Lymphedema is an abnormal collection of high-protein fluid just beneath the skin causing swelling most commonly in the arm or legs. Swelling can also occur in other parts of the body including the breast or trunk, head and neck, or genitals. Lymphedema usually develops when the lymphatic system is damaged or lymph nodes are removed but can also be present when the lymphatic system is missing parts or impaired due to a hereditary condition. Lymphedema is most commonly seen in the US after breast cancer surgery in which lymph nodes are removed.
Signs or symptoms of lymphedema include a full or heavy sensation in the limb(s), tightness of the skin, decreased flexibility in the hand/wrist/foot/ankle, difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet tightness. If you notice swelling in an area, call your physician. Even if the edema goes away at night—you could be experiencing an early sign of lymphedema. Early treatment minimizes the symptoms and can improve the outcome. If left untreated swelling can worsen leading to skin infections, fibrosis or hardening of soft tissue and further damage to the lymphatic system.
Lymphedema is treated by a process called Complete Decongestive Therapy (CDT). A specially trained therapist in CDT uses manual lymph drainage techniques, compression, exercise and skin care to reduce swelling. When the limb is back to a normal size the patient is then measured and fitted with a compression garment to prevent a re-accumulation of fluid. There is no cure for lymphedema, it is a disease process that must be managed for a lifetime.
Complete Decongestive Therapy can also help in successful treatment of chronic venous insufficiency, lipedema, post traumatic and post-surgical swelling, inflammatory rheumatism, fibromyalgia and more. -Cassandra Bennett, OTR/L, CLT
Cassandra Bennett has been a practicing Occupational Therapist for 10 years. She recently completed the specialized training program through the Academy of Lymphatic Studies and is now a Certified Lymphedema Therapist (CLT). As a CLT she is able to use all aspects of complete decongestive therapy, including compression and manual lymph drainage to treat lymphedema and related conditions. She is also certified in the measurement and fitting of medical compression garments.
Therapeutic Dry Needling
Do you have chronic pain in muscular areas that limit how you move? Do you sometimes have trigger points of pain and achiness that seem to hang around or keep coming back?
Dry Needling is a general term for a therapeutic treatment procedure that involves using a solid filament needle advanced multiple times into the muscle. There is no injectable solution and typically the needle that is used is very thin. Acupuncture and dry needling techniques are similar but dry needling targets trigger points of pain and muscular bellies rather than the traditional “meridians” accessed during acupuncture. A myofascial trigger point consists of multiple contraction knots within the muscle that contribute to the production and maintenance of the pain cycle. Proper dry needling will often elicit a local twitch response within the muscle, causing relaxation of the tissue and relief of pain, and may also work by activating our own bodies pain relieving opioids.
For the Physical Therapist, dry needling is an excellent adjunct to other treatment including therapeutic exercise and functional movement training. Dry needling often assists with relieving pain, but it can also relax the musculature enough to improve range of motion and quality of movement, sometimes immediately. Quality functional movement without pain is the goal for every patient so resumption of sports and activities can be achieved.
Dry needling can be used in the treatment of neck and low back pain, rotator cuff injuries, muscle tears and strains, shin splints, tennis/golfers elbow, headaches, sciatica, hamstring issues, Achilles tendonopathy, impingement syndromes, carpal tunnel syndrome and many more conditions. It is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. This technique is unequaled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits. If you feel you could benefit from Dry Needling, see your local Physical Therapist trained in this technique.
Sue Holz DPT
Why Work "The Core"?
What is all the buzz about our “core” and what is it anyway? Like the tough fibrous part of an apple core, our “core” refers to the musculature in our trunk or center of our bodies including our abdominal, back, hip and buttock muscles. They actually form a cylinder around the middle of our bodies and act as a foundation for all the movements we make. When our core is strong and working well, we can make powerful movements with our extremities to perform the work we need to do.
Our core muscles help control movement such as squatting to pick up a heavy box from the floor or balancing on one foot. They help us shift body weight efficiently when we walk, jog, run, skip, or move up and down the stairs. And they help us transfer energy so we can swing our arms, dance, ride a bike and hike over uneven ground.
A strong efficient core protects us from injury, so when it is weak, we are at much greater risk of hurting ourselves. Low back, hip, knee, ankle and shoulder injuries can all result from poor core strength and functional movement patterns. If the core is weak, it is easy to strain the low back picking up a simple object, injure a hip while running, or strain the shoulder while swimming.
The good news is that strengthening the core can help remediate injuries you already have. It can help decrease your low back pain, correct your running pattern to decrease knee or foot pain, or improve your shoulder stability so you can throw or catch a ball without pain.
The core should not be worked in isolation from the rest of the body. Sit-ups and back extension exercises alone do very little to actually improve the strength and efficiency in our core. Sometimes a rehabilitation program will include these exercises, but to actually make us efficient we need whole body exercises using our trunk with arm and leg movements such as plank or pushups. Great exercise programs and classes exist with core components including yoga, pilates, boot camp, and TRX.
Functional Capacity Evaluations
If you have ever been hurt on the job, your physician and/or employer may require you to perform an Functional Capacity Evaluation (FCE) prior to returning to work. An FCE provides reliable and valid measures of a person’s physical, medical, behavioral, and ergonomic ability to perform job-specific series of tasks. Rehabilitation, ergonomic, and exercise specialists such as Physical Therapists, Physical Therapist Assistants, and Occupational Therapists commonly conduct these evaluations. They also work closely with employers and physicians to communicate and interpret results in deciphering if the client can safely and effectively return to his/her current job.
Functional capacity evaluations usually take 5 hours to complete and consist of static position tolerance such as standing, sitting, and walking as well as job specific tasks that are considered “essential.” Some of these tasks include lifting, climbing, crawling, pushing/pulling, etc. Clients are observed during these tests for body mechanics, appropriate physiological responses such as blood pressure and heart rate, and safety. Other tests include questionnaires, range of motion, and strength.
The cost of employee health and productivity loss, as a result of work-related injuries, has been estimated at $1.2 trillion annually. Research has shown that FCE programs are one of several effective ways to prevent work-related injuries. Clients receive education in safe and proper lifting techniques, and are educated in improving ergonomics within their work environments. Pre-employment screenings also assist in injury prevention and are considered mandatory for some companies.
Functional employment tests can greatly assist employers in their efforts to control cost and worker efficiency, assist physicians in determining if a client can be released to work, and assist in promoting health and safety to workers. To learn more about FCEs and/or you need to schedule an FCE please contact Proactive Rehabilitation at (307) 367-6236 OR (307) 276-3050.