Abstract
Purpose: Manual lymphatic drainage (MLD) and proprioceptive neuromuscular facilitation (PNF) are potential therapeutic strategies to reduce mastectomy-induced edema. The purpose of this study was to investigate whether the combination of these therapies would induce synergistic effects to treat lymphedema-related complications and to analyze a possible physiological mechanism involved in the observed effects.Methods: A total of 55 patients diagnosed with mastectomy-induced lymphedema were recruited and randomized into three experimental groups: PNF group (n = 17), MLD group (n = 20), and PNF + MLD group (n = 18). They were subjected to designated rehabilitation program three times a week for 16 weeks. ROM (flexion of the shoulder joint), edema size, arterial blood flow velocity, and degree of pain and depression were measured every 4 weeks over experimental period.Results: Lymphedema volume, VAS pain scale, and Beck depression scale were decreased in PNF and MLD groups for 16 weeks in a time-dependent manner. In combination, a greater reduction of these variables was observed over 16 weeks compared to each PNF and MLD. While axillary arterial blood circulation rate in the affected extremity was increased in both PNF and PNF + MLD groups over 16 weeks, this value was not increased in MLD group throughout the experimental period. A greater reduction of scales of VAS pain and Beck Depression Inventory (BDI) was observed in PNF + MLD group after the 16 week-treatment, as compared to each PNF and MLD group. Pearson's coefficients test demonstrated that there are significant correlation of depression against pain (r = 0.616, p < 0.01), ROM (r = −0.478, p < 0.01), and lymphedema size (r = 0.492, p < 0.01).Conclusion: The combination of MLD and PNF induces potent synergistic effects on edema volume, shoulder range of motion (ROM), pain, and depression in patients with lymphedema. In addition, an increased rate of axillary arterial blood flow in PNF-treated patients provide a potential physiological mechanism by which local arterial pulsation in the affected extremity plays a positive role in the treatment of lymphedema. Therefore, it is suggested to incorporate an element of PNF into traditional MLD method to facilitate treatment process for patients with lymphedema.
Highlights
Lymphedema is a pathological state of chronic tissue swelling induced by the restriction of lymph drainage (Armer, 2005)
As compared to week 0, a significant and immediate reduction in lymphedema size was observed in the Proprioceptive neuromuscular facilitation (PNF) + manual lymphatic drainage (MLD) group after a 4 week-treatment and it decreased up to 26% after 16 weeks (p < 0.01)
The group differences were observed between PNF + MLD and other treatment groups (MLD and PNF) at 8, 12, 16 weeks (p < 0.01), suggesting that the combined treatment induces a potent synergistic effect on reduction of lymphedema
Summary
Lymphedema is a pathological state of chronic tissue swelling induced by the restriction of lymph drainage (Armer, 2005). Manual lymphatic drainage (MLD) has garnered attention as a non-surgical treatment. The application of MLD combined with other supplemental methods, such as complex decongestive physiotherapy is regarded as the most effective non-surgical therapeutic method. These treatments commonly cause an increase in the flow of lymph, the contraction rate of lymphatic vessels, and the re-absorption of proteins into lymphatic vessels, leading to transferring the fluid of edema in the direction of lymph nodes (Williams et al, 2002; Moseley et al, 2007; Williams, 2010; Ezzo et al, 2015)
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