Compiled by Prof. H. Wittlinger
This is a short summary of the main areas of research conducted by Prof. Dr. Paul Hutzschenreuter of the University of Ulm, Germany into the effects of Dr. Vodder’s Manual Lymph Drainage. A bibliography of his research is at the end of the article.
Manual Lymph Drainage and smooth muscle cells.
What does MLD do? It adds pressure forces which are potential energy, changing the receptor potential of the mechanoreceptors of the skin. This causes a decrease of the sympathetic activity which leads to a dilation of the lymph collectors. Consequently the pressure in the lymph collectors rises and this leads to an increase in contractions.
A further increase in contractions is achieved by passive stretching of the smooth muscle cell. If, after adding potential energy, the contraction mechanism initiates chemical energy, this will facilitate a build up of kinetic energy which is a force increasing lymph flow.
Potential energy and chemical energy are converted into kinetic energy. So easy!!
Investigating the effect of MLD on edematous, paralyzed arms.
At one time, it was doubted that the edema of a paralyzed arm is a lymphostatic edema.
How do patients with a flaccid arm paralysis react to MLD treatments with reference to the status of their autonomic nervous system and their microcirculation?
Taking the mean between the difference of two parameters – surface of the vessel and speed of blood flow before and after a series of treatments, no changes were found.
MLD has no effect on the autonomic nervous system of a patient suffering from a paralysis of the arm while MLD always has an effect on patients suffering from peripheral circulatory disturbances of the arteries.
Measuring skin resistance.
When applying MLD, the skin resistance measured in ohms significantly increases. This is triggered by a reduction of sympathetic nervous system activity and followed by an increase of the transport capacity of the lymph.
Stronger pressures activate the sympathetic nervous system, proven by a significant decrease of the skin resistance (ohm) followed by a narrowing of the vessels.
A stronger pressure will move the protein-rich interstitial fluid passively into less damaged tissues where this fluid can be absorbed by functioning initial lymph vessels.
Microcirculation in arterio-occlusive disease and diabetes mellitus.
Both diseases have a macro-and micro angiopathy which leads to a macro circulatory insufficiency. Clinically we see the walking range of a patient decreasing due to muscle pain arising from a pathologic microcirculation.
In a clinical study, 16 patients were treated with MLD during 4 weeks. The patients had to do a standardized walking training. The walking distance increased, the muscle hypertonicity decreased and the blood flow increased.
With reference to microcirculation, the effect of MLD in both diseases can be explained because the increased tone of the smooth muscle cell of the arterioles. This means we have an increased filtration and with reference to the lymph vessel system, an increased lymph flow due to a higher lymphangiomotoricity. More lymph-obligatory load is resorbed into the initial lymph vessels from the interstitial spaces and the transit stretch between capillary and cell is reduced. We all know that this brings more oxygen and nutrients to the cells. It is better to treat arterio-sclerotic vessel changes early when they are still reversible.
Proof of quality has been demonstrated for more than 30 years, i.e. measuring the volume of edemas.
Proof of quality work (i.e. an excellent MLD and bandaging) is never done or asked for.
You sitting here attending reviews belong to the exceptions.
Whiplash: neck brace not required.
Whiplash is divided in 5 grades. Grade 0 - no problems at all, grade I: problems with pain, stiffness and sensitivity to touch in the neck area, no physical signs; grade II: problems in the neck area with muscle and skeletal signs; grade III problems in the neck area with neurological signs; grade IV: problems in the neck area with fracture or dislocation.
Outpatient treatment can be applied only with grade I and II cases.
The first study was done with 30 patients. They wore a neck brace and had 10 MLD treatments. 20 out of 30 complained of ongoing headache and restriction in the range of motion of the cervical spine as well as a feeling of pressure at the base of the skull.
A second standardized study without neck brace and 10 MLD treatments was done. 24 patients were treated with MLD within the first 24 hours after the accident. The existing local post-traumatic edema in the dorsal neck area disappeared significantly after the 2nd MLD treatment. 10 of 24 patients were completely symptom free after these 10 MLD treatments and it was not necessary to give further MLD treatments to the remaining 14 patients.
Why is it not necessary to wear the neck brace? Why were the patients symptom-free after 10 MLD treatments?
Grade I and II whiplash is a combination of distortion of the cervical vertebra with a contused trauma of the soft tissues of the dorsal neck area.
