THE IMPORTANCE OF PRESSOTHERAPY IN DIFFERENT AREAS OF MEDICINE
Lic. Sandra FariñaKinesiologist
Peripheral Vascular RehabilitatorCoordinator and Spokesperson of ALCVA (American Association of Vascular Surgery and Angiology)
Teacher in the specialty: Vascular and Cardio-pulmonary (Universidad Simon Bolivar - Colombia)Director of the unit of Peripheral Vascular Rehabilitation in the Instituto Vascular Internacional (Bolivia),
Instituto Terra (Argentina) Instituto Oxígeno (Colombia)
What is peripheral vascular rehabilitation?
The PVR is based on a series of methods and therapeutic maneuvers to improve venous, arterial and lymphatic return, through different techniques we seek to improve the life quality of patients by reducing the signs and symptoms of these diseases as well as the own risks of complications such as infections, ulcers, amputations, etc.
Tools of the PVR
Manual lymphatic drainageIntermittent sequential pressure therapyMultilayer bandageGraded elastocompressionMiolinfokinetic excersicesPrevention GuidelinesSkin care and appendagesTape neuromuscularSpecial software
Stages of treatment
First StagePhase A
Manual lymphatic drainage (MLD)
Sequential pressotherapy
Specific exercises
Phase B
Manual lymphatic drainage (MLD)
Specific exercises
Sequential pressotherapy
Bandages (whichever required by each part)
Frequency of treatment: 5 sessions per week
Second Stage
Stabilization or maintenance
Manual lymphatic drainage (MLD)
Specific exercises
Pressotherapy
Containment: medium or sleeve
replacement of dressing used
Frequency: progressive reduction of the
quantity of sessions per week
Sequential Pressotherapy
The limb to be treated is introduced in an inflatable sleeve, it
produces an external force on the extremity when the sleeve
is filled with compressed air, regulated by the control unit,
through a hose system. Each sleeve
is composed of a number of separate
air chambers that inflate each other
in a predefined cycle according to
the patient’s needs.
Lymphastim is the closest to copying and giving
effectiveness to the Vodder technique. In this
type of preassure-therapies, the cameras are
arranged in the direction of the lymphatic
system, they will slowly insufflate in pants, legs
and arms in a gradual and progressive manner,
based on the Vodder
drainage technique.
Sequential Pressotherapy
Maximum number of chambers, allowing greater accuracy in treatment
22 chambers’ pants
10 chambers’ legs
8 chambers’ arms
Benefits of Sequential Pressotherapy
• The effectiveness of pressotherapy is based on producing tissue relaxation and the
opening of initial lymphatic vessels due to the progressive decrease in pressure.
• Facilitates the evacuation of the water component of edema by generating a negative
pressure that sucks the interstitial fluid.
• Stimulates the secretion of parietal fibrinolytic substances, increasing the activity of
the plasminogen in the blood (Plasminogen is the central component of the fibrinolytic
system in the body), which reduces the risk of thrombosis.
• Mainly removes water causing a gradual concentration of protein edema.
• Promotes and increases venous return, which explains the decrease in the volume of
the limb being treated, after the session of kinesiology.
Possible side effects of Sequential Pressotherapy due to misuse
Temporary increase in painPetechiaeCapillary rupture - if the pressure exceeds the level recommendedHaematomaVegetative reaction - in patients with sensibly vegetative systemLymphatic Congestion - in not treated areas
The PVR in traumatology and sports medicine
When an injury occurs the most common is an immediate response by a swelling (edema).Inflammation is a complex reaction of vascularized connective tissue from harmful stimuli.
A circle is produced
Edema by trauma pathology
Muscular atrophy
Muscular atrophy
Pain from increasing pressure in the tissue
More pain
Benefits of Lymphatic drainage through Presotherapy in traumatologic injuries
Decrease the content of extravasated fluids
(decreases tumor)
Decrease tissue tension
Facilitating the removal of bacteria, necrotic tissue,
degradation residues of RBC
Facilitate cellular nutrition
Decrease pain
Balancing intra and extravascular
pressures
Bring closer the edges of the wound
(speed healing)
Reabsorb low molecular weight plasma proteins
Allow early mobilization, having less fluid
in the joints
Considering the psychological aspect, the fact of feeling less pain, of having less swelling in the injured area and the possibility of making movements in a precocious way, stimulates the patient to a more rapid improvement and better convalescence.
