Clinical Proof Book

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Clinical Proof Book

4 5 JOURNAL PUBLICATIONS Negative Pressure Therapy In The Management Of Lymphoedema Gott,F.H.,Ly,K.,Piller,N.&Mangion,A.2018.JournalofLymphoedema,13(1).

Clinical Proof Book - Performance Health

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CLINICAL PROOF BOOK
Formerly known as PhysioTouch®

JOURNAL PUBLICATIONS

4

Negative Pressure Therapy In The Management Of Lymphoedema.................................................4

Occupational Therapy Treatment To Improve Upper Extremity Function In Individuals With Early Systemic Sclerosis: A Pilot Study.......................................................................................................4

Observation On Short Term Curative Effect Of PhysioTouch Based On Infrared Thermography Technology In Postoperative Treatment Of Tka .................................................................................5

Modeling Of Interstitial Fluid Movement In Soft Tissue Under Negative Pressure­Relevance To Treatment Of Tissue Swelling ............................................................................................................5

Experimental And Computational Analysis Of Soft Tissue Mechanical Response Under Negative Pressure In Forearm ..........................................................................................................................6

CONFERENCE AND POSTER PRESENTATIONS

8

Treatment of Breast Cancer-Related Lymphedema with a Negative Pressure Device: A Pilot Randomized Controlled Study ...........................................................................................................8

Effiziente peri- und postoperative dekongestive apparative Unterdruckbehandlung und mechanische Vibration zur antiödematösen Schwellungsbehandlung von Unfall-und Orthopädischen Patienten an der unteren Extremität ­ eine Qualitätssicherungsstudie ...................9

Efficient peri-operative and post-operative decongestive instrument-based negative pressure treatment and mechanical vibration for anti-oedematous swelling treatment of a trauma and orthopaedic patient at the lower extremity - A quality study .............................................................10

Effektive peri- und postoperative dekongestive apparative Unterdruckbehandlung und mechanische Vibration zur antiödematösen Schwellungsbehandlung von Unfall-und Orthopädischen Patienten an der oberen Extremität ­ eine Qualitätssicherungsstudie ..................11

Effective peri-operative and post-operative decongestive instrument-based negative pressure treatment and mechanical vibration for anti-oedematous swelling treatment of a trauma and orthopaedic patient at the upper extremity - A quality study.............................................................12

The effect of LymphaTouch® vs. a sham treatment on immediate pain and range of motion in acute low back pain ...................................................................................................................................13

Graded Negative Pressure: Does It Have A Place In The CDT Treatment Model? .........................14

Significant Improvement In Quality Of Life After Treatment Of Lower Extremity Lymphedema With Negative Pressure Application .........................................................................................................14

Treatment Of The Periwound With Intermittent Negative Pressure .................................................16

Negative Pressure Assisted Lymphatic Drainage: Improving Conservative Treatment Options ......16

Treatment Of Radiation Induced Fibrosis And Breast Oedema For Arm Lymphoedema Risk Reduction .........................................................................................................................................17

Observation Of Blood Inflammatory Markers In Chronic Lymphoedema .........................................17

Can Early Intervention With PhysioTouch®'s Mechanical Leverage In The Functioning Of Initial Lymphatic Vessels Help Promote Long Term Physiological Homeostasis As Well As Fluid Volume Reduction In A Locally Impacted Lymphatic Territory.......................................................................18

A Clinical Audit To Demonstrate The Use Of A Negative Pressure Device In An Mld Sequence To Improve Both Clinical and Patient Perception Treatment Outcomes ...............................................19

The Benefit Of One Session On A Negative Pressure Device When Used In A Manual Lymphatic Drainage (MLD) Sequence In Primary Lymphoedema ....................................................................19

Clinical Observation Of Postoperative Swelling Of Lower Limb Fracture ........................................20

A New Vacuum Suction Device For Management Of Lymphedema ...............................................20

Management Of Post-Mastectomy Lymphoedema By Novel Vacuum Suction Device, A Case Report ..............................................................................................................................................21

RESEARCH REPORTS

23

LymphaTouch And PhysioTouch Treatment As A Part Of Active Physiotherapy: Effect On Pain And Swelling ............................................................................................................................................23

Influence Of LymphaTouch-Treatment Method For Pain And Edema In Context Of Active Physiotherapy ..................................................................................................................................23

Effect Of PhysioTouch Treatment On Perception Of Doms And Recovery After Heavy Resistance Exercise ...........................................................................................................................................23

Lymphatic Therapy Using Negative Pressure, A Clinical Study With The LymphaTouch Device.....24

DEGREE THESES

26

The Effects of LymphaTouch-Treatment Method After Ankle Sprain................................................26

The Effect Of The LymphaTouch® Treatment Method On Recovery After Heavy Hypertrophic Resistance Exercise.........................................................................................................................26

Perceived Recovery Of American Football Players After LymphaTouch® Treatment......................27

Effect Of Lympha System Activation In Athletes' Recovery .............................................................27

