Effect of manual lymph drainage on removal of blood lactate after submaximal exercise

Can Lymphatic Transport Impaired by Total Knee Arthroplasty be Managed with Manual Lymphatic Drainage?

Objective: It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Method: Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. Results: A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: χ2 = 47.175; p = 0.000; control; χ2 = 30.995; p < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; p = 0.015; p = 0.001; p < 0.000). Leg volume significantly decreased over time in both groups after surgery (p < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; p = 0.192; p = 0.343; p = 0.453; p = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; p = 0.002; p = 0.005; p = 0.006, respectively), it increased with exercise in the control group, first day (p = 0.004) and second day (p = 0.019). Conclusions: MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.

Can Manual Lymph Drainage Be Considered as a Passive Recovery Strategy?

CONTEXT

The aim of this study was to investigate the acute effects of Swedish massage and manual lymph drainage (MLD) on performance parameters related to jumping, walking, and blood lactic acid levels after Nordic hamstring exercises.

DESIGN

This study was designed as a controlled crossover study.

METHODS

The study included 16 young trained men. Participants' lactic acid levels, gait-related parameters, and jumping performance were assessed. Assessments were performed at baseline, after Nordic hamstring exercises, and after 3 different passive recovery strategies: resting, Swedish massage, and MLD for 3 weeks.

RESULTS

As a result of the study, it was observed that lactic acid levels after the MLD and massage intervention were significantly lower in both MLD and massage conditions compared with the control condition (P < .05). There was no within- and between-conditions difference in jumping parameters after the MLD and massage interventions (P > .05). Walking speed in the MLD condition was statistically higher following the intervention compared with both before and after exercise (P < .05). Step time in the massage condition was statistically lower after the intervention compared with after Nordic hamstring exercise (P < .05).

CONCLUSIONS

Although MLD and massage interventions have positive effects on lactic acid levels and walking and jumping parameters, they are not superior to each other. MLD can be used as a passive recovery technique after exercise.

Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis

Osteoarthritis is a progressive degenerative disease process that affects a significant proportion of the canine population, impacting these animals' quality of life. Currently, there is no cure and treatment consists of managing the clinical signs of pain and reduced mobility. There are many treatments for canine osteoarthritis and in this review we discuss the evidence base behind non-pharmaceutical, non-surgical treatments of this disease. These treatments include weight management, nutraceuticals, acupuncture, physiotherapies such as therapeutic exercise, hydrotherapy as well as other therapeutic modalities including photobiomodulation therapy, electromagnetic field therapy and others.

The Effect of Pedal Pump Lymphatic Technique Versus Passive Recovery Following Maximal Exercise: A Randomized Cross-Over Trial

Context

Muscle damage and delayed onset muscle soreness (DOMS) can occur following intense exercise. Various modalities have been studied to improve blood lactate accumulation, which is a primary reason for DOMS. It has been well established that active recovery facilitates blood lactate removal more rapidly that passive recovery due to the pumping action of the muscle. The pedal pump is a manual lymphatic technique used in osteopathic manipulative medicine to increase lymphatic drainage throughout the body. Pedal pump has been shown to increase lymphatic flow and improve immunity. This may improve circulation and improve clearance of metabolites post-exercise.

Objective

This study compared the use of pedal pump lymphatic technique to passive supine recovery following maximal exercise.

Methods

17 subjects (male n = 10, age 23 ± 3.01; female n = 7, age 24 ± 1.8), performed a maximal volume O₂ test (VO₂ max) using a Bruce protocol, followed by a recovery protocol using either pedal pump technique or supine passive rest for 10 min, followed by sitting for 10 min. Outcome measures included blood lactate concentration (BL), heart rate (HR), systolic blood pressure (SBP) and VO₂. Subjects returned on another day to repeat the VO₂ max test to perform the other recovery protocol. All outcomes were measured at rest, within 1- minute post-peak exercise, and at minutes 4, 7, 10 and 20 of the recovery protocols. A 2 × 6 repeated measures ANOVA was used to compare outcome measures (p ≤ 0.05).

