Electrostatic massage therapy; helping healthcare professionals improve care pathways for lymphoedema, lipoedema, lipo-lymphoedema sufferers
Introduction
Currently there is no cure for these distressing and often disabling conditions, and service provision for affected patients appears to be inconsistent. Current recommended treatment is aimed at decreasing swelling, pain and discomfort, using a combination of massage and compression garments known as Complex Decongestive Therapy (CDT), or Decongestive Lymphatic Therapy (DLT).
CDT comprises:
- manual lymphatic drainage (MLD); a massage technique to help drain lymph fluid away from the limb, undertaken by trained lymphoedema nurses/therapists
- simple Lymphatic Drainage (SLD); a massage technique taught to patients for maintenance - performed at home
- multilayer lymphoedema bandaging (MLLB) – bandages and compression garments to move fluid from the affected area. When no further reduction in volume is needed the patient is fitted with a custom made garment to wear every day
- remedial exercise designed to activate muscles to improve lymph drainage
- skin care advice to prevent infections such as cellulitis
- compression pump; sometimes used, but not suitable for all patients
- details of local and national lymphoedema support groups
Surgical options are available to certain patients when conservative approaches have not been successful.
DEEP OSCILLATION® electrostatic massage therapy to the care pathway…
Since its arrival in the UK in 2006 and the Republic of Ireland in 2009, DEEP OSCILLATION® electrostatic massage therapy has been warmly embraced by Lymphoedema Nurse Specialists, MLD practitioners and other healthcare professionals. Notwithstanding the significant lymph volume reductions that are being achieved, nurses also report that stubborn fibrosis is more easily and quickly broken down, even in cases where they have previously struggled to make any impact. As DEEP OSCILLATION® is gentle, pleasant and relaxing to apply, it has a very high level of patient acceptance (Figure 1).
Christine Wise, RGN recently gave the following quote:
“After 15 years of treating Lymphoedema patients, I am now seeing better results than I have ever seen. I sincerely feel that Deep Oscillation is a breakthrough in Lymphoedema treatment and is one that we have waited a very long time for”
Over 100 Lymphoedema therapists are using it, both in the private sector and the NHS. DEEP OSCILLATION® personal units can be programmed to enable patient self-management and/or community nurse management. Box 1 relates a patient’s story:
Box 1: Pauline’s Story
In the autumn of 2004 I had the shock of my life when I was informed following an angiogram that I needed heart bypass surgery. I had been a fitness instructor for almost 30 years and had only gone to see my GP with what I thought was a chest infection. His sharp diagnosis of a deeper problem took me through various tests before coming to this rather frightening realisation.
I had my surgery early in 2005 and it wasn't straightforward. Veins had been harvested from both my legs for grafts and had left long wounds which took time to heal and left significant scars. However, it was about a year later when I noticed that my right leg was looking larger than my left. I got a tape measure out, and sure enough there was a difference of 5". It was also aching slightly. I made an appointment to see my GP who shipped me off for tests; first for a blood clot and then for any other kind of blockage – both were negative. He then told me that he thought what I had was lymphoedema. I waited for him to suggest treatment and when I asked him what I could do he said 'nothing'. I refused to accept that there was 'nothing' I could do so I pushed him. He said the best he could do was prescribe me compression stockings which I would need to wear 24/7. This was not good news.
I sought advice elsewhere, and was fortunate enough to be living within driving distance of a therapist who specialised in helping people with lymphoedema. I went to see her, and after consultation she treated me - first with bandages and then with fortnightly massaging. It eased my aches considerably and kept me free of the dreaded tights.
After about a year of this my therapist acquired a new machine called a PhysioPod which worked through deep oscillation massage. The results were amazing; now I only needed to visit her once a month, which apart from anything else, was a considerable financial benefit!! I don't know how much time passed before I was told that the company who made the PhysioPod had brought out a personal machine, smaller in size but equal in effect to the larger one. It was pricey, so I needed to think about it. When I sat down with my husband to talk about it he immediately said this was a 'no brainer'. What was more important than my health and keeping me mobile... nothing.
So I ordered my machine, which came with a personalised data card specific to my needs. I had one 'training session" with my therapist, and now I was on my own. Any worries I had were completely unfounded; treating myself twice a week has kept me under control, ache free and totally mobile. I take my machine everywhere, even on holidays! It has been invaluable, many times when I have been in places where it has been hot and I have been standing or walking a lot; it has literally saved that holiday from being ruined.
My PhysioPod has become a treasured possession. If I were ever asked the question 'what one thing would you rescue if your home was on fire?' There’s no doubt in my mind it would be my machine! It also comes with a data card for treating other sports injuries and I have had occasion to use this a few times too. In particular, it's sorted out problems with Achilles tendonitis on several occasions.
I whole heatedly recommend this machine to anyone plagued with lymphoedema, it will change your life and prevent you from having to resort to those miserable compression stockings!
How does it work?
DEEP OSCILLATION® uses resonant vibration of the tissue with DEEP OSCILLATION® equipment (Physiomed, Germany). Electrostatic attraction and friction produces mechanical vibrations in treated tissues of the body, both at the skin on the surface and in deeper tissues. A vinyl film placed between the applicator, and the patient functions as a dielectric, resulting in a weakly conducting capacitate layer between the contact surfaces. The frequency can be varied in the range from 5-250 Hz. The therapist sets the pressure gradient, speed and direction of the movements.
The therapist and patient are connected to the DEEP OSCILLATION® unit. The therapist wears an electrode on the arm connected via a spiral lead to the unit, and the patient holds a small titanium bar. As the therapist massages in the normal manner, intermittent electrostatic impulses are delivered via the therapists vinyl gloved hands (or applicators) to the tissue, permeating a depth of 8cm though skin, sub-cutaneous fat, muscles, blood and lymph vessels (Figure 2). An electrostatic field is created in tissue layers as the tissue is mechanically attracted and gently released back to the hands or applicator up to 250 times a second. The therapist feels the vibration in their hands and the patient feels the same relaxing deep vibration in their tissue. No pressure is required to apply the therapy, vastly reducing any strain ordinarily placed on the body/hands of the therapist when massaging. The contents of the tissue, including protein solids are broken down and gently pumped to the lymphatic system for removal. Once out, they stay out for longer than with manual lymphatic drainage alone. The procedure is characterised by minimal external mechanical effects, which allows it to be used in cases of acute pain, fresh injuries and in treatment of wounds. It is commonly used for the treatment of lymphoedema [1] and clinical benefits include:
- reduction in inflammation, fibrosis, rubor and pain
- reabsorption of oedema
- trophicity (replenishment of nutriment) improvement
- limbs become softer and mobility is improved.
DEEP OSCILLATION® can also be used for amputations, burns and ulcers, showing an improvement of decongestion and blood supply and dynamic wound healing.
Contraindications are the same as with MLD, plus pregnancy and pacemaker implant. Since it received its first patent in 1988 there has not been any reported adverse side effects to therapist or patient.
Because of its ease of use, only minimal training is required, and this is included in the cost of the EVIDENT® or the HIVAMAT® 200 DEEP OSCILLATION® Personal Unit. It can be provided over the phone or via Skype.