Is LymphaTouch-Treatment Effective For Shin-Splint? A Quantitative Study On Patients' Experience .......................................................................................................................................27

The Effectiveness Of LymphaTouch-Treatment In Carpal Tunnel Syndrome ..................................28

PROFESSIONALS' TESTIMONIALS AND ARTICLES

30

Jeffrey Tucker - Active Negative-Pressure Therapy: Enhancing Lymph Flow..................................30

Erja Kouri & Monica Ebneth-Pihlaniemi - Efficient Therapy Together With Active Exercising..........32

Mike Voight & Ashley Campbell ­ Powerful Tool In A Toolbox For Hip Patients...............................32

Leena Vallin ­ Excellent Tool For Comprehensive Care ..................................................................33

Justine Whitaker ­ Improving Veteran's Lives With LymphaTouch ..................................................34

Natalie Perkins ­ From Big Hesitation To Great Impression ............................................................35

Peetu Lehmus ­ Extra Boost For Athlete Rehabilitation ..................................................................36

Axis Fysio ­ A Great Tool In Lymph Therapy ...................................................................................37

Hyvinkään Fysioterapia ­ Relaxing Treatment For Neurologic And Disabled Individuals................39

University Hospital Queen Jovanna ­ Synergy Effect Of Combined Therapy .................................41

PATIENT TESTIMONIALS AND ARTICLES

43

Susan's Story ­ The Impact Of Lymphedema..................................................................................43

Marina's Story ­ Back To Playing Flutes After A Serious Wrist Break And Painful Neuropathy .......45

Tammy's Story ­ Head And Neck Cancer Survivor..........................................................................45

LEARN MORE ONLINE

46

Technical Note: PhysioTouch ...........................................................................................................46

Manual Strategies: Optimizing Patient Outcomes In The Clinic.......................................................46

LymphaTouch As A Tool For Manual Lymph Drainage: A Therapist's Perspective...........................46

Emerging Technologies in Rehabilitation Medicine..........................................................................46

Negative Pressure Treatment Benefits Patients with Head and Neck Cancer Symptoms...............46

Lymphatouch Brings Therapeutic Excellence For Faster Recovery ................................................46

New Approach To Thoracolumbar Fascia Pain ................................................................................46

Lymphatic And Fascial System Treatment: Time To De-Compress .................................................46

Negative Pressure Treatment: An Innovative Therapy Method For Faster Recovery......................46

4
JOURNAL PUBLICATIONS
Negative Pressure Therapy In The Management Of Lymphoedema
Gott, F. H., Ly, K., Piller, N. & Mangion, A. 2018. Journal of Lymphoedema, 13 (1).
Abstract: Lymphoedema involves chronic tissue inflammation with tissue changes that include extracellular free fluid accumulation, tissue fibrosis and fatty tissue deposition (Zampell, 2012). Despite the best efforts of modern conservative lymphatic therapy, some patients will progress to develop significant secondary tissue changes with morbidity evident via recurrent bouts of cellulitis, reduced function and lowered quality of life. Fatty tissue deposition can contribute to such severity that liters of accumulated fatty tissue warrant surgical management via liposuction (Brorson 2006). Non-invasive and painless technology should, therefore, be of interest to lymphatic therapists aiming to improve the outcomes of conservative lymphatic therapy.
Historically, conservative lymphatic therapy treatments have consisted of treatments that predominant via offering positive pressure; a pushing force onto the tissues. Compression bandaging, pressure garments, including wraps and chip bags, and massage, including massage, including manual lymphatic drainage and pneumatic compression devices, represent examples of positive pressure therapy and technology. Negative pressure, on the other hand, is a newer means offering treatment, whereby a pulling or opening force is applied to the tissues. Treatment can be targeted to specific areas, such as areas of radiation induced fibrosis and scar tissue, or the technology can be used as an adjunct to massage and manual lymphatic drainage.
Brands such as LymphaTouch (LymphaTouch Inc) and Endermologie (LPG) are examples of negative pressure massage devices designed for use by manual therapist. This article introduces technology to lymphoedema management and the proposed mechanics of action.
Occupational Therapy Treatment To Improve Upper Extremity Function In Individuals With Early Systemic Sclerosis: A Pilot Study
Murphy, S. L., Barber, M. W., Homer, K., Dodge, C., Cutter, G. R. & Khanna, D. 2018. Arthritis Care & Research, 70(11), 1653-1660
Objective: To determine feasibility and preliminary effects of an occupational therapy treatment to improve upper extremity (UE) function in patients with early systemic sclerosis (SSc) who have UE contractures.
Methods: A one-arm pilot clinical rehabilitation trial was conducted at a university health system. Participants with SSc and  1 UE contractures (N=21) participated in a total eight weekly in-person occupational therapy sessions. The therapy consisted of thermal modalities, tissue mobilization, and UE mobility. Between sessions, participants were instructed to complete UE home exercises. Feasibility was measured by present enrollment and session attendance and duration. The primary outcome measure was QuickDASH, secondary and exploratory outcomes included PROMIS physical function, objective UE measures, and skin thickening. Linear-mixed models were performed to determine treatment effects on primary and secondary outcomes.
Results: Fifty percent (24/48) of potentially eligible participants were interested. Of those, 88 % (21/24) enrolled: and 19 out of 21 (91%) completed the sessions. The mean (SD) age was 47,9 years (±16.1); 100 % had diffuse SSc, and mean disease duration was 3.1 years. At eight weeks, participants reported statistically significant improvement on QuickDash and PROMIS physical function measures (p=.0012 and p=.00). Forty ­ seven and 53 % percent

