166 Questions
What is the primary function of the lymphatic system?
Maintaining fluid balance and fighting infection
Which of the following is NOT a component of the lymphatic system?
Blood vessels
What is the function of the spleen in the lymphatic system?
Filtering dead blood cells from the body
Where are the tonsils located?
In the pharynx
What is the role of lymph vessels in the body?
Preventing backflow of lymph fluid
What is the primary composition of lymph fluid?
Water, proteins, fats, and bacteria
What are initial lymph vessels covered with to keep them closed?
Hyaluronic acid
What is the function of pre-collectors in the lymphatic system?
Collecting fluid from the initial lymph vessels
Why do collector vessels have alternate drainage routes (anastomoses)?
To prevent backflow of fluid in case of obstruction
What is the role of lymph nodes in the body?
Filtering stations for a region or organ of the body
What type of receptors do sensory nerves in lymph angions respond to?
Stretch receptors responding to filling from inside or pressure from outside
Which technique involves using digits 2-5 on the medial arm in 3 spots to pump towards the axilla?
Running vibrations
During Swedish Drainage Portion, which technique is used for passive range of motion to the affected joint and/or joints above?
Running vibrations
How many times are the scoops at the terminus performed at the lateral neck and posterior neck?
2 times
Which technique involves using thumb circles to the dorsum of the wrist in 3 spots?
Thumb circles
What is done at the same time bilaterally during the pumping at the lateral neck?
Scoops at the terminus
In how many spots is unidirectional light effleurage performed on the forearm towards cubital fossa?
5 spots
Which technique involves pumping anterior and lateral arm in 5 spots towards axilla performed 2 times?
Pump anterior and lateral arm
How many Little Soldiers are used on the medial thigh to pump towards inguinal nodes?
'8 Little Soldiers'
What is the purpose of vasodilation in the context of inflammation?
To allow more blood flow to the injured area and removal of toxins and dead cells
Which protein is responsible for attracting phagocytes to the damaged area?
Kinins
What molecules promote histamine release, attract white blood cells, promote phagocytosis, and destroy bacteria?
Complement
What does increased permeability in inflammation allow?
Allows fluid to move out of the bloodstream and into interstitial space
Which stage of inflammation involves the emigration of phagocytes?
Emigration of Phagocytes
What is a primary function of inflammation?
To destroy microbes, toxins, and foreign material
Which sign of inflammation is due to increased blood flow caused by vasodilation?
Heat
What are students expected to revisit and practice in terms of skills?
All basic Swedish Massage Techniques
What is the main focus of lymphatic massage when the primary aim is to reduce swelling (edema)?
Draining congested areas to reduce edema
In which scenario would lymphatic drainage massage be contraindicated?
Acute infection
What is an important precaution to consider when performing manual lymphatic drainage (MLD)?
Pregnancy in the 3rd trimester
What is the recommended approach after finishing a treatment with lymphatic drainage for reducing edema?
Wipe the skin clean or use corn-starch to prevent gliding over the skin
Why should lotion never be used with manual lymphatic drainage (MLD)?
It may increase interstitial fluid
What should be the pressure level when performing manual lymphatic drainage?
Light and alternating
How should movements be carried out when performing manual lymphatic drainage?
Slow, rhythmical, and repetitive
What should be done first before beginning treatment with lymphatic drainage to clear the terminus?
Removing all constrictions to the affected area
What is the collection of dead tissues and white blood cells seen at the end of the inflammatory process called?
Pus
What is recommended during a general Swedish massage?
Elevate affected area while performing GSM
What is the process called when neutrophils travel to the site of injury?
Emigration
What is an important step for chronic gout in the late sub-acute stage during MLD?
Work to the sides of the injury and then center and proximal of injury site
What is the term for the increase in white blood cells usually seen during an infection?
Leukocytosis
How should one begin working on the edematous area during a general Swedish massage with incorporated lymphatic drainage?
With stationary circles
What occurs when there is pus that cannot be reabsorbed or drained and becomes walled off?
Abscess formation
Which stage of healing involves new scar tissue formation and alignment according to force?
Post-acute Stage
What is the term for the local or general accumulation of fluid in the interstitial tissue spaces?