To answer the first question: if intracapsular fracture and ruptures of ligaments are excluded radiologically, immobilization of the small vertebral joints causes a contraction of their capsules and deposition of post-traumatic substances. Each movement of the neck stimulates the passive lymph transport. Immobilization of the neck musculature due to the neck brace decreases lymph transport. Immobilization of the neck with a brace leads to chronic pain in the head and neck area.
Each trauma of soft tissue leads to a damage of the muscle fibers. A chemical reaction starts which ends in prostaglandin E and which dilates the vessels. An exudative process occurs which can last several days. This process can develop already by the second day into a proliferative phase.
If we began right away on the day of the trauma, this explains why the local edema (with grade I and II) already decreases after the second MLD treatment and it will not become a chronic condition.
Research studies looking at how patients and/or therapists react to MLD treatments.
The functional state of the Autonomic Nervous System (ANS) can be measured looking at the resistance of the skin with biotonometry. With this method we proved a sympathicolytic reaction of the patient when being treated with MLD.
Are the values of the skin resistance different in the therapist or the patient before the treatments started?
How does the ANS of the therapist react to MLD?
Does the ANS of the therapist and the patient react the same way to MLD or not?
4 MLD therapists treated 20 patients with secondary arm lymph edema (state II-III) on 5 consecutive days for 45 minutes each session. The result was:
The summary is that a sympathicolytic reaction was seen in the therapist in 61% of all treatments and in the patient in 68% of all treatments.
As long as the therapists treated lymphedema patients with similar tissue consistency (which means the therapist could always apply the same pressure) one could see a 50% agreement with the sympathicolytic effect on the therapist and the patient.
If intensive firmer pressure was applied, as in fibrosis movements then either the therapist and patient or the therapist or the patient had a sympathetic reaction (21%).
What effect does a sympathetic reaction have on the therapist and a patient with secondary lymphedema? Therapist's and patient's lymph vessels become spastic and filtration rate of the microcirculation increases due to vasomotion, which in the past was interpreted as a higher permeability of the capillaries. Every increase in interstitial fluid must be removed by the lymph vessel system, which has to be activated.
This happens as we know by the sympathicolytic state and local passive stretching of the lymph angion from inside and outside.
The pressure which is applied using the Vodder technique depends to a great extent on the consistency of the edema. The harder the tissue, the firmer the pressure we apply and with a harder pressure we find less sympathicolytic effect even if we use rhythmic MLD techniques. Furthermore, if the therapist is able to block out external distractions such as talking with the patient, this allows him or her to be fully concentrated during the treatment. The therapist can then observe a calming or sympathicolytic effect of the MLD. If, however the therapist is uncomfortable, for example suffering from back pain, the sympathetic reaction can be understood.
Further studies should be made in order to find out causes which have to be sorted out in order to increase the sympathicolytic reaction of patients and therapists that would further increase the effectivity of the MLD treatment. Vodder assumed that his MLD is most effective as a physical therapy if a symphathicolytic (vagotonic) effect is triggered.
Effect of MLD on peristalsis in the intestines
17 patients with secondary arm edema were treated 45 minutes twice per day (morning and afternoon).
Peristaltic movements of the small intestines become audible (borborygmus) which means that peristalsis is increasing due to an activated vagus nerve by MLD.
The peristaltic intestinal motility is stimulated with MLD which is a primary effect.
A secondary effect is that the vagotonic reaction is maintained until the second treatment.
A third effect is that the second treatment increases the vagotonic reaction and it is added to the primary effect.
Vodder assumed that his MLD is most effective as a physical therapy if a sympathicolytic or vagotonic effect is triggered.
Bibliography
(provided by Prof. H. Weissleder)
Hutzschenreuter P. The treatment of tissue necrosis with the trypsin preparation empykratin N. Dtsch Gesundheitsw 1959; 14:2114-2117.
Hutzschenreuter P. Experimental and clinical studies on the problems related to nephroses in pylorostenosis. Bruns Beitr Klinischen Chir 1961; 202:62-75.
Hutzschenreuter P, Schamaun M. On the prognosis of small cell bronchial cancer. Oncologia 1965; 19:218-226.
Eichler J, Hutzschenreuter P, Rosenbladt I. The behavior of biological parameters in experimental hyperthermia. Anesthetist 1969; 18:210-215.
Hutzschenreuter P. Accelerated healing of alloplastic bone grafts through presensitization of the recipient and stable osteosynthesis. Langenbecks Arch Chir 1972; 331:321-343.