5
of the sample achieved improvements that exceeded minimally important difference.
Conclusion: In-person treatment sessions were feasible for individuals with SSc and demonstrated statistically significant and clinically meaningful improvements on UE and physical function. Future studies need to examine effects against a control condition and examine durability of treatment effects.
Observation On Short Term Curative Effect Of PhysioTouch Based On Infrared Thermography Technology In Postoperative Treatment Of Tka
Guangming, X., Xuemeng, X., Wengang, L., Yanyan, L. & Guocai, C. 2018. Chongqing Medicine, (19) 11.
Objective: To explore the effectiveness of PhysioTouch in postoperative treatment after total knee arthroplasty (TKA) and feasibility of using infrared thermography technology for conducting the curative effect valuation.
Methods: 60 patients after TKA were randomly divided into the experimental group (30 cases) and control group (30 cases). The control group adopted the routine rehabilitation therapy scheme, while on this basis the experimental group was added with PhysioTouch treatment. The knee incision temperature, leg circumference difference, VAS score, knee joint flexion and extension degrees and complications on preoperative 2 d and postoperative 3, 7, 10, 14 d were compared between the two groups.
Results: The knee incision skin temperature and VAS score on postoperative 3, 7, 10, 14 d had statistical differences between the two groups (p<0.05); the leg circumference difference value at suprapatellar 10 cm on postoperative 3, 7, 10 d in the experimental group was lower than that in the control group, the difference was statistically significant (p<0.05); but on postoperative 14 d, the leg circumference difference had no statistical difference between the two groups (p>0.05); the knee joint flexion and extension degrees on postoperative 7, 10, 14 d had statistical difference between the two groups (p<0.05). The preoperative and postoperative complications had no statistical difference between the two groups (p>0.05).
Conclusion: The infrared thermal imaging technology can provide a new clinical evaluation method; using the PhysioTouch treatment can significantly reduce the limb swelling degree and improve the activity of knee joint in the patients with TKA.
Modeling Of Interstitial Fluid Movement In Soft Tissue Under Negative Pressure­Relevance To Treatment Of Tissue Swelling
Iivarinen, J. T., Korhonen, R. K., & Jurvelin, J. S. 2016. Computer Methods In Biomechanics And Biomedical Engineering, 19(10), 1089-1098.
Abstract: Journal publication that uses computer-based finite-element model of soft tissue to analyze how pulsating and continuous modes in LymphaTouch device affect fluid flow, velocity, and pressure. The model response was matched with negative pressure (suction) measurements in human (N=11) forearm. Two experimental suction protocols were simulated to evaluate their impact on interstitial fluid flow in soft tissues. Simulated continuous suction was up to 27 times more efficient in fluid transportation compared to the cyclic suction.
A finite-element model was created using pQCT imaging and by doing measurements of soft tissue response to negative pressure on eleven healthy volunteers (nine males, two women). The negative pressure and suction protocols were performed using LymphaTouch device and the registered data was analyzed using Matlab software.

6
Two protocols were analyzed, cyclic and continuous. The simulated cyclic procedure consisted of five 100mmHg suctions and 1cm lengthwise movement. The pulsation was set at 2 s (one second suction, one second zero-pressure period). Similarly, the continuous treatment protocol consisted of one 100mmHg suction with simultaneous 4 cm (in 4 s) lengthwise movement at a constant speed of the suction head.
The study found that the continuous suction method with simultaneous change of treatment position induced higher fluid pressure, velocity transients, and more effective fluid movement along the treatment direction than the cyclic method. It is to be noted that the model does not take into account how negative pressure treatment of edema may affect pressure-dependent promotion of the interstitial fluid flow into lymphatic system and/or activation of the lymphatic system in transportation of lymph fluid. In other words, the role of lymphatic system is not included in the model, meaning that the conclusion stating that continuous mode is more effective for moving fluid, applies better in areas where lymphatic system does not fully work.
Experimental And Computational Analysis Of Soft Tissue Mechanical Response Under Negative Pressure In Forearm
Iivarinen, J. T., Korhonen, R. K., Julkunen, P. & Jurvelin, J. S. 2013. Skin Research and Technology, 19(1), e356-e365.
Background: Instrumentation, relying on the use of negative pressure (suction), has been introduced to reduce pathological tissue swelling. Then relative contribution of skin, adipose tissue and muscle, to overall mechanical response is not known.
Method: Under suction, stretch of soft tissues in the forearm of human subjects (N=11) was experimentally measured at rest and under venous occlusion. Three dimensional, fibrilreinforced hyperplastic finite element (FE) model was constructed, the model response was matched with the experimental measurement and mechanical characteristics of each tissue were derived. Parametric analyses were conducted to evaluate the impact of different tissues on the total stretch.
Results: The model suggested that, at large strains, the stretch response was more sensitive to changes in the elastic modulus of skin than those in adipose tissue. During venous occlusion, reduction of the stretch of forearm tissues was related to stiffening of the skin and adipose tissue, as evidenced by increased modulus of 27 ±21 % and 35 ± 26 %, respectively.
Conclusion: The method based on suction may be used to diagnose and monitor skin changes in properties of soft tissues, especially those of skin, as well as tissue swelling typical to pathological condition such as edema.