Edema
What are the common complications of chronic inflammation?
Tendinosis
"PRISH / SHARP" treatment for inflammation focuses on:
Reducing pain and discomfort associated with inflammation
"Manual lymphatic drainage" can help with what aspect of the inflammatory process?
Reduction of swelling
What are the common complications of chronic inflammation?
Tendinosis
"Manual lymphatic drainage" can help with what aspect of the inflammatory process?
Reduction of swelling
What is the primary function of inflammation?
To prevent the spread of harmful substances to other tissues
Which stage of inflammation involves vasodilation and increased permeability?
Stage 1
What causes vasodilation and permeability in inflammation?
Histamine and kinins
What is the purpose of vasodilation in the context of inflammation?
To allow more blood flow to the injured area
What is the function of the spleen in the lymphatic system?
Removal of damaged red blood cells and storage of platelets
What molecules promote histamine release, attract white blood cells, promote phagocytosis, and destroy bacteria?
Leukotrienes and complement
Where are the tonsils located?
In the throat
What are initial lymph vessels covered with to keep them closed?
Valves
What does increased permeability in inflammation allow?
Movement of fluid from bloodstream to interstitial space
What is done at the same time bilaterally during the pumping at the lateral neck?
Pumping at the posterior neck
What is the role of lymph vessels in the body?
Removing excess interstitial fluid from tissues
During the acute stage of the inflammatory process, which cells arrive at the site of damage?
Platelets and white blood cells
What is the main focus during the sub-acute stage (proliferative stage) of healing?
Formation of new scar tissue
Which of the following is a possible outcome of chronic inflammation?
Abscess formation and tissue damage
What occurs during the post-acute stage (maturation stage) of healing?
Dense scar tissue is remodeled
Which stage of healing involves the immune system continuing to attack the tissue due to unsuccessful resolution?
Chronic Inflammation
What is a common complication associated with chronic inflammation that involves an abnormal overgrowth of scar tissue?
Keloid scarring
The inflammatory process may result in ______ formation.
abscess
The ______ stage of healing involves new scar tissue formation and alignment according to force.
post-acute
During the ______ stage of healing, specific cells accumulate and work to fill in damaged tissue.
sub-acute
Chronic inflammation can lead to ______ scarring.
keloid
The ______ stage of inflammation involves vasodilation and increased permeability.
acute
The ______ is responsible for attracting phagocytes to the damaged area.
chemokine
The inflammatory process should not be ______ as it is necessary to fight infection and initiate repair.
eliminated
[Blank] is a local or general accumulation of fluid in the interstitial tissue spaces.
Edema
Increased permeability of the capillaries can result from ______, tissue trauma, immune response or burns.
inflammation
During the ______ stage of inflammation, specific cells accumulate and work to fill in damaged tissue.
sub-acute
The ______ stage of healing involves new scar tissue formation and alignment according to force.
post-acute
A common complication of chronic inflammation is ______ scarring.
keloid
Inflammation is the body's innate immune response to an ______ or injury.
irritant
One of the signs and symptoms of inflammation is ______ (Rubor).
redness
During the first stage of inflammation, there is ______ and increased permeability.
vasodilation
Increased ______ is needed to allow more blood flow to the injured area.
permeability
The second stage of inflammation involves the ______ of phagocytes.
emigration
Chronic inflammation can lead to ______ scarring.
adhesive
Histamine is produced and released by mast cells, basophils, and platelets in response to ______
injury
Prostaglandins are released by damaged cells, enhancing the vascular permeability effect of histamine and kinins. They also attract ______ to the damaged area
phagocytes
Increased permeability causes fluid to move out of the bloodstream and into interstitial space, leading to ______
edema
Neutrophils slow down by sticking to the inner surface of the blood vessel near the damage, then squeeze through the walls to travel to the site of injury - this is called ______
emigration
Macrophages come in after neutrophils to clean up dead cells, pathogens, and pus. They are a bigger, more powerful type of ______
phagocyte
Pus is the collection of dead tissues and white blood cells seen at the end of the inflammatory process. It will either drain away or be reabsorbed by the ______
body
An abscess occurs when pus cannot be reabsorbed or drained and becomes walled off, leading to localized ______
infection
Chronic inflammation may result in the accumulation of ______ tissue
scar
The sub-acute stage of healing is also known as the ______ stage
proliferative
The post-acute stage of healing involves tissue ______ and maturation
repair
What is the primary function of the lymphatic system?