Results

No significant differences were found in VO₂, HR, or SBP between any of the recovery protocols. There was no significant difference in BL concentrations for recovery at minutes 4, 7, or 10 (p > 0.05). However, the pedal pump recovery displayed significantly lower BL concentrations at minute 20 of recovery (p = 0.04).

Conclusion

The pedal pump significantly decreased blood lactate concentrations following intense exercise at recovery minute 20. The use of manual lymphatic techniques in exercise recovery should be investigated further.

Investigation of the Less Known Effects of Manual Lymphatic Drainage: A Narrative Review

Introduction: Manual lymphatic drainage (MLD), one of the components of complex decongestive physiotherapy, which is accepted as the gold standard in the treatment of lymphedema, is used for therapeutic purposes in many diseases. The most well-known feature of MLD is that it helps to reduce edema. In addition to reducing edema, MLD has many effects, such as increasing venous flow, reducing fatigue, and raising the pain threshold. To the best of our knowledge, there is no study examining the effects of MLD other than its effects on edema in detail. The aim of this study is to compile effects of MLD and to provide a better understanding of the effects of MLD. Methods: A literature search was conducted in Medline, Embase, and the Cochrane Library in July 2019, to identify different effects of MLD. The articles were chosen by, first, reading the abstract and subsequently data were analyzed by reading the entire text through full-text resources. To undertake the study, we have collected information published about different effects of MLD over the last 30 years (1989-2019). According to our results, 20 studies met inclusion criteria. Conclusions: This study suggests that MLD can be used in symptomatic treatment of various diseases (multiple sclerosis, Parkinson's disease) considering the effects of MLD on the systems.

Comparison of the Effect of Kinesio Taping and Manual Lymphatic Drainage on Breast Engorgement in Postpartum Women: A Randomized-Controlled Trial

Objectives: To investigate the effect of kinesio taping (KT) and manual lymphatic drainage (MLD) on pain severity, breast engorgement, and milk volume in postpartum women. Materials and Methods: In this prospective randomized-controlled trial, we recruited 67 postpartum women who had breast engorgement and randomly assigned them to the KT, MLD, and control group. In the KT group, taping plus breast care was performed, MLD plus breast care was performed in the MLD group, and in the control group, only routine breast care was given for 10 days. Pain, breast engorgement, body temperature, and milk volume were measured. Examinations were repeated on days 1, 4, and 10. Results: The MLD group had significant reductions in pain and breast engorgement at all postintervention days compared with the control and KT group (p < 0.05). Milk volume increased among three groups, but the change in the MLD group was higher than in the KT and control groups (p < 0.05). There was no significant difference in the milk volume among the KT and control groups at all postintervention days (p > 0.05). Conclusions: MLD relieved breast pain and firmness more and increased milk volume in postpartum women compared with the KT and control groups. MLD can be recommended to postnatal mothers to better manage breast engorgement.

Does the type of foam roller influence the recovery rate, thermal response and DOMS prevention?

PURPOSE

Supporting post-exercise recovery requires choosing not only the right treatment but also the equipment, in which the impact is not always clear. The study aimed to determine the effect of foam rolling on the rate of lactate removal and DOMS prevention and whether the type of foam roller is effective in the context of post-exercise recovery.

METHODS

This randomized trial enrolled 33 active healthy males divided into three groups of eleven individuals: foam rolling with a smooth (STH) or grid roller (GRID) or passive recovery (PAS). All the participants performed full squat jumps for one minute. Examination took place at rest (thermal imaging of skin temperature-[Tsk] and blood lactate-[LA]), immediately following exercise (Tsk & LA), immediately after recovery treatment (Tsk) and after 30 minutes of rest (Tsk & LA). Their pain levels were assessed using the Visual Analog Scale (VAS) 24, 48, 72, and 96 hours after exercise.

RESULTS

The magnitude of lactate decrease depended on the type of recovery used. In the PAS group, the decrease in lactate concentration by 2.65 mmol/L following a half-hour rest was significantly lower than that in the other groups (STH vs. PAS p = 0.042 / GRID vs. PAS p = 0.025). For thermal responses, significant differences between both experimental groups were noted only 30 minutes after exercise. A significant decrease in pain in the STH group occurred between 48 and 96 hours, while the GRID group showed a systematic significant decrease in VAS values in subsequent measurements. Changes in VAS values in subsequent measurements in the PAS group were not statistically significant (p>0.05).