Management of Edema in athletes from PVR
The treatment goals are:• Immediate control of the inflammatory reaction
• Decrease the pain
• Decrese the edema
• Reduce muscle spasm
If we meet the stated goals, timing of
rehabilitation will be significantly reduced
and the occurrence of unintended
consequences will be avoided, such as
the residual inflammation.
Pressotherapy in sports practice
Due to intense physical activity, muscles increase their volume to the point of reaching
inflammation. This inflammation can block or interrupt the smooth flow of lymph.
Besides muscle soreness, fatigue symptoms appear.
That’s when with a session of just 30 minutes of pressotherapy we can accomplish
restoring lymph and blood circulation, reduce inflammation and eliminate fatigue.
The recovery of muscles and tissue is noted immediately, the athlete is safe and well.
Similarly, all people who regularly practice some intense sport, should also recover the
muscles with the help of pressotherapy.
When the body is subjected to high energy expenditure induced by physical training
with heavy loads, it is essential to get the muscular system to obtain rapid
rehabilitation, so that once recovered, it can again be stimulated and generate a
new adaptation process in order to gain greater training load. By placing an athlete
in pressotherapy after training or competition, we can achieve a quicker recovery
and thereby accelerate the processes of adaptation and with it an improvement in
physical capacity.
Pressotherapy in sports
The swelling of the chambers produces a sedative effect, relaxing, derived from the
rhythmic and synchronized massage while providing an anti-inflammatory effect.
Pressotherapy promotes lymphatic and venous circulation, a satisfactory drainage and
filtering toxic substances act revitalizing the area treated, significantly diminishes the
recovery time after sports body burden and be able to undergo re-training in a shorter
period of time.
The effect of pressotherapy helps us to make work sessions more continuous and
demanding of a shorter period of adaptation to the effort made, it is understandable
that this will impact very positively on the success of sports performances.
We must remember that in order for the massaging sensation to be effective, it must be always pleasant. not in a single case more is better, thus we wish to emphasize that increasing the air pressure when it produces unpleasant sensations is harmful.
Therefore
When using PRESSOTHERAPY we produce a mechanical stimulus aimed at accelerating the reabsorption of toxins that accumulate in the muscle and in the interstitial space, improving circulation, promoting the diffusion of lactic acid into the lymph collectors and from them to the lymphatics (authentic ducts washout), resulting in getting more rest and avoiding injury.
It is applied pressotherapy for 7 days to the patient, half an hour per session accompanied by massage therapy, ultrasound and magnetic therapy. In the first session, it is managed to decrease the edema and increased joint range previously presented the patient, breaking adhesions proper of immobilization.
Skater, sprinter of the Atlantic, suffers a fall leading to breaking multiple tables with his leg, which produces multiple trauma. It can be seen: edema, broken capillaries, bruising, pain and functional limitation.
Sequential pressotherapyComprehensive elastic bandages Multilayer bandages with exercises TENS Neuromuscular taping Magnetotherapy Ultrasound Rehabilitation of walking
Marco in Peripheral Vascular Rehabilitation
Guillermo Celis
He is a player that performs as defensive midfielder in the team Atlético Junior de Barranquilla, in the Colombian first division: it is a great pleasure to be able to help him improve his physical performance from kinesiology as a Peripheral Vascular Rehabilitator and devoted to sports, serving both fields.Thank you very much, Guillermo, for trusting in my team.
José Luis Chunga
José Luis Chunga, goalkeeper of the Atlético Junior of Barranquilla, Colombia. As a kinesiologist, it is a pleasure to be able to care for the physical performance, by means of the Peripheral Vascular Rehabilitation, of an excellent football goalkeeper, great person with a great heart, of one of the most important clubs in Colombia, the “Atlético Junior de Barranquilla”. We are working in the injury prevention area, which tends to transform in the enormous ghost of most of professional players and also work on their agility, flexibility and joint mobility.
Cases
The goalkeeper of a professional football club playing in the national tournament B of Argentina, suffered a subluxation of the ring finger of his left hand. The edema prevents him to wear a glove, even without bandages. He was treated with manual lymphatic drainage, pressotherapy and adhesive bands for three sessions. Neuromuscular taping was performed, managing to place the glove and play regularly.Lymphatic drainage in addition to facilitating the evacuation of extravasated fluid promotes the elimination of waste products,such as degraded red blood cells that form the hematoma.In skater children, I have observed the impact velocity of the drainage on their recovery. In the case of Esteban Duarte, skater of the Atlantic, after recovering with this method, he accomplished, after a few days, several medals at the National Championship in the children’s category of 9-11 years.