To regulate the immune response and transport lymph fluid
Which of the following is a contraindication for lymphatic drainage massage?
Sprains
What is the purpose of vasodilation in the context of inflammation?
To increase blood flow and deliver more oxygen to the injured area
What is the role of lymph nodes in the body?
To filter and trap bacteria, viruses, and other foreign substances from the lymph fluid
What is the primary composition of lymph fluid?
Water, white blood cells, and antibodies
What is the purpose of lymphatic drainage massage?
To drain congested areas and reduce edema
What is the primary function of lymph nodes?
To filter and remove pathogens and waste from lymphatic fluid
Which statement about the location of lymph nodes is correct?
Lymph nodes are commonly found around joints
How does the location of lymph nodes around joints assist in fluid movement?
The pumping action created by joint and muscle movement aids in lymph fluid circulation
What is the primary aim of lymphatic drainage massage?
To reduce swelling (edema) by focusing on the lymphatic system
How does the duration of lymphatic drainage massage affect the response?
The longer the massage, the more profound the response will be
The human body contains over 600 ______ which are most commonly found around the joints.
nodes
Lymph ______ act as filtering stations for a region or organ of the body.
nodes
Lymphatic Drainage Massage Procedure All massage will affect the circulatory and ______ system to some degree.
lymphatic
Their location around joints assists in movement of fluid via the pumping action created by the ______ and muscle contraction.
joints
Fluid from the lymph angion eventually flows into a group of ______ nodes where several important processes will occur.
lymph
The ______ system is responsible for removing metabolic waste and dead cells from the body.
lymphatic
Lymphatic drainage massage can help reduce ______ after an injury or surgery.
edema
Lymphatic drainage massage is contraindicated in cases of ______ cancer.
untreated
Chronic inflammation can lead to ______ scarring.
fibrotic
The ______ stage of healing involves new scar tissue formation and alignment according to force.
remodeling
The ______ is responsible for attracting phagocytes to the damaged area during inflammation.
chemokine
Which of the following is a contraindication for lymphatic drainage massage?
Untreated/Undiagnosed cancer
What is the primary purpose of lymphatic drainage massage?
To reduce metabolic waste and improve circulation
Which of the following is a precaution when performing lymphatic drainage massage?
Diabetes
What is the term used to describe the local or general accumulation of fluid in the interstitial tissue spaces?
Edema
What is a common complication associated with chronic inflammation?
Excessive scarring
Lymphatic Drainage Massage will affect the circulatory and ______ system to some degree.
lymphatic
Chronic inflammation can lead to ______ scarring.
excessive
The ______ stage of healing involves new scar tissue formation and alignment according to force.
remodeling
[Blank] is the primary composition of lymph fluid.
Water
Lymph ______ act as filtering stations for a region or organ of the body.
nodes
Lymphatic drainage massage can help reduce swelling and inflammation after an injury or surgery.
True
Lymph nodes act as filtering stations for the lymphatic system, but they are not part of the lymphatic system itself.
False
Chronic inflammation can lead to the formation of abnormal scar tissue, a condition known as fibrosis.
True
Lymphatic drainage massage should be performed on patients with untreated or undiagnosed cancer.
False
Lymphatic Drainage Massage can help reduce ______ and inflammation after an injury or surgery.
swelling
Chronic inflammation can lead to ______ scarring.
abnormal
During the acute stage of inflammation, ______ cells arrive at the site of damage.
phagocytes
The primary function of lymph nodes is to attract ______ to the damaged area during inflammation.
phagocytes
Lymphatic Drainage Massage will affect the circulatory and ______ system to some degree.
lymphatic
What is the recommended approach when performing manual lymphatic drainage on an area with chronic edema?
Work distal and through the injury site
What technique is recommended to be incorporated into a general Swedish massage routine for lymphatic drainage?