7

8
CONFERENCE AND POSTER PRESENTATIONS
Treatment of Breast Cancer-Related Lymphedema with a Negative Pressure Device: A Pilot Randomized Controlled Study
Lampinen, R., Leano, J., Smoot, B., Mastick, J., Miaskowski, C., Brinker, L. & Lee, J. Q. 2020. APTA Combined Sections Meeting, Denver.
Purpose/Hypothesis: 1 in 5 women develop lymphedema (LE) following breast cancer (BC) treatment. If untreated, LE may become chronic and result in persistent swelling, inflammation, skin thickening, and abnormal fibro-adipose tissue deposition. Current conservative treatments do not specifically address secondary soft tissue changes that may limit response to treatment. The purpose of this pilot randomized controlled trial (RCT) is to evaluate efficacy of treatment for chronic LE using a negative-pressure device, which mobilizes skin and subcutaneous tissue to support lymphatic circulation.
Subjects: Data were analyzed for 28 women (informed consent provided) who were >1 year post active BC treatment and have had unilateral upper extremity LE for >1 year. Women were randomized into the negative-pressure device treatment group (n=14) or the manual lymphatic drainage (MLD) control group (n=14).
Material/methods: This study compared negative-pressure massage using the LymphaTouch device (Helsinki, Finland) to MLD. Both groups used the Vodder unilateral upper extremity LE sequence. All participants received twelve 1-hour treatments over 4 to 6 weeks. Patients completed demographic and clinical questionnaires, and the Disability of Arm, Shoulder, Hand (DASH). Objective measures included bioimpedance (L-Dex; Impedimed) and limb volume (ml) calculated from limb circumference. T-tests and ANOVA (General Linear Model­Repeated Measures) were used to evaluate within and betweengroup differences and interaction effects.
Results: Average age was 62.4 years (SD 12.3) and BMI was 29.0 (SD 9.6). Mean baseline interlimb volume difference (affected vs unaffected limbs) was 511.3 ml (SD 378.2) and L-Dex was 29.0 (SD 23.3). Differences between groups at baseline were not statistically significant for age (p=0.108), BMI (p=0.802), L-Dex (p=0.218), DASH (p=0.259) and interlimb volume difference (p=0.076). The LymphaTouch group demonstrated slightly greater improvement in L-Dex, volume, and DASH scores, compared to the MLD group. However, only the between-groups difference in the change in L-Dex reached statistical significance, favoring the LymphaTouch group (L-Dex change: MLD mean +2.79 L-DEX units, SD 5.08); LymphaTouch: mean -4.16 L-Dex units, SD 7.51; interaction p=0.008).
Conclusions: Treatment with the negative-pressure massage device resulted in statistically significantly greater improvement in L-Dex scores compared to MLD, in women with unilateral upper extremity LE of >1-year duration. Slightly, but not statistically significantly greater improvements were also observed in volume and self-reported function. Three adverse events were recorded during the study but all were deemed unrelated to the treatment.
Clinical Relevance: Further research is needed to identify effective treatments for chronic LE that addresses not only limb volume but also secondary soft tissue changes. This can improve our ability to offer targeted interventions and improve outcomes for patients impacted by breast cancer-related LE. Results from this pilot study will guide the development of a larger, hypothesis driven RCT.