Hutzschenreuter P, Allgower M, Borel JF, Perren SM. Second-set reaction favouring incorporation of bone allografts. Experientia 1973; 29:103-104.
Hutzschenreuter P, Baltensperger A, Ruter A, Perren SM. Experimental studies on a load-steady, plate osteosynthesis in the sheep. Dtsch Tierarztl Wochenschr 1973; 80:105-107.
Claes L, Hutzschenreuter P. The significant difference between the two values of torque for the lag screw and screw with two threaded holes in cortical bone (author's transl). Arch Orthop Unfallchir 1974; 79:347-352.
Hutzschenreuter P, Burri C. Biomechanical studies of knee joint ligaments. Helv Chir Acta 1974; 41:51-54.
Claes L, Hutzschenreuter P. Torque load and types of fractures of threaded holes in cortical bone by lag screw. Mechanic and histological studies (author's transl). Z Orthop Ihre Grenzgeb 1975; 113:237-242.
Hauser P, Hutzschenreuter P. Problems of osteosynthesis, demonstrated with treatment of isolated tibia and combined tibia-fibula fractures in the dog. Schweiz Arch Tierheilkd 1975; 117:1-8.
Claes L, Hutzschenreuter P, Pohler O. The dependence of the removal torque of a leg screw a screw surface and implantation time (author's transl). Arch Orthop Unfallchir 1976; 85:155-159.
Hutzschenreuter P, Claes L, Pohler O. Loosening capacity of corticalis tension screws with varying surfaces and their histological correlations. Helv Chir Acta 1976; 43:765-768.
Hutzschenreuter P, Claes L. Structure and solidity of new bone in a cortical gliding hole by implanted leg screw (author's transl). Arch Orthop Unfallchir 1976; 85:161-169.
Lintner P, Burri C, Hutzschenreuter P, Ruter A, Stemann HJ. Deformation stability of plate and composite osteosyntheses of the femoral shaft. Helv Chir Acta 1976; 43:759-763.
Rudzki M, Burri C, Hutzschenreuter P. Installation and reconstruction of autologous spongiosa and compacta after substitution with ground bone. Langenbecks Arch Chir 1976; Suppl: 263-266.
Rudzki M, Burri C, Hutzschenreuter P, Neumann G. Formation of autologous spongiosa in bone layers as a function of revascularization. Chir Forum Exp Klin Forsch 1977:73-78.
Spier W, Burri C, Helbing G, Hutzschenreuter P. After-care following suture or plastic replacement of knee ligaments. Hefte Unfallheilkd 1977:195-199.
Lintner P, Burri C, Claes L, Hutzschenreuter P. Biomechanical studies on the stabilization effect of cortico-spongiosa chips in imperfect osteosynthesis . Chir Forum Exp Klin Forsch 1977:79-84.
Hutzschenreuter P, Claes L, Bick R. Bending-and torsion-strength measurements in healed metatarsal osteotomies in sheep. Dtsch Tierarztl Wochenschr 1977; 84:438-439.
Claes L, Hutzschenreuter P. Pressure resistance of the cortical bone in horses, cattle and sheep. Dtsch Tierarztl Wochenschr 1977; 84:354-356.
Claes L, Hutzschenreuter P. The influence of the countersink geometry on the cortical screw force (author's transl). Z Orthop Ihre Grenzgeb 1977; 115:235-238.
El Saman M, Hutzschenreuter P, Claes L. Tensile strength of partially cut lateral knee ligaments following, or without plaster immobilization. Chir Forum Exp Klin Forsch 1978:267-269.
Hauser P, Hutzschenreuter P. Surgical management of fractures in the dog and cat using the dynamic compression plate (DCP). Schweiz Arch Tierheilkd 1978; 120:195-204.
Mutschler W, Claes L, Mohr W, Hutzschenreuter P. Biomechanical efficiency and biocompatibility of lubricating sprays PTFE or graphite (author's transl). Arch Orthop Trauma Surg 1978; 91:129-135.
Plank E, Burri C, Hutzschenreuter P. Osteogenetic potential of gelatin and collagen in poorly regenerating bone layers (animal experiments). Chir Forum Exp Klin Forsch 1978:247-249.
Wolter D, Hutzschenreuter P, Burri C. Studies of the incorporation of autologous spongiosa in compact bones in relation to the transferred amount and adjacent tissue. Langenbecks Arch Chir 1974; Suppl:225-228.