Swedish lymphatic drainage techniques
In the acute stage of inflammation, what treatment is recommended before performing manual lymphatic drainage?
Apply cold to the area for 10 minutes
Which of the following techniques is NOT mentioned as part of the manual lymphatic drainage protocol?
Tapotement
During the sub-acute stage of inflammation, what treatment is recommended before performing manual lymphatic drainage?
Perform contrast warm/cool therapy for 5 minutes each, 3 sets
What is the recommended starting point for manual lymphatic drainage?
Begin at the neck to clear the terminus
The ______ system is responsible for removing metabolic waste and dead cells from the body.
lymphatic
Chronic inflammation can lead to ______ scarring.
fibrosis
During the pumping at the lateral neck, stationary circles and scoops are done at the same time ______.
bilaterally
Lymph ______ act as filtering stations for a region or organ of the body.
nodes
The inflammatory process may result in ______ formation.
edema
The inflammatory process should not be ______ as it is necessary to fight infection and initiate repair.
suppressed
The ______ stage of healing involves new scar tissue formation and alignment according to force.
remodeling
Lymphatic drainage massage can help reduce ______ after an injury or surgery.
swelling
Lymph ______ act as filtering stations for a region or organ of the body.
nodes
Increased ______ is needed to allow more blood flow to the injured area.
vasodilation
Chronic inflammation can lead to ______ scarring.
fibrotic
During the ______ stage of inflammation, specific cells accumulate and work to fill in damaged tissue.
proliferative
Lymph ______ act as filtering stations for a region or organ of the body.
nodes
The inflammatory process may result in ______ formation.
scar
Increased ______ is needed to allow more blood flow to the injured area.
permeability
What is the primary purpose of performing lymphatic drainage massage?
To reduce swelling and inflammation after injury or surgery
Which technique is used to massage the posterior and lateral thigh?
Pumping with a single hand or alternating hands in 7 spots towards the greater trochanter
How many times are stationary thumb circles performed on the ankle?
2 times in 2 spots
What technique is recommended to finish the lymphatic drainage massage on the lower extremity?
2 of the following: unidirectional light effleurage, running vibrations, stimulating stroking, or passive range of motion to the affected joint and/or joints above 7-10 times
Which technique is used on the medial thigh to promote lymph flow towards the inguinal nodes?
8 little soldiers in 3 spots, 5 times each spot, towards the medial inguinal nodes
What is the primary aim of the lymphatic drainage massage technique described in the text?
To reduce swelling and inflammation after an injury or surgery
In which stage of the inflammatory process should manual lymphatic drainage not be performed?
Acute stage
What is the purpose of the pumping technique described in the text, starting from the thoracic spine and moving towards the upper ribs?
To stimulate the lymph nodes in the upper quadrant above the umbilical line
What is the purpose of the draping technique described in the text, where the therapist angles the drape from the waist/midline towards the greater trochanter?
To drain lymph fluid from the gluteus region towards the greater trochanter
Which of the following techniques is recommended to be incorporated into the general Swedish massage routine for lymphatic drainage, as described in the text?
Unidirectional light effleurage
Study Notes
Inflammation Process
- The inflammatory process has three stages: vasodilation and increased permeability, emigration of phagocytes, and tissue repair.
- The body's innate immune response to an irritant or injury is inflammation.
- Causes of inflammation: pathogens, trauma, chemical, immunological, extreme temperatures, obesity, diet, stress, and anxiety.
- Signs and symptoms of inflammation: PRISH (Pain, Redness, Immobility, Swelling, Heat) or SHARP (Swelling, Heat, A loss of function, Redness, Pain).
Stages of Healing
- The four stages of healing are: acute stage, sub-acute stage (proliferative stage), post-acute stage (maturation stage), and chronic inflammation.
- Acute stage: initial inflammatory phase, chemical released by damaged cells, exudate/edema develops, cells arrive (platelets & WBCs), and may last 1-3 days.
- Sub-acute stage: specific cells accumulate and work to fill in damaged tissue, new capillaries grow into the area for new cell growth, scar tissue forms, WBCs clean up debris, and can last 2-3 weeks depending on severity.
