Millions of women experience a form of pelvic floor dysfunction at some stage in their lives. Aging, pregnancy, childbirth, and trauma can all cause severe pelvic pain that can affect the quality of your life. However, women can improve their pelvic health and overall wellness with the help of licensed specialists.

What Is Women’s Health Physical Therapy?

Women’s Health Physical Therapy is an umbrella term for the therapeutic treatments of all pelvic floor dysfunctions. Pelvic floor dysfunction includes a variety of symptoms that appear due to weakened pelvic muscles and ligaments. 

From infections, fecal incontinence, and prolapse to dysfunction with intercourse, and unbearable pelvic pain, the number of musculoskeletal conditions that can affect women is long,  but research proves that physiotherapy can help alleviate, treat and cure pelvic floor dysfunctions. Pelvic floor dysfunctions can also affect men and cause erectile dysfunction. These types of disorders can be caused by pregnancy, childbirth, aging, trauma, constipation, and chronic coughing. Additionally, pelvic floor dysfunction can be hereditary. 

It’s worth noting that pelvic floor dysfunctions are fairly common, in fact, research by the National Institute of Health shows that nearly 24 percent of U.S. women are affected with one or more pelvic floor disorders. However, many women decide to ignore the symptoms and not seek medical care which can lead to burning pain and a decreased quality of life.

How Does Women’s Health Physical Therapy Help Patients?

Physical therapy is performed by licensed clinicians who can evaluate the severity of pelvic floor dysfunction and treat musculoskeletal disorders. During their lifespan, women can experience a variety of pelvic floor disorders which, in many cases, can be treated relatively easily if a therapist is contacted for help. Your therapist will evaluate your condition and create a personalized therapy that usually lasts between three weeks and a couple of months. 

Women’s health physical therapy includes manual therapy, pelvic floor exercises, bladder training, and biofeedback. 

The therapy also teaches women how to help themselves, prevent new symptoms, and gain control over their bodies. Last but not least, physical therapists encourage women to take charge of their wellness and maintain their pelvic health.

How Long Is Physical Therapy for Women’s Health?

The length of the therapy depends on the severity of the symptoms. Usually, patients take six to eight weeks of treatment to alleviate the symptoms. However, the treatment can last several months for patients with severe pain. 

Once the symptoms start to improve, it’s very important for patients to do regular check-ups and periodically have treatments. Keep in mind that taking medications regularly is vital for the process to finish as soon as possible. Also, don’t skip physical therapy appointments and exercises because this will prolong your symptoms.

Conditions Women’s Health Physical Therapy Can Help With

The most common conditions treated by women’s health specialists are:

• Urinary incontinence
• Fecal incontinence
• Constipation 
• Endometriosis
• Breast cancer
• Osteoporosis
• Low back pain during pregnancy
• Loss of pelvic floor function after childbirth
• Discomfort in the bladder and urethra
• Sports injuries 

Women’s Health Physical Therapy for Pelvic Health

Physical therapy can improve your overall pelvic health. It alleviates myofascial pelvic pain and can reduce the symptoms caused by pelvic floor dysfunctions.

Women’s Health Physical Therapy for Incontinence

A range of treatments is available to treat incontinence. Physical therapists usually determine the severity of the symptoms patients are suffering from by examining the type of incontinence, your overall musculoskeletal health, and the strength of your pelvic muscle. 

After the evaluation, your physical therapist would be able to develop an individualized exercise treatment program for your needs. This type of program can help patients avoid surgery and medication.

Incontinence is usually treated with the following methods:

• Pelvic floor exercises

Pelvic floor exercises or Kegel exercises involve contraction and relaxation of the pelvic floor muscles. Kegel exercises can help you strengthen and nourish the muscles around your bladder, bottom, vagina, or penis. They can alleviate severe pain, improve intercourse, treat pelvic organ prolapse, and help with urinary incontinence. Patients need to do the exercises several times a day, be consistent, and stay patient. The effect of kegel exercises is usually noticeable after one to three months.

• Bladder training

Bladder training or scheduled voiding helps the patient have better control over their bladder. It’s recommended for the patient to not experiment on their own and do training solely under the supervision of a continence health expert. Bladder training is considered to be one of the crucial methods for the treatment of overactive bladder and urinary incontinence. The training can help patients reduce the constant need to visit the toilet, help them control the urges, and increase the volume of urine they can comfortably hold.