9
Effiziente peri- und postoperative dekongestive apparative Unterdruckbehandlung und mechanische Vibration zur antiödematösen Schwellungsbehandlung von Unfall-und Orthopädischen Patienten an der unteren Extremität ­ eine Qualitätssicherungsstudie
Dresing, K., Fischer, A.-C., Spering, C. & Saul, D. 2019. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House. DocAB32-1248.
Fragestellung: Beim traumatischen bzw. postoperativen Ödem kommt es auf dem Boden eingeschränkter Transportkapazität (fehlende Muskelpumpe, Zerstörung von Lymphbahnen) zur Stauung. Ödemfolge sind: Veränderungen der Form, Schmerzen, Funktionseinschränkung, höhere Infektions- und Wundstörungen. Im Rahmen der Komplexen Physikalischen Entstauung (KPE) ist die Manuelle Lymphdrainge (MLD) ein wesentlicher Baustein. MLD aktiviert den Lympfabfluss, vermindert pop-Komplikationen.
Ziel der Studie: Evaluierung, ob eine apparative Negativ-Druck-Lymph-Drainage (NPLD) die perioperative Schwellung an der unteren Extremität effektiv und nachhaltig vermindern kann.
Methodik: Prospektive der Ethikkommission vorgelegte Untersuchung. Über einen silkonummantelten Applikator wird der Unterdruck lokal mit dem Lymphatouch®(LT) (FDA zugelassen) appliziert. Es kann lokal stationär, in Gleittechnik oder mit der ,,Lift + Twist" Technik gearbeitet werden. Je nach Haut- und Weichteilbeschaffenheit werden Drücke zwischen 20-250mm HG angewendet. Die Frequenz wird mit 90-70Hz gewählt. Art der Applikation: pulsierte oder kontinuierliche Unterdruckbehandlung, Hochfrequenz Vibration. Begonnen wird immer in der Fossa supraclaviculare, fortgesetzt bis zum OP-Gebiet an der oberen bzw. unteren Extremität, Dauer ca. 30 Min. Nach der Behandlung (LTB) wird der Patient angehalten, Flüssigkeit zu trinken. Nach Aufklärung, Dokumentation der Befunde (Messung, Foto) wurden die Maßnahmen durchgeführt.
Einschlusskriterien: Patient (P) mit Verletzung an unteren Extremität (E), elektive P, Alter >18Jahre, Einwilligung
Umfangsmessung, Bewegung nach NNO, Statistik: Multivarianz, Wilcoxon-Test nicht parametrisch.
Ergebnisse: 101 P mit Verletzungen/Operationen an der unteren Extremität, MW 3,6± LTB. Die Schwellung war am ausgeprägteren am Knie. Nach 4 Behandlungen bestand eine messbare Schwellungsabnahme von 11,6% an der UE. Bei P mit Hüfttraumen/Ops verminderte sich der Schwellungsumfang am OS um 8,6% zwischen LTB 1 vs. 5. Knietraumen/Ops: Geschlechterunterschiede der Schwellungen waren signifikant größer bei Frauen. Die Beweglichkeit verbesserte sich objektivierbar, die Schmerzen nahmen ab. Die Patienten berichteten über subjektive sofortige Linderung, Komplikationen wurden nicht dokumentiert.
Fazit: Die perioperativen und posttraumatischen Schwellungszustände an der unteren Extremität lassen sich nachhaltig mit der LT-NPLD positiv beeinflussen. Die präoperative Dauer bis zur geplanten Operation kann ebenso wie die postoperative Phase verkürzt werden. Dank Schwellungabnahme kann früher operiert, früher entlassen und weniger Analgetika gegeben werden.

10
English translation:
Efficient peri-operative and post-operative decongestive instrument-based negative pressure treatment and mechanical vibration for anti-oedematous swelling treatment of a trauma and orthopaedic patient at the lower extremity - A quality study
Dresing, K., Fischer, A.-C., Spering, C. & Saul, D. 2019. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House. DocAB32-1248
Queries: In case of traumatic or post-operative oedemas, it deals with the limited transport capacity (missing muscle pump, destruction of lymphatic channels) for congestion. Consequences of oedema are e.g. change in shape, pain, limited functionality, higher infection and wound disorders. Manual lymph drainage (MLD) is an important treatment with respect to the complex physical decongestion (CPD). MLD activates the lymph drainage and reduces the postoperative complications.
Objective of the study: Evaluation whether an instrument-based negative pressure lymph drainage (NPLD) can reduce peri-operative swelling at the lower extremity effectively and sustainably.
Methodology: Prospective study submitted to the Ethics Commission. The negative pressure was applied locally with the Lymphatouch®(LT) (FDA permitted) using a siliconecoated applicator.Treatment can be done in a local stationary manner or by using the "Lift + Twist" - technique. Pressure between 20-250mm HG was applied depending on the skin and tissue texture. The frequency was chosen between 90-70 Hz. Type of application: pulsed or continuous negative pressure treatment combined with high-frequency vibration. The process is always started in the supraclavicular fossa area, continued till the OP area at the upper or lower extremities, duration approx. 30 min. The patient was encouraged to drink fluids after the LymphaTouch treatment (LTT). The actions have been taken after the clarification, documentation of the findings (measurement, photo).
Inclusion criteria: Patient (P) with injury at the lower extremity (E), elective P, age > 18 years, consent
Girth measurement, movement according to NNO, Statistics: Multi-variance, Wilcoxon test not parametric
Results: 101 P with injuries/operations at the lower extremity, MW 3.6± LTT. The swelling was more pronounced at the knee. After 4 treatments, there was a measurable decrease in swelling of 11.6% at the lower extremity. For P with hip traumas/ops, the swelling at the femur reduced by 8.6% between LTT 1 vs. 5. Knee trauma/Ops: Gender differences of the swelling were significantly more in case of women. The mobility improved objectively, the pain decreased. The patients reported subjective immediate relief, complications were not documented.
Conclusion: The perioperative and post-traumatic swelling states at the lower extremity can be sustainably and positively affected with the LT-NPLD. The pre-operative duration up to the planned operation can, likewise, be reduced like the post-operative phase. Thanks to the decrease in swelling, the patient can be operated earlier, discharged earlier and needs less analgesics.