- Post-acute stage: new scar tissue (collagen fibres) is remodeled and reshaped, becomes denser and aligns according to force, and it's important not to limit mobility entirely during this stage to allow most ideal scar formation.
Chronic Inflammation
- Chronic inflammation is when the inflammatory process is not successful, pathogens/irritants are not removed, and the immune system continues to attack tissue.
- Complications of chronic inflammation: cysts, abscesses, fistulae, sinuses, tendinosis, keloid scarring, and musculoskeletal structures never regain full function.
Treatment of Inflammation
- RICE method: Rest, Ice, Compression, Elevation, and Immobilize (sometimes and only for a specific period of time).
- Massage can be beneficial in the post-acute stage (maturation/remodelling) for fluid turnover (circulatory techniques) and alignment of scar tissue.
- Manual lymphatic drainage can help with the reduction of swelling in all stages, provided that the appropriate principles are followed for each respective stage.
Edema
- Edema is a local or general accumulation of fluid in the interstitial tissue spaces.
- Causes of edema: increased permeability of capillaries from inflammation, tissue trauma, immune response, or burns; obstruction of lymphatic flow; increased capillary pressure from heart failure, thrombophlebitis, pregnancy, or a generalized allergic response; and decrease of plasma protein with liver and kidney diseases, starvation, and following extensive burns.
Lymphatic System
- The human body contains over 600 lymph nodes, most commonly found around the joints (160 in the neck).
- Lymph nodes act as filtering stations for a region or organ of the body, and their location around joints assists in movement of fluid via the pumping action created by the joints and muscle contraction.
Lymphatic Drainage Massage
-
Lymphatic drainage massage aims to reduce swelling (edema) by focusing on the lymphatic system.
-
Indications for lymphatic drainage massage: metabolic removal, local inflammation, acne, gout, stress, constipation, bruising, bronchitis, carpal tunnel, thoracic outlet syndrome, and sinusitis.
-
Contraindications for lymphatic drainage massage: sprains, strains, tendonitis, arthritis, burns, mastectomy, breast augmentation, breast reduction, dental/oral surgery, cosmetic surgery, joint replacement, scarring, untreated/undiagnosed cancer, acute infection (local or systemic), thrombosis (blood clot), heart-related edema (congestive heart failure, advanced high blood pressure), and precautions for tuberculosis, pregnancy (if history of miscarriage or in 3rd trimester), diabetes (may cause insulin shock), extreme low blood pressure (may cause fainting), and asthma (sternal work may cause asthma attack).### Lymphatic Massage Effects
-
Drains congested areas and reduces edema, such as in acute injuries like sprains or strains
-
Localizes and reduces inflammation, particularly post-surgery
-
Helps remove metabolic waste, dead cells, and debris, especially post-surgery
-
Re-routes the lymph if there is an obstruction, such as scar tissue, typically performed by a certified lymphedema therapist
Indications for Lymphatic Drainage Massage
- Metabolic removal
- Local inflammation
- Acne
- Gout
- Stress
- Constipation
- Bruising
- Bronchitis
- Carpal Tunnel
- Thoracic Outlet Syndrome
- Sinusitis
Contraindications for Lymphatic Drainage Massage
- Sprains
- Strains
- Tendonitis
- Arthritis
- Burns
- Mastectomy
- Breast Augmentation
- Breast Reduction
- Dental/oral Surgery
- Cosmetic Surgery
- Joint Replacement
- Scarring
- Decongestive Pre/Post Operative
- Untreated/Undiagnosed cancer
- Acute infection (local or systemic)
- Thrombosis (blood clot)
- Heart-related edema (congestive heart failure, advanced high blood pressure)
Precautions for Lymphatic Drainage Massage
- Tuberculosis
- Pregnancy (if history of miscarriage or in 3rd trimester)
- Diabetes (may cause insulin shock)
- Extreme low blood pressure (may cause fainting)
- Asthma (sternal work may cause asthma attack)
Lymphatic Drainage Massage Protocol
- Removes all constrictions to the affected area