• Biofeedback

Biofeedback therapy can help patients get a better awareness of automatic body functions such as breathing, blood pressure, and heart rate. This type of therapy can help patients take conscious control over their involuntary body functions. Aside from treating pelvic floor dysfunctions, biofeedback can also help with high blood pressure, anxiety, and pain, and improve your overall medical condition.

Women’s Health Physical Therapy for Prolapse

Prolapse is caused by the stretching of the pelvic organs and ligaments such as the uterus, rectum, and bladder. Physical therapy offers exercises that strengthen the core muscles (abdominal muscles) and lower back muscles, which can ease the symptoms of prolapse. They are usually practiced alongside kegel exercises and breathing techniques. These exercises can help patients with minor pelvic organ prolapse, while severe prolapse is usually treated with surgery.

If you have any questions concerning pelvic floor dysfunctions and treatments, please do not hesitate to contact our team.

It’s a well-known fact that shoulder injuries are common. People experience shoulder injuries due to the type of sports they play or the work they do each day. But, just how common are shoulder injuries, and how can they be resolved?

Around eight out of 10,000 workers experience shoulder injuries in the workplace. And in 2006, approximately 7.5 million people reported shoulder injuries to their doctors, according to data from the American Academy of Orthopaedic Surgeons.

If you’re experiencing shoulder pain caused by something you did at home, school, or work, don’t suffer in silence. Instead, it makes sense to have shoulder physical therapy to help your body recover from your shoulder injuries.

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What is Shoulder Physical Therapy?

Shoulder physical therapy is a type of treatment customized to address specific individual shoulder injuries. The idea behind shoulder physical therapy is that it helps patients recover from their shoulder injuries or shoulder surgery and regain their mobility.

Another advantage of shoulder physical therapy is patients will receive advice on altering their daily activities to lessen the risk of such injuries occurring in the future. Shoulder physical therapy helps to strengthen the body, especially after shoulder surgery.

How Does Shoulder Physical Therapy Help Patients?

Virtually everyone will experience shoulder pain at some stage in their lives. The pain can be mild and only last a few hours or a couple of days. But, for many people, the pain can become intolerable and adversely affect their everyday lives.

When the pain stops being manageable and doesn’t go away on its own, shoulder physical therapy can help. The treatment offered aims to alleviate the pain and tackle the source of the problem.

Shoulder physical therapy isn’t just for people that have injured their shoulders or experience shoulder impingement. It’s also for patients that have had shoulder surgery and need to strengthen their shoulders post-surgery.

With the right shoulder physical therapy, patients will experience faster recovery times and enjoy a better quality of life.

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How long is physical therapy for shoulder injuries?

The duration of each person’s shoulder physical therapy will depend on several factors. Firstly, the nature of the patient’s injuries will dictate how long it will take that person to successfully recover.

Secondly, other factors such as general physical health and mobility will also play a part in the duration of their recovery. And third, the treatment offered will also depend on the rehabilitation activities the patient can do at home.

Shoulder Conditions Physical Therapy Can Help

Knowing the reason for your shoulder pain is the first step to treating it. Did you know that shoulder physical therapy can treat a wide range of shoulder injuries? They are as follows:

• Sudden Injuries. Injured tendons, ligaments, nerves, strained muscles, broken and dislocated bones, and torn rotator cuffs are the main causes of sudden injuries to shoulders;
• Overuse Injuries. Everyday activities can sometimes cause shoulder overuse injuries like bursitis, tendinitis, muscle strain, and shoulder impingement;
• Less-Common Injuries. Sometimes, shoulder injuries can occur from problems such as irregular posture, osteoarthritis, and infections.

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Physical Therapy for Shoulder Pain

Are you experiencing shoulder pain due to sudden, overuse, or less-common injuries? If so, you’ll benefit from physical therapy for shoulder pain. It’s a successful, non-surgical way of strengthening the muscles around your shoulders to facilitate function and mobility.

When you see a physical therapist for your shoulder pain, they will examine the affected shoulders and determine the best treatment plan for your needs.

Physical Therapy for Shoulder Surgery

Have you recently had surgery on one or both of your shoulders, or will soon have the surgery? Physical therapy for shoulder surgery will ensure the correct rehabilitation of your shoulders, resulting in a speedy recovery and restored mobility and function.

Your physical therapist will work with you to create a custom treatment plan specific to your shoulder surgery.

