Duration: 18:34
I'm Sarah. I have Eva with me. She has lymphedema in her left arm, and I'm showing her how to do the self manual lymph drainage. This is the gentle massage technique to help reroute the fluid, and make new pathways for the fluid and stimulate the lymphatic system to help drain the fluid from your arm. We always work what is called proximal to distal; that is, we clear closest to the heart, and gradually work away from the heart because that's where we're taking the lymphatic fluid. So we always start at the neck, because right below the neck is the last place the fluid drains back to the heart. So to find the spot in your neck, it's about halfway up between your collarbone and the top of your shoulder. You can either cross your hands, or keep your hands apart; I'll demonstrate that.
We are going to use these two fingers. Another way to help find the hollow in your neck is to bring your shoulders forward, and you can feel the little spot right here. That is where you want to go. Just relax your shoulders. It's right here. What I'm going to be doing is I'm going to stretch the skin down to the collarbone, into the neck, and then release. You want to do this very slowly. You want to spend about two seconds... down, in, and then just let the skin bounce back in place.
We want to do all these motions 15 times. So again, you can either keep your hands in this position, or if it's easier for you, you can cross your hands. And if it's easier for you, you can always just do one at a time. So we're going down towards the collarbone, into the neck. Let me show you again. So it's down to the collarbone, into the neck, and then release; you do that 15 times. And try it with your hands crossed and see if that's easier for you.
We want to go down to the collarbone and into the neck. So it's in this position. Down, in, and then release. Down, in, and release. So it's down, in, and release.
OK good. You want to do that nice and slowly, 15 times. Then the next place we're going to go, we're going to be rerouting the fluid. Normally, the fluid drains into your left underarm, but most of our patients have either had lymph nodes removed or had radiation, and therefore those lymph nodes are not functioning. So instead, we're going to be rerouting the fluid to the lymph nodes either in the neck, the opposite underarm, or down to the groin. So we are going to clear the lymph nodes in the underarm next. So you're going to want to have your underarm slightly open. You're going to take your left hand into your underarm, and you're going to want to slightly stretch the skin towards your midline and up into your underarm, and then just release. Now we're going to be working on this underarm... because that's where we want to take the fluid. So you're going to stretch towards your midline, up into your underarm, and then just release. Just let the skin bounce back in place. And again, we're going to do this slowly, 15 times.
Good. We're not going to do all the repetitions now but that's the idea. And now we're going to clear the left chest area. This is the way the fluid normally drains, so we're just clearing that. So what you're going to do, you're going to put your flat hand on your chest and you're going to stretch the skin towards your right underarm, because if you want to reroute the fluid in that area. So you stretch the skin and then let the hand bounce back in place. Right. So you're moving the fluid to your right underarm, and that's the way the fluid normally drains. So you do that 15 times, and it's very, very light. It's just enough pressure to stretch the skin and let the skin bounce back in place. It's not deep massage, and that's why I really prefer to call this a skin technique and not massage. Then the next place we're going to take your hand, either hand, you're going to move the fluid from your underarm towards your right underarm. So again, I'm just stretching the skin and letting the skin bounce back in place very slowly. Each stroke is about two seconds, and I'm not coming back with my hand, I'm just letting the skin bounce back in place.
Can I use my right?
You can use that hand. Stretch and release. So we're making a new pathway for the fluid. That's the opposite of how the fluid normally drains. Good. We do that 15 times. Then the third place we're going to be taking the fluid is down to the lymph nodes in your left groin. Those lymph nodes drain from the groin, they drain into the deep abdominal lymph nodes before they're taken back to the heart. So first we're going to drain the deep abdominal lymph nodes. You're going to put your hands at the base of your ribs, right below the ribs, and remember the deep breathing that you learned with your exercise techniques. This is a good opportunity to do a lot of deep breathing while you're doing the self manual lymph drainage. You're going to take a deep breath in through the nose, your abdomen comes up, and you hold that for one or two seconds, and as you exhale you're going to press into the abdomen and slightly up. So it's as if you're helping yourself exhale. And then as you inhale you just release that pressure. Exhale, press in and slightly up. You are only pressing in as you exhale. And as you inhale you just release that pressure. This one we only need to do three to five times, and you want to do it nice and slowly so you don't hyperventilate. The next place we're going to go is to the groin. So we're only going to be directing the fluid to the left groin, so you only have to do the affected side. You're going to take your middle finger and you're going to put it right in your groin, but you're going to use your whole flat hand, and you're going to very gently stretch or scoop up the tissue into your midline, slightly up and into your midline. So let me show you what it feels like. So it's not a whole lot of motion. For demonstration purposes, we're doing this sitting. Perhaps at home you might find it easier to do it when you are lying down. The most important thing is to do it when you are as relaxed as you can be.