CONCLUSIONS

Foam rolling seems to be effective for enhancing lactate clearance and counteracting DOMS, but the type of foam roller does not seem to influence the recovery rate.

Effect of manual lymph drainage for up to 10 days after total knee arthroplasty: Arandomized controlled trial

OBJECTIVE

To assess the effect of manual lymph drainage (MLD) on pain in Japanese patients up to 10 days after a total knee arthroplasty (TKA).

METHODS

This study was a randomized controlled trial performed at a University Medical Center. Patients who underwent unilateral TKA and received once daily MLD for 20 minutes prior to standard physical therapy up to 10 days after TKA were investigated. Pain at rest, knee extension muscle contraction, and maximum load were assessed using the visual analog scale (mm) before surgery, after drain removal, and after the fifth MLD. As secondary outcomes, the circumference, range of motion, muscle strength, walking speed, and walking rate were evaluated.

RESULT

Forty-one patients aged 45-85 participated in this study, 21 of whom were assigned to the intervention (MLD group) and 20 who were not (control group). Ten days after TKA, no significant difference was evident between the MLD and control groups for resting pain [4.5 mm (1.6-10.8) vs 7.0 mm (1.8-25.5), respectively, p=0.17], pain during knee extension muscle contraction [12.3 mm (4.5-24.8) vs 20.8 mm (6.4-31.8), p=0.41], and pain at maximum load [13.0 mm (8.3-39.8) vs 16.0 mm (4.6-32.5), p=0.73]. There were no significant differences between groups in terms of secondary outcomes.

CONCLUSION

This study shows that MLD up to 10 days after TKA does not affect pain.

Massage Therapy Modulates Inflammatory Mediators Following Sprint Exercise in Healthy Male Athletes

Massage therapy is a common postexercise muscle recovery modality; however, its mechanisms of efficacy are uncertain. We evaluated the effects of massage on systemic inflammatory responses to exercise and postexercise muscle performance and soreness. In this crossover study, nine healthy male athletes completed a high-intensity intermittent sprint protocol, followed by massage therapy or control condition. Inflammatory markers were assessed pre-exercise; postexercise; and at 1, 2, and 24 h postexercise. Muscle performance was measured by squat and drop jump, and muscle soreness on a Likert scale. Significant time effects were observed for monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor alpha (TNFα), drop jump performance, squat jump performance, and soreness. No significant effects for condition were observed. However, compared with control, inflammatory marker concentrations (IL-8, TNFα, and MCP-1) returned to baseline levels earlier following the massage therapy condition (p < 0.05 for all). IL-6 returned to baseline levels earlier following the control versus massage therapy condition (p < 0.05). No differences were observed for performance or soreness variables. MCP-1 area under the curve (AUC) was negatively associated with squat and drop jump performance, while IL-10 AUC was positively associated with drop jump performance (p < 0.05 for all). In conclusion, massage therapy promotes resolution of systemic inflammatory signaling following exercise but does not appear to improve performance or soreness measurements.

The Neglected Leg Lymphatic Vascular Changes in the Pathomechanism of Delayed Onset Muscle Soreness in Runners