Physical Therapy for Shoulder Impingement

Shoulder impingement is often caused by overuse activities, resulting in a tendon rubbing or getting caught on a bone. It can also mean that your shoulder is weak, and becomes more painful when you lift it.

Physical therapy for shoulder impingement aims to strengthen the shoulders and encourage good posture to speed up the recovery process.

The posterior pelvic floor is a complex region. When it is working right we don’t even think about it, but when it goes awry our bodies become overwhelmed. Many of our women and men athletes have poor functioning of their posterior pelvic floor. We can often see pudendal nerve entrapment in the pelvic floor in our cyclists, long distance runners, cross fit and weight lifters. This can lead to bowel, bladder and sexual dysfunction. 

What is the Posterior Floor

The posterior floor is responsible for posterior organ support, anal health and good bowel function.  The muscles there are striated  muscles like we have in our arms and legs. They respond as all muscles do,  when we use them in a coordinated fashion they work well, but if we overstrain them during training, then they will become dysfunctional. They are controlled by a set of sacral nerves that are highly sensitive and can become irritated and painful when the function of the floor muscles are not working well.   Neural “cross-talk” between pelvic organs shows an increase in sensitivity between the urinary, bowel and sexual organs function in the physiological system. This sensitivity appears to be related to the bodies need to have good daily regulation in these organs and often when one is affected they all become involved.

The pelvic floor muscles consist of layers of muscles and they have a complex integration system. There is a superficial layer which consists of the anal sphincter and deep muscle system that creates a sophisticated sling like set of muscles that integrates with the gluteal muscles, the hip adductors, rotators and  hamstrings. These pelvic floor muscles make up part of our “core” region. The “core” needs good functioning of the floor to remain healthy.  Any core muscles that are not functioning well will disrupt the system.

Physical therapy for pelvic floor health is a key integration as PT’s are movement specialists and their ability to coordinate the “core” and retrain the floor is needed. The signs and symptoms are key to knowing if posterior pelvic floor health is an issue for you. 

Signs and symptoms of Posterior Floor Dysfunction: 

• Posterior pelvic pain and pressure 
• Bloating, sense of non-complete evacuation of bowels 
• Low back,sacroiliac joint and/or lower abdominal pain
• Chronic prostatitis  
• Pain with prolonged sitting 
• Non-relaxing pelvic floor disorder with tight hip muscles 
• Hemorrhoids 
• Anal Fissures 
• Burning and Irritation to the Pudendal nerve in floor, around base,shaft of penis 
• Anal receptive intercourse 
• Fecal incontinence 
• Chronic constipation 
• Pelvic floor dyssynergia-external anal sphincter dysfunction 
• Type A personality -anxious mood 
• Pelvic organ prolapse,Perineal Body decent due to obstetric trauma, multiple births vaginally 
• Can begin in childhood 
• Often have dysfunction bladder voiding as well 
• Irritable bowel syndrome (IBS)
• Interstitial cystitis (IC)

Daily Health Habits Needed:

• Comfortable lightweight clothing ie cotton underwear for breathability. 
• Sleep hygiene 7-8 hours a night for healing.
• Increased water intake.
• Healthy diet with fiber, dosing magnesium. 
• Wean off use of laxatives. 
• Relaxation training- Meditation, breathing ex’s. 
• External and internal pelvic floor mobilization for increased blood flow. 
• Physical therapy for education instruction on pelvic floor health mobilization, stretching 
• and muscle coordination and integration of the floor 5-20 mins a day. 
• Natural paraben free Lubricants -increased need for lubrication upon bowel mvts and anal intercourse.  
• Education and instruction on health bowel habits- positions for improved function, decrease straining for bowel mvt and focus on relaxation and taking time for evacuation. 
• Night time propping of hips and legs up on pillows for floor relaxation for 20-30 mins a day. 
• Improved sitting postures to decrease floor pressure.

Physical therapy is an integral part of pelvic floor health. Please get a referral to a pelvic health PT for the restoration of the muscle function of the floor and to restore correct re-integration of the core. As much as we need our athletes to be strong, we also need them to have the coordination and balance to be able to relax the floor and have down time as well, for overall pelvic floor health.

Sheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her amazing  staff are here to help you during your athletic endeavors with good pelvic health. Please call for an appt. tomorrow Cda office (208)667-1988, Spokane Valley(509)891-2623, Hayden (208)762-2100, Post Falls (208) 457-3435.

If you are suffering from constipation, you should consider pelvic floor therapy. This treatment can help ease the symptoms of this condition, as explained below. 