OK.
Very good, excellent. Yes, you do that slowly 15 times. Normally, the fluid from the waist down drains into the groin. So we want to clear that area before we can start moving fluid in. So you want to have your hands from the waist down, you're stretching down towards the groin. Exactly. And you're not sliding on this skin, you're stretching and releasing. At home, our viewers would want to be doing it right on the skin, but we're demonstrating over your clothing. OK, so first we do from the waist down, that's the way the fluid normally drains. And then the next place you want to take it is from your underarm down to the groin. So this is making the new pathway now - just stretching the skin and releasing. Again, all these are at least 15 times. For someone that has a lot of edema, or issues in their chest area, or especially underneath the underarm, this is an area that gets a lot of fluid accumulation. In this case, you would want to spend a little extra time in that area, which is certainly a good idea. You can just spend more time, more repetitions. So we've cleared the trunk area, and now we're ready to do the arm. Again we always work proximal to distal. So it's not wrong to start at your hand and come up, it's just more effective if you start at the top of the arm. So we want to clear the area before we move fluid into it. So you're going to start at the top of your arm, and you want to stretch the skin up towards your shoulder. Slowly stretch and release. So you're letting the skin bounce back in place. And you want to do it very, very lightly. It shouldn't cause any redness or any kind of white marks, because again we're just moving the skin. So we repeat 15 times at the top part of the shoulder, moving it towards the shoulder, and then we do the bottom half of the arm; the outer arm. So right above the elbow you can go down a little bit further. Just stretch and release slowly, 15 times. That's what you want to achieve - moving the skin, exactly. OK. We are working only with the upper arm for right now. Then the next place we're going to move the fluid is from the inside of the arm to the outside. You're going to have your hand slightly angled, and we're going to move the fluid from the inside to the outside in an upward position. If you can kind of move and turn your hand in this position; you're angling it up. So from the inside to the outside, angling up towards your shoulder with the intention that you are taking it towards your shoulder. That's right; you want to make sure your thumb is in line with your finger so you're not accidentally causing your thumb to cause the fingers to push the fluid into the underarm. Since you've had those lymph nodes removed we don't want to encourage any of the fluid to drain into the underarm.
OK.
So we do that 15 times and now we're ready to do the forearm, so we've prepared the upper part of the arm. We're going to start with your palm towards you, and you're going to start stretching the skin closest to the elbow towards the elbow 15 times. Exactly, stretch and release. And then we'll do the same thing from the wrist - stretch and release 15 times. You can see how my skin moves and it relaxes, but without doing any kind of deep pressure. And then you'll have your palm away from you and you'll do this area of your forearm. Again just stretching the skin 15 times, slowly, and letting it bounce back in place. And then a little bit further towards, right above the wrist.
And then the next place we're going to do is the back of the hand. Again, if there is any area that you have particular accumulation of swelling, spend a little bit more time on that area. You were saying earlier that you have a lot of accumulation in the back part of the arm, and that's maybe where you would want to spend more time. A lot of the patients I see get a lot of fluid right in here, and sometimes it can be very hard, and then we can tell the patients to use just a little bit more pressure in that area. So when the tissue is nice and soft you want to be very, very light. Only when patients have hardness or fibrosis where the protein has stayed in the tissue and scarred, then we use a little bit more pressure. But if the tissue is soft, you want to be soft. So we want to spend a little bit of extra time wherever there are areas that need more attention. So now we're back to doing the hand. We're going to take your thumb and we're going to gently stretch the skin from the base of the knuckles to the wrist.