Esteban Duarte Rubio
The young barranquillero skater, Esteban Duarte Rubio, is a diamond in the Rough for this sport: shinning with his own light he follows the steps of the triple world champion, Alex Cujavante.
Written by Francisco Figueroa Turcios
Definition
The diabetic foot is a result of chronic complications of diabetes and at the same time it is an acute complication that requires immediate treatment and for which there are existing prevention measures of great importance.
Peripheral vascular disease in diabetic patients
Diabetes also damages the blood vessels, reducing blood flow to the feet. Poor circulation weakens the bone and can cause disintegration of the bones and joints in the foot and ankle. As a result, people with diabetes are at increased risk of bone fractures of the foot.
Chronic Limb Ischemia
It appears as a result of the slow and progressive decrease in blood flow, and therefore oxygen supply to the muscle groups of the lower limbs during exercise.
Intermittent Claudication
Peripheral Neuropathy
Peripheral nerves carry information to and from the brain. They also carry signals to and from the spinal cord to the body. Peripheral Neuropathy means that nerves do not function properly. This neuropathy may damage a single nerve or a nerve group. It can also affect the nerves throughout the body.
Treatment
Don't forget that good control of the disease with non-pharmacological measures (proper diet, exercise, peripheral vascular rehabilitation) and drug therapy (oral hypoglycemic agents, insulin) can prevent many of the serious complications that occur in these patients.
Fisiokinesic treatment
Objectives
Increasing transport capacity of the lymphatic and venous
vascular system
Decrease the volume of the affected limb
Prevent the patient’s progress toward a elephantiasis
Rehabilitate muscle pump
Improve joint mobility
Correct posture of the patient
Reduce pain
Physiotherapy
The agents most used in the treatment of diseases of the circulatory system.
Sequential pressotherapyMagneto therapyLaserUltrasound
Sequential Pressotherapy
The Lymphastim works on the principle of intermittent pneumatic compression, using a pressure wave progresses to facilitate lymphatic drainage. Stimulates the activity of the lymphatic channels, increases the flow of lymph hot-spots, improving blood flow and accelerates the exchange of body fluids.
Lymphatic system
The lymphatic system is in charge of draining the plasma of the processes of cellular exchange. In the same manner, this system works as a true filter for catching bacteria’s and residues from the organism.
Maximum number of chambers, allowing a more accurate treatment. Through these pressure waves, the circulatory system is stimulated.
22 chambers pants
10 chamber legs
With the use of Pressotherapy in diabetic patients we accomplish:
Improve circulationReduce edemaImprove mobilityImprove flexion and extension (twin pump)Improve gaitReduce infection risksImproved healing (in the case of ulcer)Improve the trophism of the skin
Contraindicaciones
Malignant tumors
Skin conditions
Acute bronchial asthma and asthmatic bronchitis
Phlebitis, thrombosis, thrombophlebitis
Decompensated heart failure
Hypotension
Acute infections
Therefore, diabetic patients
If not properly controlled, high blood glucose level, typical of diabetes, can cause progressive damage to the nerves and blood vessels of the lower limbs which can lead to severe health complications, such as diabetic foot.
Surgery and Sequential Pressotherapy
Any surgical intervention, due to the trauma it causes (ruptured blood and lymph vessels, cell injury, etc.), produces a local inflammatory reaction with swelling and edema in many of the affected and surrounding tissues.The application of Lymphatic Drainage before and after surgery, helps always get better results than if we let the body to respond alone to the surgical aggression.
Benefits of pre-surgical application of Pressotherapy
When we activate the lymphatic circulation in the area to be operated, the positive
impact of the intervention is higher, results especially useful in patients with previous
alteration of your lymphatic circulation.
By acting the LD on regional lymph nodes in the area where the surgery will be
performed, the conditions of repair and response to surgical aggression improve.
It is important for a better surgical procedure that the interstitial medium and the
fundamental substance of connective tissue are not waste loaded.
If the area where the surgery will be performed presents edema, lymphatic drainage
can reduce it and it is possible to anticipate surgery.
Stimulates the immune system.
Drainage benefits in Traumatic Inflammatory Joint diseases
Considering the psychological aspect, the fact of feeling less pain, of having less swelling in the injured area and the possibility of making movements in a precocious way, stimulates
the patient to a more rapid improvement and better convalescence.