Constipation is far more common than most people realize. Indeed, one study has revealed that approximately 52 million people, or 16% of the American population suffer from some form of chronic constipation. As you age, this issue becomes far more prevalent and causes numerous people to visit the doctor to treat the problem. There are even over 700,000 visits to the emergency room each year related to constipation. If you are looking for relief from this condition, you could consider pelvic floor physical therapy. 

Get in touch now and we can book you in for an appointment immediately, helping you reduce issues with this condition.  

What Is Pelvic Floor Therapy For Constipation? 

Pelvic floor therapy focuses on issues with the pelvic floor. These muscles control various processes in the body including:

• Urination
• Defecation
• Intercourse

Constipation can cause numerous issues including infrequent bowel movements as well as the sensation that the bowels are never fully empty. Many people who suffer from constipation do have issues with pelvic floor dysfunction. While there are numerous lifestyle causes of constipation, this is certainly a contributing factor. 

Pelvic floor therapy for constipation is used to manage any tightness that exists in the muscles or through the intestines and the diaphragm. Any constrictions here are going to make issues with constipation a lot worse. 

With pelvic floor therapy, therapists use internal treatment to help with the issue of muscular tension as well as breathing and relaxation exercises. In doing so, it’s possible to help key muscles relax more. 

Who Is Qualified To Perform Pelvic Floor Therapy For Constipation? 

There are numerous people who will be qualified to complete pelvic floor therapy. For instance, a doctor may recommend a gynecologist, a urologist, or even a urogynecologist. It largely depends on the issues that a patient is suffering from. 

For constipation, it is best to contact a pelvic health physical therapist. Experts in the field, we are trained specifically to assess and treat a wide range of different pelvic floor problems. Be aware that constipation can impact men and women as well as children. 

If you are experiencing issues with constipation, we encourage you to contact us today. A friendly member of our team will book you in for an appointment so that we can work to resolve your issue. 

Does Pelvic Floor Therapy Work For Constipation? 

Many patients do experience new levels of relief when they start using pelvic floor therapy for constipation. Studies have shown that pelvic floor therapy can be highly beneficial for this issue because it helps ensure that muscles do relax which makes it easier for patients to complete a bowel movement. 

While there are other issues that often contribute to constipation such as diet and hydration, pelvic floor therapy can provide the level of relief that patients need. It can even ensure that they feel less pain and discomfort when dealing with a condition like this. 

Pelvic Floor Therapy Exercises For Constipation 

As well as providing internal treatments as well as expert advice, we also recommend pelvic floor therapy exercises for constipation. These exercises are based on helping you relax the vital muscles that will be causing you issues. 

While there are various exercises and stretches that can help, many are based on yoga poses such as child’s pose and happy baby. 

Happy baby involves lying down on your back with your legs in the air. You can then pull your knees towards your chest, holding your feet before pulling your legs apart. Alternatively, childs pose involves spreading your knees wide and allowing your belly to rest on the floor. You can then rest your forehead on the floor as well. 

Be aware that the exercise used will depend on which muscles are causing you problems and which ones feel tighter than they should. 

Furthermore, we can also teach you abdominal massages. These are beneficial for relieving tension and pain that can be caused by constipation. If you are struggling with painful issues, it can be helpful to try kneading and stroking the abdomen in a pattern that remains consistent. This is a popular method that is commonly used during therapy sessions. 

Do you need more support? If so, please contact us today. Our professional support and expert treatment methods have helped numerous patients gain relief from issues with constipation and we’re confident we can help you too. 

If you have just given birth then you may have heard about postpartum sitz baths. If you haven’t and want to know more about them, then this is the guide for you.

A postpartum sitz bath is essentially a special bath which is used during the postpartum period to try and help you to ease pain while promoting healing. It also helps you to maintain a high standard of hygiene for the perineal area. This is very useful if you have had an episiotomy, or a tear during birth. The great thing about a postpartum sitz bath is that it can help you to drastically reduce any perineum swelling you have, and if you have a swollen labia, it’s great for that as well. If you feel too sensitive for a postpartum sitz bath, then there are other options out there that can provide you with some relief, so don’t be afraid to check them out. Remember that everyone is different and what works for one person might not work for another. Take a look below to find out more about postpartum sitz baths and if they could benefit you.

How Often Should I Take a Sitz Bath After Delivery?