Good. Or you can just simply stretch. So that's the idea - we're stretching the skin and letting it release, and then we can do the palm, the same idea - taking the thumb... and just rubbing from the knuckles to the wrist. And again we're doing this 15 times. Then lastly we're going to do the fingers. So we just kind of "milk" the fingers from the nail to the knuckles. You can do it however it is comfortable for you to do it, 15 times each finger.
Or we can also go like this. And in between these tendons, or try to help find the tendons if we have so much edema we can't find those. And then once we finish the hand we want to go back, if you have time, go back and do this again in reverse order; but again all redirecting it towards the heart. So we've done the hand, so now we would go back and do the back of the wrist, the back of the forearm 15 times, the inside of the wrist and the inside of the forearm. From the inside to the outside.
OK.
The outside of the arm 15 times, the top part of the arm 15 times. Good. And now we're ready to clear the trunk again, so we're going to clear from the shoulder. You're taking it towards the right underarm. So you do that 15 times, and then your left chest, move it towards your right underarm. And then you would move it... you could probably do both at the same time, just moving it from your underarm down to the groin 15 times.
OK.
Now we're ready to do the back. So go ahead and turn with your back towards me so we can demonstrate on the video. We're going to move the fluid from your shoulder up to your neck. Normally, all the fluid from the top of your collarbone drains down into the underarm, but instead, we're going to reroute the fluid to the neck. So reach across with your hand, and move the fluid from your shoulder up towards your neck. Do this 15 times. So the intention is to move the fluid from your underarm up towards your neck. Exactly. So you're reaching across and stretching up and towards your neck. You do that 15 times. Then the second place we're going to take the fluid is just like you did around the front, you went from the waist to your groin. You're going to reach across and you're going to move the fluid from your side, from your waist down to the groin 15 times. And then you can also go from the underarm down to the groin. So this is making the new pathway; moving the fluid from the underarm, or if you can you can also reach this way, or if you're having a hard time reaching it you can always use a long-handled soft body brush, a long handle sponge on a stick like this one, a paint roller, a back scratcher, anything that works for you. So you can hold that and move the fluid from your underarm down to the groin; either in long sweeps or you can stretch and release, stretch and release. Right. Do this 15 times. And then the third position we want to take the fluid, is we want to move the fluid from your left underarm to your right underarm. And again this is when it comes in very handy to use the soft body brush. You can reach across with your right hand, and move the fluid from your left underarm down across to your right underarm. So if someone has lymphedema in their right arm, obviously everything we would be doing would be in the opposite direction; taking the fluid to the left underarm into the right groin. And then you can also do it from the waist up. So you can go down right across your back and move from right. So everything from the waist up, we are redirecting the fluid. You want to do self manual lymph drainage, at least 10 to 15 minutes every day. OK, thank you. You can go ahead and move around. We want to do it at least 10 to 15 minutes every day, either sitting or if you're more comfortable and more relaxed you can do it lying down. And then also you can do it in bits and pieces in addition to the 10 to 15 minutes every day; like if you're sitting at a stoplight you could inconspicuously do your neck, or waiting for an elevator. When you're watching TV, you could be working on your arms. As much as you can break it up during the day, you can be doing the manual lymph drainage. It's best to do it right on the skin though. When you take your bandages off to bathe, that would be an excellent time to do the self manual lymph drainage. And then also whenever you're bathing or putting lotion on, always remember to rub up your arm and away from your underarm; either up towards your neck, your right underarm, or down to the groin. So you can always use that opportunity. And when you're drying off with a towel, instead of going back and forth with the towel, try to move the towel left to right. So you can try to re-train yourself. These are all some things you can do to help break up and do the self manual lymph drainage throughout the day to help reroute the fluid and stimulate the lymphatic system.
OK. Thank you.
OK, good job!
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