLD as a modality.

A bit of good news: knee passive flexion contracture was a little reduced in the MLD group after 3 months. That’s a nice result, but a modest one, and not pertinent to the central claim of MLD.

Some procedural notes: swelling was measured all fancy-like, “using bioimpedance spectroscopy and volume.” All patients “followed the standard rehabilitation program of the department,” including ice, passive motion, strengthening, and getting walking. And the MLD treatments were done by therapists we have every reason to have confidence in: “five physiotherapists with experience in MLD who completed two training sessions for standardization. The same therapist performed all of the study treatments for a given patient. The treatment was standardized according to the recommendations of Földi and Kubik.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To evaluate the effects of manual lymph drainage (MLD) on knee swelling and the swelling's assumed consequences following total knee arthroplasty (TKA).

DESIGN: Randomized controlled trial.

SETTING: Primary care hospital.

PARTICIPANTS: Two groups of 30 patients were randomized before TKA surgery (65% ♀, age 70.7±8.8 y.o., weight 77.8±11.3 kg., size 1.64±0.08 m., BMI 29.9±4.1 kg·m(-2))

INTERVENTION: Participants received either five treatments of MLD or a placebo, added to rehabilitation, in between the second (D2) and the seventh (D7) postsurgical days.

OUTCOME MEASURES: Swelling was measured by blinded evaluators before surgery, at D2, D7 and 3 months (3M) using bioimpedance spectroscopy and volume. Secondary outcomes were active and passive ROM, pain, knee function and gait parameters.

RESULTS: At D7 and 3M, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3M which was smaller and less frequent in the MLD group (-2.6° [95%CI -5.0° to -0.21], P=0.04; absolute risk reduction 26.6% [95% CI 0.9 to 52.3%]; NNT = 4). Pain decreased between 5.8 and 8.2 mm on the VAS immediately after MLD, which was significant after four out of five MLD treatments.

CONCLUSION: The MLD applied early following TKA surgery did not reduce swelling. It reduced pain immediately after treatment. Further studies, should investigate if the positive effect of MLD on knee extension is replicable.

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