If you have never had a child before then the recovery time may be a little longer. You may need to take a sitz bath or two every day for the first week. If you have had a child before then you may find that one bath every couple of days is enough to soothe you.

Does the Hospital Give You A Sitz Bath?

In the hospital, there’s a chance that you will be given a portable sitz bath. This essentially sits over the toilet. You will fill the container with warm or cold water and then sit on the bath. The water will flow over your sensitive perineum and this will help you to heal and cleanse yourself. You can easily add medication or even herbal preparations as well if you want. If you need some help with preparing your sitz bath then your birthing doctor should be able to talk you through everything you need to know, while also helping you to get the right temperature. If you aren’t sure how warm your bath should be, or if you are worried about being too sensitive to the bath then take a look below.

How warm should a sitz bath be?

While you have the option of using warm and cold water, you should know that cold water will provide you with more relief. Studies have shown that cryotherapy or using ice to relieve perineal pain is very effective. Cold water might be quite a shock and it probably doesn’t seem like the best way to obtain comfort, but when you look at injuries to the body, you will soon see that cold packs tend to be the way to go. Cold water can reduce swelling much more effectively when compared to warm water.

How does a sitz bath work?

A sitz bath is a form of therapy that is done by sitting in shallow water. It’s ideal if you want to soothe itching, pain or any other symptoms that you may experience after childbirth. It’s also ideal if you want to keep your areas clean, but you are unable to take a bath or a shower. It’s more than possible for you to use either warm or cold water when you use your sitz bath, and you would be surprised at how easy it is for you to gain a level of relief without much effort. Sitz baths are very soothing and they are very popular with those who have just given birth.

How long should I stay in a sitz bath?

If you want to use your sitz bath, then you will be glad to know that you can sit in it for as long or as little as you’d like. If you want to get the best results, then you will want to use it for at least half an hour. When you do, you’ll soon find that you can easily reap the benefits. Remember that you can take as many baths as you need per day. So many people try and have one per day but if this is overwhelming for you, then don’t worry about it. You can easily have one every few days if you want, as this will still give some of the benefits so keep that in mind.

Due to the current nature of our national and international health care crisis, our physical therapy profession and businesses have been designated as “essential healthcare” for our communities. Therefore we need to have way to stay connected to our patients so they continue to have the highest quality of life.   

As evidenced to me today, we still need to be in a relationship with each other, even as you “shelter in place”. We know your healthcare challenges did not go away just because of this crisis. 

As a result of your needs we have trained our highly talented group of physical therapists to provide “Telehealth” to our community of patients. Our Physical Therapists can assist you with education to address your medical concerns with your musculoskeletal system, we can teach you self care modalities — such as how to use specific techniques to help ease your pain. 

We have free resources online, and can deliver exercises such as stretching and strengthening to you via our free app.  

We have the ability to progress your physical therapy program by using a HIPPA compliant medical portal where we will be able to video chat with you in real time, so you can ask questions and get answers, all within the safety and comfort of your home. 

We understand that having health issues during this time is stressful and it is easy to feel alone and unheard. 

We want our patients to know that we are here for them so that their fear and stress can be decreased and they can continue to thrive for their themselves, their families and this community. 

We can help through Telehealth! 

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Use the form below to schedule an Telehealth appointment.

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Author Bio:

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff can help you with your telehealth physical therapy needs. Sheree has 35+ years of physical therapy experience — 30+ of those years spent in private practice. She owns and manages 4 clinics in the greater Spokane/CDA area. Schedule an appointment – https://lakecitypt.com/telehealth/

The Lymph system is a major system in our body that probably is the least understood and one of the systems that is barely talked about in health care today. However, really it is of vital importance on a daily basis for our health and overall well-being. The lymph systems primary function is to protect the body from infection and disease via the immune response system according to the National Lymphedema Network. It does this by the production, maintenance and distribution of lymphocytes. The lymphocytes are the “infection fighting cells.”

The spleen and thymus gland produce the lymphocytes. These cells then fight the unhealthy cells and they are transported by little watersheds and vessels to the bloodstream and ultimately flushed out of the body. The Lymph system could be called the body’s own “garbage disposal system,” it gets rid of all the junk.

The lymph system is made up of more than 700-800 lymph nodes throughout the body.

There are chains of nodes and then clusters of nodes in strategic areas. The clusters are located in a specific area to protect that area from invasion. For example, when you get a sore throat often you will often have enlarged lymph nodes on either side of your neck. These nodes collect and filter the waste, and regulate the protein levels, so we know we are “fighting off something” when they are enlarged.