- Begins at the neck and pumps the terminus
- Techniques include:
- Stationary circles
- Pump
- Scoop
- Rotary
- Thumb circles
- Acute: no treatment distal or through injury site
- Early sub-acute: work around periphery of injury site
- Late sub-acute: work to the sides of the injury and then center and proximal of injury site
- Chronic: work distal and through injury site
Manual Lymphatic Drainage Routine
- Incorporated into a General Swedish Massage
-
- Elevates affected area (if possible) while performing GSM
-
- Treats all other conditions first using GSM
-
- Hydrotherapy vs No Hydrotherapy:
- Acute: applies cold for 10 minutes
- Sub-acute: applies contrast warm/cool for 5 minutes each, 3 sets
- Chronic: warm to decrease gelling of edema (via Swedish techniques)
-
- Performs Deep Diaphragmatic Breathing
-
- Removes all pillowing and loosens draping
-
- Begins treatment at the neck to clear the terminus
-
- Works on the edematous area from furthest area of closest segment to lymph node cluster
-
- Can close with 2 or 3 Swedish Lymphatic Drainage Techniques:
- Light unidirectional effleurage
- Light course running vibrations
- Passive relaxed range of motion
- Muscle setting
- Shaving
- Soothing stroking
- Neck & Terminus Pumping
Upper Extremity (Anterior) Lymphatic Drainage
- Starts with neck & terminus pumping
- Unidirectional light effleurage to limb
- Pumps deltoid and shoulder in 3 spots, 3x each spot, towards terminus
- Uses digits 2-5 (‘8 Little Soldiers’) on medial arm in 3 spots to pump towards axilla
- Pumps anterior and lateral arm in 5 spots towards axilla
- Scoops to posterior arm in 3 spots
- Pumps to forearm in 5 spots towards cubital fossa
- Thumb circles to dorsum of wrist in 3 spots
- Swedish Drainage Portion:
- Finishes with 2 of the following to the entire arm; direction is always towards axilla:
- Unidirectional light effleurage
- Running vibrations
- Stimulating stroking
- Passive range of motion to affected joint and/or joints above 7-10x
- Finishes with 2 of the following to the entire arm; direction is always towards axilla:
Lower Extremity (Anterior) Lymphatic Drainage
- Starts with neck & terminus pumping
- Unidirectional light effleurage to limb
- 8 little soldiers to medial thigh in 3 spots, 5x each spot, towards inguinal nodes
- Pumps to anterior and lateral thigh with single hand or alternating hands in 7 spots, towards inguinal nodes
- Alternating thumb circles to pes anserine in 3 spots
- Stationary circles to popliteal space 5x
- Pumps anterior lower leg in 5 spots, towards pes anserine & popliteal fossa
- Stationary thumb circles to ankle in 2 spots
- Stationary thumb circles to dorsum of foot
- Squeeze ball of foot
- Swedish Drainage Portion:
- Finishes with 2 of the following to the entire leg; direction is always towards greater trochanter:
- Unidirectional light effleurage
- Running vibrations
- Stimulating stroking
- Passive range of motion to affected joint and/or joints above 7-10x
- Finishes with 2 of the following to the entire leg; direction is always towards greater trochanter:
Lower Extremity (Posterior) Lymphatic Drainage
- Performed with client in prone
- Starts with neck & terminus pumping
- Unidirectional light effleurage to limb
- Stationary circles/pump to glut region in 3 spots towards greater trochanter
- 8 little soldiers to medial thigh in 3 spots, 5x each spot, towards medial inguinal nodes
- Pumps to posterior and lateral thigh with single hand or alternating hands in 7 spots, towards greater trochanter
- Stationary circles to popliteal space 5x
- Pumps/squeeze with whole hand to posterior lower leg in 5 spots, towards popliteal fossa
- Stationary thumb circles to ankle in 2 spots
- Swedish Drainage Portion:
- Finishes with 2 of the following to the entire leg; direction is always towards greater trochanter:
- Unidirectional light effleurage
- Running vibrations
- Stimulating stroking
- Passive range of motion to affected joint and/or joints above 7-10x
- Finishes with 2 of the following to the entire leg; direction is always towards greater trochanter:
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