Wolter D, Hutzschenreuter P, Burri C, Steinhardt B. [Incorporation of autologous spongiosa into compact substance of bones in relation to the vitality of transplanted cells]. Langenbecks Arch Chir 1975; Suppl:383-387.
Hutzschenreuter P, Walk H, Heinrich K. The determination of tensile and torsion stress in cortical bone during bone healing. Microsc Acta Suppl 1980; Suppl 4:116-119.
Schafer R, Fries L, Feilen KD, Hutzschenreuter P. Computer-assisted Fourier spectrum analysis for characterization of the pendular movements of the longitudinal muscles in the small intestine of the rat. Biomed Tech (Berl) 1984; 29:53-55.
Hutzschenreuter P, Brummer H. Embedding, cutting and grinding methods to produce undecalcified cortical bone sections over the whole bone. Acta Anat (Basel) 1984; 118:201-204.
Hutzschenreuter P, Ehlers R. Effect of manual lymph drainage on the autonomic nervous system. Z Lymphol 1986; 10:58-60.
Hutzschenreuter P, Brummer H. Lymphangiomotoricity and tissue pressure. Z Lymphol 1986; 10:55-57.
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Hutzschenreuter P, Brummer H, Ebberfeld K. Experimental and clinical studies of the mechanism of effect of manual lymph drainage therapy. Z Lymphol 1989; 13:62-64.
Hutzschenreuter P.und H. Brümmer: Die manuelle Lymphdrainage bei der Wundheilung mit Decollement. Eine experimentelle Studie. Lymphhologica, Jahresband 1989: 97-100.
Hutzschenreuter P, Einfeldt. Lymphologie für die Praxis. Stuttgart: Hippokrates Verlag, 1991.
Hutzschenreuter P, Brümmer H. Lymphbildung und Lymphtransport beim experimentellen Lymphödem. In:Aktuelle Beiträge zur Manuellen Lymphdrainage. Heidelberg: K.F.Haug, 1992; 11-18.
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Hutzschenreuter P., Brümmer H, I. Kurz und D. Wittlinger: Veränderungen der Mikrozirkulation während der Manuellen Lymphdrainage-Technik nach Dr. Vodder. Aktuelle Beiträge zur Manuellen Lymphdrainage Bd. 3: (1992): 44-52.
Hutzschenreuter P., G. und H. Wittlinger und I. Kurz: Das sekundäre Postmastektomie-Armlymphödem nach Manueller Lymphdrainage-Behandlung und Kompressionstherapie.Aktuelle Beiträge zur Manuellen Lymphdrainage. Band 3, 1992: 41-43.
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P.Hutzschenreuter, G.T.Werner
Manuelle Lymphdrainage beim Inaktivitätsödem bei schlaffer Parese der Arme
Schriftenreihe“Manuelle Lymphdrainage nach Dr.Vodder“ Bd.4 1994,
Hutzschenreuter und H. Brümmer: Biotonus und Grifftechniken bei der Manuellen
Lymphdrainage. Aktuelle Beiträge zur Manuellen Lymphdrainage Bd. 5 (1996): 17-22.
P.Hutzschenreuter, I.Kurz, G.Zimmermann, H.Wittlinger, D.Wittlinger
Sekundäre Beinlymphödeme behandelt mit Manueller Lymphdrainage nach Dr.Vodder und Bandagierung
Aktuelle Beiträge zur Manuellen Lymphdrainage, Bd.5 1996,
Hutzschenreuter P, Weissleder H. Manuelle Lymphdrainage-Qualitätsmanagement-Qualitätssicherung und Qualitätskontrolle. LymphForsch 1999; 3:7-10.
Hutzschenreuter P., Wittlinger H., Hermann H. und K. Silberschneider: Das vegetative Nervensystem bei Patienten und bei Behandlern unter Manueller Lymphdrainage nach Dr. Vodder. Aktuelle Beiträge zur Manuellen Lymphdrainage Band. 7, 2000: 109-126.
Hutzschenreuter P., H. Brümmer und K. Silberschneider
Die vagotone Wirkung der Manuellen Lmphdrainage nach Dr. Vodder. LymphForsch 2/2003: 7-14.
Hutzschenreuter P
Was sollte der lymphologisch tätige Arzt wissen? Qualitätskriterien der kombinierten physikalischen Entstauungstherapie LymphForsch 2004;7:30-36
Hutzschenreuter P, Brümmer H. Die Regelkreise der Lymphsysteme bei Patient und Therapeut unter Manueller Lymphdrainage nach Vodder. LymphForsch 2005; 9:21-27.
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