The lymph system has lymph fluid that is clear and colorless. It is made up of protein, water, cellular debris and fatty acids. Now imagine the lymph vessels as a stream, which runs in one direction. They have a one-way value only and this pushes the lymph in that direction. All streams run back toward the heart. So the bloodstream needs to be able to handle the load each day of the lymph cleaning system. The lymph fluid can be mobilized by massage, compression; the “muscle pump” which is why exercising is so important, external pressure, breathing patterns, etc.

If the lymph fluid builds up in the tissue and is not flushed each day, as it should be it could harden the surrounding tissue. It also loves to bind to the fatty tissue and then it is especially hard to mobilize. The skin integrity is then compromised due to too much fluid and breakdown of the tissues can occur and then the efficiency of the muscle pump decreases. The lymph vessels will dilate and the one-way values cease to function and the area becomes swollen. This can happen anytime there is any accumulation of swelling, whether from an injury, a bruise, a localized tendonitis or post-surgically. You do not want fluid that is ever stagnant, because that is where infection can brew.

When the body is functioning efficiently the lymph system will activate itself no problem. However, if nodes have been damaged or destroyed as with radiation or surgical lines that interrupt the lymph streams flow pattern, then the lymph system cannot handle the load and will shut down. We see fluid get backed up behind C-sections scar lines, and even edema from a total joint.

If this happens to you do not be dismayed. There are things you can do to mobilize the flow of protein rich fluid. The first thing to do some very basic things like drinking more water, up to eight glasses a day. Decreasing your sodium intake to below 1,800mg a day (the average American consumes 3,500mmg a day). Stop smoking because this slows the lymph system down and decreases tissue healing.

Make sure you are sleeping at least eight hours a night to ensure the body’s healing mechanisms. Then increase your leafy greens veggies, fruits and decrease all processed foods to a minimum.

Next seek the assistance of your physical therapist, which has been specifically educated in the care of the lymph system. Remember, the lymph system can be trained how to move fluid around areas of scarring. We also teach the system how to transport edema around an area that there is restriction with four specific steps.

The four steps include specific muscle pump strategies, compression techniques or kinsiotex taping, manual lymph drainage massage and meticulous skin care. The therapists who are trained in edema reduction know and use these steps to assist the lymph system in re-booting itself whether it is from an orthopedic, cancer or immune system related problem. Please know your therapists can get your lymph system back on track.

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Sheree DiBiase is a licensed physical therapist and the owner of Lake City Orthopedic and Sports Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.

1) The initial lymphatics are endothelial vessels converging to form collecting lymphatics. The linings of the initial lymphatics have a high endothelial layer but no pericytes or smooth muscle media. They form a 3 dimensional plexus – like patterns within the connective tissue. The walls of these initial lymphatics have a one-way valve system. The valves prevent the reversal of the flow pattern. They are anchored by filaments to the connective tissues. The molecular structure of the vessels is similar to the anchoring filaments. The initial lymphatics collect interstitial fluid, proteins, lipids, colloids and cells. They feed into the contractile lymphatics, which has smooth muscle media. The unidirectional flow pattern happens here at this level. Since they have no smooth muscle media they depend on neighboring tissue structures for expansion and compression. This occurs by rhythmic deformation in 4 easy ways- skeletal muscle movements, arterial pulse and vasomotion, intestinal peristalsis and skin massage.

2) Collecting Lymphatics – The collectors have a sympathetic motor innervation. The values are bicuspid. The outer wall of the collectors is supplied by a rich network of blood vessels and myelinated nerve fibers. Collectors walls have 3 layers. Tunica intima, tunica media, tunica adventitia. In the tunica intima the endothelial cells have a cuboid/rhomboid shapes. There is a nuclear bulge in the lumen. In the cytoplasm there are vesicles, ribosomes and cytoplasmic filaments. Mitochondris Gogi app, centrioles and multivesicular bodies are in the cytocentrum. In the tunica media there are long smooth fusiform muscles cells that are essential to its function. Between the endothelium and the tunica media is an elastic membrane.

Open junctions are not present in the collectors. The adventitial layer has fibroblasts, collagen fibers and fiber bundles loosely arranged and parallel to the axis of the vessel. The outer wall of the collectors is supplied by a rich network of blood vessels and myelinated nerve fibers.