11
Effektive peri- und postoperative dekongestive apparative Unterdruckbehandlung und mechanische Vibration zur antiödematösen Schwellungsbehandlung von Unfall-und Orthopädischen Patienten an der oberen Extremität ­ eine Qualitätssicherungsstudie
Dresing, K., Fischer, A.-C., Spering, C. & Saul, D. 2019. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House. DocAB77-1230
Fragestellung: Beim traumatischen bzw. postoperativen Ödem kommt es auf dem Boden eingeschränkter Transportkapazität (fehlende Muskelpumpe, Zerstörung von Lymphbahnen) zur Stauung. Ödemfolge sind: Veränderungen der Form, Schmerzen, Funktionseinschränkung, höhere Infektions- und Wundstörungen. Im Rahmen der Komplexen Physikalischen Entstauung (KPE) ist die Manuelle Lymphdrainge (MLD) ein wesentlicher Baustein. MLD aktiviert den Lympfabfluss, vermindert pop-Komplikationen.
Ziel der Studie: Evaluierung, ob eine apparative Negativ-Druck-Lymph-Drainage (NPLD) die perioperative Schwellung effektiv vermindern kann.
Methodik: Prospektive der Ethikkommission vorgelegte Untersuchung. Über einen silkonummantelten Applikator wird der Unterdruck lokal mit dem Lymphatouch®(LT) (FDA zugelassen) appliziert.
Es kann lokal stationär, in Gleittechnik oder mit der ,,Lift + Twist" -Technik gearbeitet werden. Je nach Haut- und Weichteilbeschaffenheit werden Drücke zwischen 20-250mm HG angewendet. Die Frequenz wird mit 90-70Hz gewählt. Art der Applikation: pulsierte oder kontinuierliche Unterdruckbehandlung, Hochfrequenz Vibration. Begonnen wird immer in der Fossa supraclaviculare, fortgesetzt bis zum OP-Gebiet an der oberen bzw. unteren Extremität, Dauer ca. 30 Min.. Nach der Behandlung (LT) wird der Patient angehalten, Flüssigkeit zu trinken. Nach Aufklärung, Dokumentation der Befunde (Messung, Foto) wurden die Maßnahmen durchgeführt.
Einschlusskriterien: Patient (P) mit Verletzung an oberer oder unterer Extremität, elektive P, Alter >18Jahre, Einwilligung
Umfangsmessung, Bewegung nach NNO, Statistik: Multivarianz, Wilcoxon-Test nicht parametrisch
Ergebnisse: 45 P obere Extremität, 3,5±1 NPLD. Bei Verletzungen von Schulter und Oberarm waren die Schwellung prox. Ellenbogen am ausgeprägten. An der OE war der Schwellungsunterschied zwischen jungen und älteren Patienten (aP) signifikant zu ungunsten von aP. Nach 4 Behandlungen bestand eine messbare Schwellungsabnahme von 19,9% an der OE. Die Abnahme 15 cm prox. + direkt am Ellenbogen waren im T-Test ebenso wie die Handbeweglichkeit signifikant am besten.
Fazit: Die perioperativen und posttraumatischen Schwellungszustände an der oberen Extremität lassen sich nachhaltig mit der LT-NPLD positiv beeinflussen. Die präoperative Dauer bis zur geplanten Operation kann ebenso wie die postoperative Phase verkürzt werden. Dank Schwellungsabnahme kann früher operiert, früher entlassen und weniger Analgetika gegeben werden.

