MLD & CRPS

CRPS-I? CRPS-II? RSD? Sudeck's Dystrophy?

No idea what I'm talking about?

These are all current and previous names for a condition now recognised as Chronic Regional Pain Syndrome. A distressing and elusive neurological disorder which causes skin changes, vascular malfunctions and repeated or constant bouts of unprovoked pain and inflammation.

Women in their middle years who suffer wrist fractures are particularly vulnerable to developing CRPS, but any surgery or traumatic injury can cause the persistent neurological alterations responsible for the many symptoms of CRPS. People report pain, swelling, changes in skin colour, abnormal sweating, hair and nail growth, and in the most severe cases bone and muscle wasting (CRPS-II).

CRPS is a secondary disease which can continue to progress long after the original injury has healed. It is caused when C-fibres carrying pain messages from the initial injury interact with sympathetic reflexes in the spinal cord. A lesion develops in which inappropriate sharing and amplification of neural impulses occurs affecting both ascending pain messages and descending motor messages.

Pain messages are received by the brain even though no painful event has occurred. Inappropriate sympathetic messaging to the blood and lymph vessels results in swelling or vascular congestion and one of my clients described this symptom as her 'blue gloves'. Interaction between C-fibres and immune functions initiate inflammation with redness and heat also among common symptoms, even though no infection or injury is present.

How can MLD help?

Its easy to think about MLD as only affecting lymph vessels and fluid balance in the tissues, but it's also the treatment of choice for most chronic pain syndromes. MLD has a profound influence on the sympathetic nervous system and reducing overall sympathetic tonus can help with some of the vascular and lymphatic symptoms. For my client with the 'blue gloves', I used Applied MLD for her neck, upper thorax and shoulders. This reduced both swelling and blueness even though I didn't work directly on her lower arms. Early and frequent MLD may prevent the newly forming lesion from developing, and in more progressed disease MLD will be effective in this kind of symptomatic relief.

Spinal injection of beta-blockers has been shown to offer relief, and although people often ask about cutting the nerves and even amputation, surgical interventions are more likely to worsen the condition rather than relieve it. A 2009 study on MLD to manage CRPS-related oedema (1) noted that volume reduction when MLD was used was significant immediately after treatment but did not last over time without follow up. The authors are clinicians of Physical Medicine and Rehabilitation at a Turkish Military Medical Academy, who note that patients experiencing allodynia and hyperalgesia cannot tolerate application of conventional massage techniques, but that the gentle circulate movements characteristic of Dr Vodder's MLD are well received. But in CRPS (aka reflex sympathetic dystrophy) even gentle touch can cause a temporal summation effect and increase pain messages. Duman and colleagues (1) explain why the application of MLD does not trigger increased pain messages....

Read the NIH CRPS Fact Sheet for patients and caregivers

Read the #TalkingLymph post on MLD for stress and pain

Read about training in Dr Vodder's Applied MLD

References

1. Duman I, Ozdemir A, Tan AK, Dincer K. The efficacy of manual lymphatic drainage therapy in the management of limb edema secondary to reflex sympathetic dystrophy. Rheumatology international. 2009;29(7):759.

ABSTRACT

The objective of this study is to investigate the efficacy of manual lymphatic drainage (MLD) therapy in edema secondary to the reflex sympathetic dystrophy (RSD).

A total of 34 patients were allocated randomly into two groups. All of the patients undertook nonsteroidal anti-inflammatory drug, physical therapy and therapeutic exercise program for 3 weeks. Patients in study group undertook MLD therapy additionally. Then the patients continued 2-month maintenance period with recommended home programs. Volumetric measurements pain scores and functional measurements were assessed at baseline, after treatment and 2 months after the treatment.

After treatment, improvement in edema was statistically significant in the study group but not in the control group. At follow-up, with respect to baseline, improvements were not significant in both of the groups. Between the groups, difference of the percentage improvements in edema was statistically significant with superiority of MLD group after treatment, but not significant at follow-up. In this pilot study, MLD therapy was found to be beneficial in the management of edema resulted from RSD. Although the long-term results showed tendency towards improvement, the difference was not significant.