3) Lymphangions – In the collecting lympatics each vascular segment between 2 sets of valves represents the morphofunctional unit called a lymphangion. The contractions of smooth muscles of the lymphangion play a decisive role in lymph transport. It resembles small hearts.

4) Lymph nodes – They are peripheral and secondary lymph organs, along with the spleen, tonsils and lymphatic tissues of the mucous membranes. The nodes are present in groups or chains along the blood vessels. Their number size and form vary. The lymph node is encapsulated by an outer layer of collagen fibers. Blood vessels and efferent lymph vessels leave via the hilum. The internal framework is composed of trabeculae. Some trabeculae carry vessels from the capsule to the hilum. Between trabeculae there are reticular cells and reticular fibers. The space is filled with lymphatic tissue. The lymph traverses the nodes via the sinus system. The afferent collectors penetrate in the node through the capsule to peripheral sinus. Lymph runs from the peripheral sinus to the medullar sinus. At the hilum the medullar and peripheral sinuses combine to form a terminal sinus form the efferent lymph vessels originate.

Lymph node function: The lymph nodes are biological filtering stations. The phagocytic action of the macrophages cleanses the system of bacteria, cell debris, antigens and corpuscular elements. The lymph nodes produce lymphocytes. The lymph nodes regulate the protein content of the lymph, so that is the same as the intercellular fluid. The most significant changes in the lymph fluid occur there. They are like fluid exchange chambers where the protein concentration is established so there is equilibrium as Starlings law suggests.

Lymphatic pathways of UE-Lower arm to elbow – 4 primary-anterio-lateral and anterio-medial, posterio-lateral and posterior-medial.

4 secondary-bicepital, anterio-medial basilic, anterio-lateral cephalic and posterior triceptial Caplans pathway.

The cephalic pathway has 3 routes – to cephalic vein to nodes in axilla, across clavicle to C/S transverse nodes, to the clavicopecotoral group of the cephalic lymph nodes.

Lymphatic pathways of the LE – The superficial bundle: The ventromedial bundle – greater saphenous vein, the dorso-meidal bundle lesser saphenous vein.

The deep bundles: the anterior tibialis bundle, the posterior tibialis bundle.

(Lymph nodes of the LE. There are Superfical nodes there are upper and lower groups and Deep inguinal nodes that follow the femoral vein.)

Lymphedema is a collection of protein rich fluid caused by reduced transport capacity with insufficient tissue proteolytic activity in the face of a normal lymphatic load as defined by Foldi. It is an accumulation of water, proteins and in increase in cellular and ground matrix.

Unilateral Chronic Lymphedema clinical findings:

1) Pain is not constant

2) Positive stemmer sign

3) Fibrosis – development of fatty tissue

4) Papillomatosis

Lipedema: Edema that is caused by abnormal adipose deposits in the subcutaneous regions. It is usually bilateral in nature and affects mostly women. There is often a family history. There is no pitting signs, often associated with obesity and “orange peel ” at visual inspection and painful with pressure. Usually located between the pelvis and the ankle with sparing of the feet. Often it occurs 1-2 years after puberty.

Research for MLD-Leduc Method: The research method included using a Lymphoscintigraphy and a nanocolliod with TC 99 and a gamma camera to record activity. The call up maneuver enhanced the flow when applied proximally to the lymphedema. The reabsorption maneuver increased significantly the colloidial protein reabsorption. The call up maneuver will not enhance the flow if lymph nodes are in between the lymphatic site and the treated area. In 8/13 people a new pathway was established with MLD who underwent a min of 19 MLD RX’s. The study showed there is no contraindications in using MLD in people with heart failure or lower limb edema. It was shown that with the use of lymphoflouroscopy an increase in lymph flow was seen with the MLD and superficial mapping of the pathway could be seen as a result also. It is evident that MLD is a significant intervention for those with lymphedema and can be used alone as a source of treatment with good results.

Research for MCB-Leduc Method: They researched whether MCB with muscular contractions would effectively decrease lymphedema. They used a pressure transducer at the skin/bandage region to record the results and a hand held manometer to do the repeated contractions with. Then they were able to track the labeled colloids at the axilla and it was statistically significant. An increase in activity occurred at 6 min and 40 secs aft her the beginning of the exercise and this increased remained after the exercise was done. It was noted that when muscle contractions were done in the limb with the MCB in place an increase in colloid reabsorption and transport occurred. In those who only did a muscular contraction with no MCB in place no noted increase in transport occurred. It is recommended to limit the use of MCB with those suffering from lower limb lymphedema.

