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

In which fields of medicine is our therapy

important?

Can I use pressotherapy

on them?

Vascular

Diabetology

Traumatology

Sports medicine

Surgery

THE IMPORTANCE OF PRESSOTHERAPY IN SPORTS

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.

How can pressotherapy achieve

an improvement in athletic performance?

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.

Patient 22 years, playing rugby dislocates the humerus-radial joint

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

Back to the competition...

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

Esteban Duarte in PVR

THE IMPORTANCE OF PRESSOTHERAPY IN DIABETIC PATIENTS

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.

Peripheral Vascular Rehabilitation in diabetic 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

Diabetic patient with amputation of 4th and 5th toe

Diabetic patient 18 years of age

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.

BENEFITS OF PRESSOTHERAPY IN PRE AND POST SURGICAL

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.

Hallux Valgus Postsurgical

The importance of Pressotherapy as a tool of Peripheral Vascular

diseases in PVR

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.

Lymphedema

Female patientAge: 84Weight: 25 kilos

Elephantiasis

Secondary lymphedema by gait disturbances

Patient with left arm lymphedema, Chronic Venous Insufficiency in mmii

THE IMPORTANCE OF PRESSOTHERAPY AS A TOOL OF PVR IN ULCERS

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

PRESSOTHERAPY IN ONCOLOGY PATIENTS

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.

Axillary lymphadenectomy

Lymphedema with 30 years of evolution, secondary to breast cancer

Is it allowed the use of pressotherapy in oncology patients?

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

THE IMPORTANCE OF PRESSOTHERAPY IN DIFFERENT AREAS OF MEDICINE

Lic. Sandra Fariña

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