Decrease the content of extravasated fluids
(decreases tumor)
Decrease tissue tension
Facilitate the removal of bacteria, necrotic tissue,
degradation residues of RBC
Facilitate cellular nutrition
Decrease pain
Balancing intra and extravascular pressures
Brings together the edges of the wound
(speed healing)
Reabsorb high molecular weight plasma proteins
Allow early mobility, by having less fluid
in the joints
Goals of postsurgical drainage
Goals
Reduce edemas
Decrease pain
Decrease fibrosis
Ameliorate ecchymosis
Ameliorate ecchymosis
Obtain good wound
healing
Reduce retractions
Improve mobility
Undermine alterations in the
sensitivity
Eliminate toxins
Decrease edema: main goal
Manual Lymphatic Drainage and Pressotherapy are indicated from the start. Its effectiveness percentage is above 80%.
Evacuation
Reabsorption
Return
The Peripheral Vascular Rehabilitation is important after a surgical procedure. When producing an incision in the tissue, damage is done to the lymphatic system, there is rupture of blood vessels, etc. An accumulation of fluid in the interstitial space is produced, which delays the recovery of the patient and can present some complications such as thrombosis, adhesions, etc.In a patient being able to move is very important to reestablish the circulatory pumps in charge of returning the blood to the heart; with PVR, we help to significantly shorten rehabilitation time.
The PVR in peripheral vascular diseases
Lymphedema Elephantiasis Lymphedema mmss
EdemaLymphedemaLymphedemaUlcers
Kinesiology in patients with vascular diseases
Goals:
• Activate venous and lymphatic return• Reduce edema• Prevent/correct ankyloses or unnormal articular position capable of obstructing the venous return• Help closing the ulcer as second intention through desbrindantes maneuvers and approximation of the borders
Chronic Venous Insufficiency
Valves in normal veins
This healthy valve prevents the
return of the flow
There is a return of the flow due to a damaged valve
Blood flows to the heart
Blood flows to the heart
Valves in varicose veins
Varicose Veins
Permanent dilations of the veins associated with elongation, functional or organic avalvulación and irreversible damage to the parietal endothelium.
Morphology:
• Telangiectasia• Reticular Varicose Veins• Truncal Varicose Veins
Edemas
In a flooded area,
communications are
hindered, resulting in an
adverse swamping to the
health of the person.
Accumulation of fluid in the interstitial space
Lymphedema
It is a protein rich edema It can be: Primary (hereditary)It’s divided in 3:• Congenital lymphedema• Early Lymphedema: before the age of 35• Late Lymphedema occurs after the age of 35 SecondaryIt’s divided in:• Benign: acquired• Malignant: tumor
A patient after traveling from Canada to Colombia presents an acute lymphedema. After three therapies a great improvement in signs and symptoms was shown – The patient had to return to Canada so two therapies were done on the same day and the other on the day.
It was recommended compression stockings, lymphokinetic exercises and following therapy when arriving the country of residence.
Ulcers
Consists in the loss of substance, chronic, of extension and variable depth, located preferentially in the distal third of the leg.
Mixed ulcers (arterial and venous)
Vascular Ulcers (most frequent)
Arterial ulcers
Complications of Peripheral Vascular Pathologies due to negligence, carelessness
and/or misinformation
• Fungal infections of the skin• Erysipelas (staphylococcus and streptococcus bacteria)• Papillomatosis: warts and skin protrusions• Elephantiasis• Thrombosis• Cellulite
Inguinal-iliac lymphadenectomy
Part of the treatment in oncology patients (retroperitoneal cancer, ovary, endometrium, prostate, etc.) This lymphatic decompensatio produces lower limb lymphedema occurs in a large percentage.
After the various treatments to which are subject oncology patients, they suffer some sequels, product of the lack of full or partial lymph nodes in different lymphatic node stations where the filtering of surpluses in the organism occurs. When a blockage of the lymphatic system occurs, blocking proper evacuation of lymph, it begins to produce what is known as Secondary Lymphedema.
Previously, the use of Pressotherapy in oncology patients was discouraged because the sleeves had a single chamber that when insufflated performed a tissue pressure around the affected limb, creating dangerous areas of hydric pressure and tissues with little possibility of draining of liquids proximally.
However
When increasing the number of chambers and while making a more fragmented sequential pressure, a gradient of more fragmented sequential pressure is created, it is subsequently also created a gradient of tissue and water pressure similar to “tile roof”, with partial overlapping of the chambers- one above the other- which avoiding coetaneous pressure.
What are we looking for in the treatment of the oncologic patient?
• Decrease the volume of the affected limb• Improving quality of life• Reduce risk of complications• Improve joint range• Improve the psychological state of the patient• Improve skin trophism
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