Background: Delayed onset muscle soreness (DOMS) in runners is classified as a leg muscle strain injury and presents with tenderness or stiffness to palpation and movement limitation. Most attention is directed at muscles but not at the mass of other limb soft tissues, including their lymphatic vasculature, although they undergo mechanical stress and bruises, edema, nail destruction, and pains contributing to symptoms. Methods and Results: The study was done on lower limbs of long-distance runners suffering from DOMS complaints. There were 16 runners, 11 males and 5 females, age 22-28, practicing long-distance running over the last 5 years, with body mass index (BMI) 23 ± 4. Inclusion criteria: three to five marathon runs per year and daily 3-5 km slow runs. Last long distance run 3 to 7 days before the investigation. Controls were six subjects initiating running, of the same age group and BMI. Testing of blood and lymph flow was done before and after standard ergometer 300 W 30 minutes cycling. The measurement methods were leg and big toe venous plethysmography, big toe capillary Doppler, tonometry of skin and deep tissues, lymphoscintigraphy, and indocyanine green (ICG) fluorescent lymphography. (a) Strain gauge plethysmography of the calf and big toe revealed a two- to three-times higher venous capacity in runners than in controls, (b) the increased toe venous capacity was confirmed by point Doppler recordings showing two- to three-times higher blood capillary flow compared to controls, (c) lymphoscintigraphy revealed retention of tracer in feet, dilated superficial and deep lymphatics, and enlarged popliteal and inguinal lymph nodes, and (d) ICG lymphograms showed confluents of accumulated fluid in foot and calf subcutaneous tissue with fluorescence level reaching 40%-50% compared to 20% in controls. Conclusion: Our results show that, 3-5 days after run, not only muscles but also skin and subcutaneous tissue reveal major tissue fluid accumulation, an overload bringing about functional lymphatic transport insufficiency. This may be an additional factor responsible for DOMS symptoms.

Effect of deep oscillation as a recovery method after fatiguing soccer training: A randomized cross-over study

Background/Objective

In soccer the recovery time between matches is often not long enough for complete restoration. Insufficient recovery can result in reduced performance and a higher risk of injuries. The purpose of this study was to evaluate the potential of Deep Oscillation (DO) as a recovery method.

Methods

In a randomized crossover study including 8 male soccer players (22 ± 3.3 years) the following parameters were evaluated directly before and 48 h after a fatiguing soccer-specific exercise: Maximum isokinetic strength of the leg and hip extensors and flexors (Con-Trex^® Leg Press, Physiomed, Germany), rating of perceived exertion (RPE) during isokinetic testing (Borg scale 6–20), creatine kinase (CK) serum levels and Delayed Onset Muscle Soreness (DOMS; visual analogue scale 1–10). By random allocation, half of the group performed a DO self-treatment twice daily (4 applications of 15min each), whilst the other half received no intervention. 4 weeks later a cross-over was conducted. Two-way repeated measures analysis of variance was used to compare treatment versus control.

Results

A significant treatment effect was observed for maximum leg flexion strength (p = 0.03; DO: 125 ± 206 N vs. CG: −115 ± 194; p = 0.03) and for RPE (DO: −0.13 ± 0.64; vs. CG: +1.13 ± 1.36; p = 0.03). There was a trend to better recovery for maximum leg extension strength (DO: −31 ± 165 N vs. CG: −138 ± 212; p = 0.028), CK values (DO: 72 ± 331 U/ml vs. CG: 535 ± 797 U/ml; p = 0.15) and DOMS (DO: 3.4 ± 1.5 vs. CG: 4.1 ± 2.6; p = 0.49).

Conclusion

In the present study we found significant effects of DO on maximum leg flexion strength and perceived rate of exertion. Other variables showed a consistent trend in favour of DO compared with the control without significance. DO seems to be a promising method to accelerate the time-course of peripheral recovery of muscle which should be addressed in larger studies in future.

Trial registration

ClinicalTrials.gov; NCT03411278, 18.01.2018 (during the study).

Effect of Physical Methods of Lymphatic Drainage on Postexercise Recovery of Mixed Martial Arts Athletes

OBJECTIVE

Physical methods are reported to be important for accelerating skeletal muscle regeneration, decreasing muscle soreness, and shortening of the recovery time. The aim of the study was to assess the effect of the physical methods of lymphatic drainage (PMLD) such as manual lymphatic drainage (MLD), the Bodyflow (BF) therapy, and lymphatic drainage by deep oscillation (DO) on postexercise regeneration of the forearm muscles of mixed martial arts (MMA) athletes.

DESIGN AND METHODS

Eighty MMA athletes aged 27.5 ± 6.4 years were allocated to 4 groups: MLD, the BF device, DO therapy, and the control group. Blood flow velocity in the cephalic vein was measured with the ultrasound Doppler velocity meter. Maximal strength of the forearm muscles (Fmax), muscle tissue tension, pain threshold, blood lactate concentration (LA), and activity of creatine kinase were measured in all groups at rest, after the muscle fatigue test (post-ex) and then 20 minutes, 24, and 48 hours after the application of PMLD.

