COMFORT MASSAGE for CLIENTS with a COMPROMISED … Massage for Clients with a Compromised Lymphatic...

Comfort Massage for Clients with a Compromised Lymphatic System, page 1 of 6

COMFORT MASSAGE for CLIENTS with aCOMPROMISED LYMPHATIC SYSTEM

Treatment Protocol

In this section:

Working with a client with a compromised upper extremity

Working with a client with a compromised lower extremity

Working with a client with compromised head & neck region

GUIDELINES and CONTRAINDICATIONS are the same

regardless of the compromised quadrant or region.

GUIDELINES

Indications: Client currently in treatment or post treatment for cancer with lymph

node involvement, removal or radiated nodes.

Pressure: Touch Level 2 slowly increasing to Touch Level 3.

Touch Guidelines:

The 4 L’s:

•Last – massage the affected quadrant last

•Less time – massage the effected quadrant for less time than the rest

of the body

•Lateral to Medial – massage from lateral to medial

•Light – always use Touch Level 2 on the affected quadrant

Always work towards working nodes.

Work extremities proximal to distal.

Watershed boundaries define quadrants.

Remember: Using a Touch Level 2 affects the circulatory system, not the

lymphatic system. Be careful that you do not go too light.

Client Self Care: Follow up with client asking open-ended questions “how is your energy level?” “How was your

sleep?”. Refer client to Manual Lymph Drainage Therapist or Complete Decongestive Therapist.

CONTRAINDICATIONS

Do NOT use deep tissue in the affected quadrant ever.

Do NOT point figures or direct strokes toward lymph nodes (axilla, inguinal, neck), especially in compromised quadrant.

It is NOT recommended to provide a comfort massage to a client for 90 minutes while the client is undergoing

treatment for cancer.

Do NOT go beyond Touch Level 3 while in treatment or within one year of treatment.

Do NOT avoid touch altogether in the affected area—this leaves your client feeling rejected and disconnected to their

body.

Do NOT massage a client in active treatment for lymphedema unless you are trained in Manual Lymph Drainage or

Complete Decongestive Therapy or have instructions from the client’s MLD/CDT therapist.

© WellnessforCancer. This material is for informational purposes only and may not be relied on as a substitute for actual professional medical advice, care or treatment. Such information is not intended for diagnosing or treating any health condition and is not a substitute for professional medical evaluation, diagnosis or treatment. Wellness for Cancer does not make any medical claims and cannot guarantee any results or outcomes. Wellness providers are independent practitioners in private practice and are neither employees nor agents of Wellness for Cancer. Wellness for Cancer accepts no liability for injury or damage resulting from your decision to use any service, information, or instruction found or referenced in these materials.

COMFORT MASSAGEfor CLIENT AT RISK for LYMPHEDEMA

Treatment ProtocolCompromised Head & Neck Region

50—60 minutes

PRONE

1. If your client request scalp massage, use Touch Level 2 working from the crown of the head towards the shoulders. Finish your stroke at or below the scapula. (1 minute)

2. Use effleurage to apply lotion or oil on the back using slow long sweeping strokes. Move from the top of the shoulders all the way to the low back. Include the arms in these sweeping effleurage stokes. Finish all strokes at or below the scapula. (5 minute)

3. Using petrissage, continue to massage the back. (4 minute)

4. Finish with effleurage strokes to the back, include the arms. (1 minute)

5. Massage the client’s gluteus muscles with long slow strokes from the upper thigh to the low back to transition to the posterior leg. Or light compression over drape to massage the gluteus muscles. (1 minute)

6. Massage the posterior leg using effleurage to apply lotion or oil to the entire leg. Use long sweeping SLOW stokes to cover the entire leg. Petrissage muscles of the calf (2 minutes) and hamstrings (3 minutes). Repeat on the opposite leg. (10 minutes total)

7. Gently squeeze the feet.

SUPINE

1. Begin on the right or left anterior leg using effleurage apply lotion or oil to the entire leg. Gently petrissage the calf and foot (2 minutes). Massage up the leg to the anterior quadriceps and IT band (3 minutes). Repeat on the opposite leg. (10 minutes total)

2. Massage the arm, by applying lotion or oil to the entire arm using effleurage. Work the shoulders, biceps, forearms and hands. Move to the opposite arm. (10 minutes total)

3. Massage the muscles of the neck and upper shoulders, including the trapezius, levator scapulae and all of muscles in the neck. Finish all strokes below the clavicle. Provide security under the neck by maintaining contact with the client as the head is gently moved. (5 minutes)

4. Finish with gentle massage to both feet and hold Bubbling Springs (Solar Plexus). (3 minutes)

XX

XX

XX

XX




Treatment ProtocolCompromised Upper Extremity

50—60 minutes


SUPINE

1. Massage the neck and shoulders using Touch Level 2. End the stroke above the clavicle. Use effleurage and gentle kneading on the neck and shoulders. Cat walk the shoulders. (5 minutes)

2. Begin with the UNAFFECTED arm. Divide the arm into thirds. Begin with the proximal (upper) third of the arm. Work all strokes towards the outside of the arm and towards the shoulder. (1-2 minutes)

3. Massage the second third. Working the strokes towards the shoulder. (1-2 minutes)

4. Continuing to the distal third working from the fingers towards the upper arm and shoulder. Do NOT pull on fingers or massage towards the fingertips. (1-2 minutes)

5. Move to the AFFECTED arm. Dividing the arm into thirds, begin with the proximal third, effleurage strokes towards the outer arm and towards the shoulder. (1 minute)

6. Massage the middle third, keeping the direction of the strokes towards the shoulder. (1 minute)

7. Move to the distal third, working the fingers, hands and lower arm in an upward direction towards the outer arm and up to the shoulder. (1 minutes)

8. Proceed to the legs. Dividing each leg into thirds and begin massage with the proximal third (quadriceps) using effleurage and gentle petrissage work towards the hip.