12
English translation:
Effective peri-operative and post-operative decongestive instrument-based negative pressure treatment and mechanical vibration for anti-oedematous swelling treatment of a trauma and orthopaedic patient at the upper extremity - A quality study
Dresing, K., Fischer, A.-C., Spering, C. & Saul, D. 2019. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House. DocAB77-1230
Queries: In case of traumatic or post-operative oedemas, it deals with the limited transport capacity (missing muscle pump, destruction of lymphatic channels) for congestion. Consequences of oedema are e.g. change in shape, pain, limited functionality, higher infection and wound disorders. Manual lymph drainage (MLD) is an important treatment with respect to the complex physical decongestion (CPD). MLD activates the lymph drainage and reduces the post operative complications.
Objective of the study: Evaluation whether an instrument-based negative-pressure lymph drainage (NPLD) can reduce peri-operative swelling effectively.
Methodology: Prospective study submitted to the Ethics Commission. The negative pressure was applied locally with the Lymphatouch®(LT) (FDA permitted) using a siliconecoated applicator. Treatment can be done in a local stationary manner or by using the "Lift + Twist" - technique. Pressure between 20-250mm HG was applied depending on the skin and tissue texture. The frequency was chosen between 90-70 Hz. Type of application: pulsed or continuous negative pressure treatment combined with high-frequency vibration. The process is always started in the supraclavicular fossa area, continued till the OP area at the upper extremities, duration approx. 30 min. The patient was encouraged to drink fluids after the LymphaTouch treatment (LT). The actions have been taken after the clarification, documentation of the findings (measurement, photo).
Inclusion criteria: Patient (P) with injury at the upper extremity, elective P, age > 18 years, consent
Girth measurement, movement according to NNO, Statistics: Multi-variance, Wilcoxon test not parametric
Results: 45 P upper extremity, 3,5±1 NPLD. The swelling was more pronounced at the elbows in case of shoulder and upper arm injuries. The difference in swelling between younger and older patients (oP) was significantly less favorable for oP at the upper extremity. After 4 treatments, there was a measurable decrease in swelling of 19.9% at the UE. The reduction 15 cm prox. + direct at the elbow was significantly the best in the T-test as well as the hand mobility.
Conclusion: The perioperative and post-traumatic swelling states at the upper extremity can be sustainably and positively affected with the LT-NPLD. The pre-operative duration up to the planned operation can, likewise, be reduced like the post-operative phase. Thanks to the decrease in swelling, the patient can be operated earlier, discharged earlier and needs less analgesics.

13
The effect of LymphaTouch® vs. a sham treatment on immediate pain and range of motion in acute low back pain
Greenstein, J., Etnoyer-Slaski, J., Huffman, A. & Behm. D. 2019. The 21st Annual Performance Health Scientific Advisory Committee (TRAC) Research Meeting.
Background: Low back pain is the number one global burden, affecting 80% of people in the US at some point in their life. The LymphaTouch® is a medical treatment device which uses the effects of negative pressure in tissues for pain and swelling. It has been shown to improve pain 63.9%, with an average 3.5 decrease in pain scores in back and hip patients.
Purpose: The purpose of this study is to determine the effect of LymphaTouch® versus a sham treatment on pain and range of motion in individuals with acute low back pain
Design: Single-blind randomized clinical trial
Methods: A convenience sample of forty acute low back pain patients were recruited from an outpatient chiropractic clinic at their initial appointment. Participants were 18 years or older and diagnosed with acute low back pain. Exclusionary criteria \ included less than 18 years of age, pregnancy, cancer, a corticosteroid injection within the past 2 weeks, previous back surgery, acute deep vein thrombosis, acute infection, congestive heart failure, cardiac edema, kidney dysfunction, and any conditions in which increased venous and lymphatic return is undesirable. Eligible patients who agreed to participate in the study completed the informed consent, demographics information questionnaire (including pain medication usage), rated their overall pain on the Numeric Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), and the Functional Rating Index (FRI) [T0]. Following the doctor's evaluation, range of motion (ROM) was assessed using a digital goniometer and pain rated during each motion. Participants were then randomized into either the LymphaTouch® group [A] (n=30) or sham treatment group [B] (n=30). The participants were blind to which group they were assigned. Following the group selection, each participant received their assigned intervention. After the respective intervention, both groups immediately rated their overall pain and repeated the ROM tests [T1]. Then, all participants completed a satisfaction questionnaire about the intervention they received.
Statistical Analysis: Statistical analyses were completed using the SPSS software (Version 26.0, SPSS, Inc. Chicago, IL). First, Mauchly's test of sphericity was conducted for all dependent variables. If the assumption of sphericity was violated, the GreenhouseGeisser correction was employed. A mixed model repeated measures 2-way ANOVA (2 groups x 2 times) was used to analyze the data. Paired t-tests with Holm­Bonferroni corrections were used to decompose significant interactions, and Bonferroni post hoc tests were used if main effects were found. Significance was set at p 0.05. For significant main effects and interactions, eta (proportion of variance associated with one or more main effects, or interactions) and observed power (statistical power of the test based on the effect size indicating the probability of finding a statistical difference) were calculated. Eta values represent; small (0.01), medium (0.06), and large (0.13) effects. Cohen's d effect sizes (ES) were also calculated for significant specific interactions. Effect size (d) magnitude of change were calculated for interactions and reported as trivial (<0.2), small (0.2-0.49), medium (0.50.79) or large (0.8) effect sizes (d) (Cohen 1988). Data is reported as mean ± SD.
Results/Conclusion: A total of 41 participants enrolled in the study with 38 having completed the study, 20 in the LymphaTouch® group (7M, 13F) and 18 in the sham treatment (11M, 7F). There was no significant between group effects (p=0.26) for pain, however there was a main effect for time (p<0.0001, eta: 0.34, Observed Power: 0.988) with a 10.04% (d=0.34) decrease from baseline (7.071.9) to post-treatment (6.362.15). A significant time x group interaction (p=0.001, eta: 0.27, Observed Power: 0.945) demonstrated a 18.5% (d=0.59) pain reduction with LymphaTouch® Group from baseline (7.02.03) to post-treatment (5.72.3). There was no significant (p=0.16) change over time for the Sham Group. For trunk flexion ROM, there was no significant between group effects