A study was also done on the types of bandages to use. The pressure was measured at he interface between the bandage and the limb. When the MLB was used the increase was significant at rhe interface and increased tension in the limb. In the elastic bandages it increased pressure at the interface and then plateaued.

Contraindications to MLB:

1) DLA, erysipelas

2) Cardiac condition

3) DVT

4) Arterial perfusions impairment

Contraindications to Pneumatic Pump:

1) DLA, erysipelas

2) Cardiac condition

3) DVT

4) Arterial perfusions impairment

Sheree DiBiase, PT, and her staff can be reached at (208) 667-1988 and they can help you with your physical health challenges. Never give up on your health. It’s your prized possession. Lake City Physical Therapy.

Lymphedema affects approximately two million people in the United States. Its incidence is on the rise because each year approximately 500,000 Americans will be treated for some type of cancer that will be treated for some removal or the destruction of their lymph nodes. One out of every five of those people will then develop lymphedema.

Lymphedema occurs when the normal drainage of fluid in our body is disrupted. As the fluid accumulates, the area will become red, hot, swollen and painful. Often the arm or leg will double in size. In a normal lymph system, the body utilizes a network of nodes and ducts. Those nodes and ducts maintain the balance of the body’s fluid, they filter our waste products and fight bacteria.

However, when lymph nodes have been removed or destroyed by radiation this lymphatic system loses its ability to maintain this delicate fluid balance. As a result, there is an accumulation of protein-rich fluid that becomes a breeding ground for bacteria. If this swelling in the tissue is left untreated, it can lead to permanent tissue damage, scarring and long-term disability.

Presently, it is seen most often in women who have had breast cancer surgery where lymph nodes have been removed and radiation therapy has been done. This swelling in their arms can occur weeks, months or even years later after surgery.

That is exactly what happened for Sarah Micheals. She had decided to take an airplane trip to New York City to visit her daughter. Five years earlier she had breast cancer surgery and had been doing just fine since then. However, the next morning after she woke up at her daughter’s home, something just didn’t seem right. She felt like she was getting the flu. Her body ached and her right arm had a strange red streak on it. Throughout the day the pain in her arm became worse and her arm started to swell. She got so swollen she could barely hold her coffee cup and she had to remove her rings. Finally her daughter took her to the ER, where it was discovered she was suffering from an infection in that arm resulting from lymphedema. She was given antibiotics, which cured the infection, however, the swelling in her arm remained. She then was referred to physical therapy for treatment of the swelling.

Physical therapy care for lymphedema consists of Manual Lymph Drainage Massage (MLDM), Medical Compressions Bandaging (MCB), special exercises that milk the lymph system and supplement the massage, skin care and treatment of any infections.

The physical therapy care will help decongest the swollen body part, eliminate fiber tissue and improve the immune system function. Once the body part has reduced in size a protective garment needs to be worn on that extremity to avoid re-accumulation of that lymph fluid. This protective garment helps to maintain the natural fluid balance of the affected body part.

If you are a cancer patient who has had any lymph nodes removed or radiated here are some guidelines you should follow in order to prevent this chronic, progressive disease.

• Wear a protective garment for flying of when doing any new actives you are not accustomed to.

• Wear gloves during household chores or gardening to avoid minor cuts, animal scratches, bug bites and puncture wounds. Use antibacterial ointment right away if you do get a wound and consult your physician immediately.

• Avoid injections and blood pressure monitoring on the body part.

• Exercise at a moderate pace and keep “muscle pump” active. (Swimming in 75 to 85 degree F water is one of the best forms of exercise due to the natural pressure gradient in the water).

• Avoid hot baths such as Jacuzzi tubs, whirlpools, heat from hair dryer and sun exposure.

• Avoid any deep tissue massage.

• Wear clothing that is not restrictive to allow appropriate lymph flow. Wear your rings and watch on other extremity.

• Eat a diet low in sodium and saturated fats. Discontinue use of alcohol and nicotine.

• Keep skin clean and well moisturized. Use electric razors only.

If you have further questions regarding Lymphedema or you are wondering whether you have this disease, you can go online to the National Lymphedema Network at www.lymphnet.org or call them at (800) 541-3259.

Sheree DiBiase, PT, is a licensed physical therapist and the owner of Lake City Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.