9. Massage the middle third, using the same techniques always moving up the leg towards the outer hip.

10. Finish with the distal third (toes, foot, ankle and calf) effleurage and petrissage from the toes upwards towards the hips. Repeat on the opposite leg. (10 minutes total)

X2

4

5

6

7

3

X

2

4

5

6

7

3

X X

88

9 9

1010



Treatment ProtocolCompromised Upper Extremity (con’t.)

50—60 minutes

PRONE

1. Use effleurage to apply lotion or oil using long strokes down the back and up the arms and down the back. Release each stroke at the low back. (3 minutes)

2. Bring hands together at the spine from lateral to medial. Begin strokes at the upper back and continue working down the back, release each stroke at the spine as the hands come together. (3 minutes)

3. Use gentle “c” stokes from lateral to medial towards the spine, working from the upper back towards the low back. (3 minutes)

4. Finish the torso with long effleurage strokes down the back, up the arms, and down the back, releasing your touch at the low back. (1 minutes)

5. Begin with the UNAFFECTED arm, divided into thirds. Massage the proximal third of the arm. Work all strokes towards the outside of the arm and towards the shoulder. (1-2 minutes)

6. Massage the second third. Working strokes towards the shoulder. (1-2 minutes)

7. Massage the distal third from the fingers towards the upper arm and shoulder. Do NOT pull on fingers or massage towards the fingertips. (1-2 minutes)

8. Move to the AFFECTED arm. Dividing the arm into thirds, begin with the proximal third, effleurage strokes towards the outer arm and towards the shoulder. (1 minute)

9. Massage the middle third, keeping the direction of the strokes towards the shoulder.(1 minute)

10. Move to the distal third, working the fingers, hands and lower arm in an upward direction towards the outer arm and up to the shoulder. (1 minutes)

PRONE (legs)

11. Proceed to the legs. Dividing each leg into thirds and begin massage with the proximal third (hamstrings) using effleurage and gentle petrissage work towards the hip.

12. Massage the middle third, using the same techniques always moving up the leg towards the outer hip.

13. Finish with the distal third (toes, foot, ankle and shin) effleurage and petrissage from the toes upwards towards the hips. Repeat on the opposite leg. (10 minutes total)

X

X

X

5

6

7 10

9

8

X

X





Treatment ProtocolCompromised Lower Extremity

50—60 minutes

PRONE

1. Effleurage to apply lotion or oil from the low back towards the scapula and shoulder region — towards the working nodes. Using petrissage, gentle kneading and effleurage, continue to massage the back in an upwards direction from the low back to the scapula and shoulder region.

2. Include the arms in the back massage, working the arms with gentle effleurage. Sweeping strokes down the arms and up the back, releasing touch at the shoulder region. (15 minutes)

3. Massage the proximal third of the UNAFFECTED lower extremity, using effleurage and gentle petrissage working the hamstrings from the inner thigh towards the outer thigh up towards the hips.

4. Massage the middle third using the same techniques always moving up the leg towards the hips.

5. Finish with the distal third, using both effleurage and petrissage massage from the toes, foot, ankle and calves upwards towards the hips. (5 minutes)

6. Massage the AFFECTED lower extremity beginning with the proximal third. Effleurage and gentle petrissage hamstrings from the inner thigh towards the outer thigh up towards the hips.


8. Finish with the distal third, using both effleurage and petrissage moving from the toes, foot, ankle and calves upwards towards the hips. Use long strokes from the feet to the hip and gently kneading. (5 minutes)

X X

7

8

6

4

5

3

X

7

8

6

4

5

3

X



SUPINE

1. Massage neck and shoulders. Strokes can pass over the clavicle. Massage the chest from the mid-line outwards towards the axilla. Use effleurage and gentle kneading on neck and shoulders. Cat walk the shoulders. (5 minutes)

2. Divide the arm into thirds. Begin with the proximal third of the arm. Work all strokes towards the outside of the arm and towards the shoulder.

3. Massage the second third. Working the strokes towards the shoulder.

4. Continuing to the last third working from the fingers towards the upper arm and shoulder. Repeat on the opposite arm. (10 minutes total)

5. Begin with the UNAFFECTED leg, dividing it into thirds. Massage the proximal third of the leg, using effleurage and gentle petrissage working the quadriceps from the inner thigh towards the outer thigh up towards the hips.


7. Effleurage and petrissage the distal third from the toes, foot and ankle upwards towards the hips. Long strokes from the feet to the hip and gently kneading. (5 minutes)

8. Massage the AFFECTED proximal lower extremity using effleurage and gentle petrissage of the quadriceps from the inner to outer thigh up towards the hips.

9. Massage the middle third using the same techniques towards the hips.

10. Finish massage to the distal third, moving from the toes, foot and ankle upwards towards the hips. Long strokes from the feet to the hip and gently kneading. (5 minutes)

X X

2

3

4 4

3

2

6

7

5

9

10

8

X X

6

7

5

9

10

8


Treatment ProtocolCompromised Lower Extremity (con’t.)

50—60 minutes


COMFORT MASSAGE for CLIENTS with a COMPROMISED … Massage for Clients with a Compromised Lymphatic...

Documents

Transcript of COMFORT MASSAGE for CLIENTS with a COMPROMISED … Massage for Clients with a Compromised Lymphatic...