RESULTS

The muscle fatigue test reduced Fmax in all subjects, but in the groups receiving MLD, DO, and BF significantly higher Fmax was observed at recovery compared with post-ex values. The application of MDL reduced the postexercise blood LA and postexercise muscle tension.

CONCLUSIONS

The lymphatic drainage methods, whether manual or using electro-stimulation and DO, improve postexercise regeneration of the forearm muscles of MMA athletes. The methods can be an important element of therapeutic management focused on optimizing training effects and reducing the risk of injuries of the combat sports athletes.

An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis

Introduction: The aim of the present work was to perform a meta-analysis evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), perceived fatigue, muscle damage, and inflammatory markers after physical exercise. Method: Three databases including PubMed, Embase, and Web-of-Science were searched using the following terms: ("recovery" or "active recovery" or "cooling" or "massage" or "compression garment" or "electrostimulation" or "stretching" or "immersion" or "cryotherapy") and ("DOMS" or "perceived fatigue" or "CK" or "CRP" or "IL-6") and ("after exercise" or "post-exercise") for randomized controlled trials, crossover trials, and repeated-measure studies. Overall, 99 studies were included. Results: Active recovery, massage, compression garments, immersion, contrast water therapy, and cryotherapy induced a small to large decrease (-2.26 < g < -0.40) in the magnitude of DOMS, while there was no change for the other methods. Massage was found to be the most powerful technique for recovering from DOMS and fatigue. In terms of muscle damage and inflammatory markers, we observed an overall moderate decrease in creatine kinase [SMD (95% CI) = -0.37 (-0.58 to -0.16), I2 = 40.15%] and overall small decreases in interleukin-6 [SMD (95% CI) = -0.36 (-0.60 to -0.12), I2 = 0%] and C-reactive protein [SMD (95% CI) = -0.38 (-0.59 to-0.14), I2 = 39%]. The most powerful techniques for reducing inflammation were massage and cold exposure. Conclusion: Massage seems to be the most effective method for reducing DOMS and perceived fatigue. Perceived fatigue can be effectively managed using compression techniques, such as compression garments, massage, or water immersion.

Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis

Purpose: The purpose of this systematic review and meta-analysis was to evaluate the effects of massage on alleviating delayed onset of muscle soreness (DOMS) and muscle performance after strenuous exercise.

Method: Seven databases consisting of PubMed, Embase, EBSCO, Cochrane Library, Web of Science, CNKI and Wanfang were searched up to December 2016. Randomized controlled trials (RCTs) were eligible and the outcomes of muscle soreness, performance (including muscle maximal isometric force (MIF) and peak torque) and creatine kinase (CK) were used to assess the effectiveness of massage intervention on DOMS.

Results: Eleven articles with a total of 23 data points (involving 504 participants) satisfied the inclusion criteria and were pooled in the meta-analysis. The findings demonstrated that muscle soreness rating decreased significantly when the participants received massage intervention compared with no intervention at 24 h (SMD: –0.61, 95% CI: –1.17 to –0.05, P = 0.03), 48 h (SMD: –1.51, 95% CI: –2.24 to –0.77, P < 0.001), 72 h (SMD: –1.46, 95% CI: –2.59 to –0.33, P = 0.01) and in total (SMD: –1.16, 95% CI: –1.60 to –0.72, P < 0.001) after intense exercise. Additionally, massage therapy improved MIF (SMD: 0.56, 95% CI: 0.21–0.90, P = 0.002) and peak torque (SMD: 0.38, 95% CI: 0.04–0.71, P = 0.03) as total effects. Furthermore, the serum CK level was reduced when participants received massage intervention (SMD: –0.64, 95% CI: –1.04 to –0.25, P = 0.001).

Conclusion: The current evidence suggests that massage therapy after strenuous exercise could be effective for alleviating DOMS and improving muscle performance.