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(p=0.08). A main effect for time (p<0.0001, eta: 0.53, Observed Power: 1.00) revealed a 22.3 (d=0.47) improvement in trunk flexion ROM (baseline: 23.610.6 vs. post-treatment: 28.811.3). In addition, a significant (p<0.0001, eta: 0.47, Observed Power: 1.00) time X group interaction indicated 37.5% (d=0.83) ROM increase for LymphaTouch® Group (p<0.0001) from baseline (24.511.6o) to post-treatment (33.710.6o), but no significant change for the Sham Group (p=0.33). There were no significant main effects or interactions for trunk flexion pain and hip flexion ROM or pain.
Clinical Relevance: The LymphaTouch® significantly reduced their pain from pre- to immediate post-treatment, while the sham group had no reduction in pain. Additionally, the LymphaTouch® group significantly improved Trunk Flexion ROM pre- and post-treatment. These results advocate the use of a negative pressure machine, like the LymphaTouch®, to immediately improve pain and trunk ROM in an acute low back pain population. Future research should investigate the long-term effects of the device on acute and chronic low back pain.
Graded Negative Pressure: Does It Have A Place In The CDT Treatment Model?
Donahue, P. & Donahue, M. J. 2019. 9th Conference of the International Lymphoedema Framework
Objective: To test the hypothesis that mobilization of protein-enriched hardened tissue using graded negative pressure therapy in conjunction with CDT will improve patient-valued functional outcomes compared to CDT alone.
Methods: Six patients with advanced secondary arm or leg lymphedema received sequential CDT with and without graded negative pressure therapy. Therapy was provided by the same trained lymphedema physical therapist. Patient Specific Functional Scale (PSFS) outcome measure was evaluated pre and post the course of treatments.
Results: Patients improved with both conservative therapies. PSFS scores support all six patients' expressed thoughts of greater improvement when graded negative pressure was utilized in their care. They felt tissue softer, lymphedema easier to manage and limb feeling lighter with less pain.
Conclusion: In this pilot study, the inclusion of graded negative pressure therapy with CDT provided further improvements in patient valued outcomes than CDT alone. Further investigation is needed to evaluate quantitative and qualitative treatment impact on these two conservative therapies.
Significant Improvement In Quality Of Life After Treatment Of Lower Extremity Lymphedema With Negative Pressure Application
Mackenzie, A. & Donahue, P. 2017. 26th World Congress of Lymphology. September 2017.
Abstract: The patient case presented was conducted to assess if CDT combined with PhysioTouch has a patient--valued- impact on the patient´s expressed pain & quality of life. A 55-year-old female diagnosed with secondary Stage III lower limb lymphedema. She received ten weekly treatments of MLD combined with PhysioTouch treatment, one session lasted 60 minutes. Pain was assessed using the VAS scale, volumetric measurements obtained via perometry, clinical assessment of skin and superficial tissue mobility via palpation, QOL measures: Patient Specific Functional Scale (PSFS) & Lower Extremity Functional Scale (LEFS).
The conclusion was that QOL and pain improved which patient reported and compared to previous courses if CDT treatments. The results indicate that; Pain improved: VAS reduced from 4/10 to 1 /10, PSFS improved by four points, LEFS improved by eleven points.

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Treatment Of The Periwound With Intermittent Negative Pressure
Briggs J. & McKennedy K. 2016. Symposium of Advanced Wound Care Spring. April 5th-9th 2017. San Diego, USA.
Abstract: This whitepaper includes two patient cases presenting negative pressure as an approach in treatment of the periwound. Each patient received standard wound care including a weekly physical therapy visit with pulsed lavage and debridement and weekly occupational therapy visits with use of manual lymphatic drainage, using intermittent negative pressure device and compression. Special wound dressings were also applied.
The intermittent pressure device was applied to the medial knee and down the lymphatic tracts opening the tracts towards the wound bed. The device was applied around the wound bed on various settings depending on the amount of fibrosis, skin condition and patient sensations. This included altering settings between 80-250 mmHg, duration of pulse 0.5-4 seconds. Vibration was also applied in most fibrotic areas at 20 Hz. The settings were adjusted to the patient tolerance to avoid pain or damage to the skin.
Once the area around the wound bed was treated, the device was applied along the lymphatic channels from the wound bed toward the medial knee, where MLD was also applied distal to proximal to the inguinal lymph nodes.
Patient 1 demonstrated resolution of stagnant wound measurements following two sessions. Patient 2 demonstrated a 37% reduction in wound measurements following three treatments, a 35% reduction after additional four treatments and a 90% reduction to near wound closure after the final three treatments.
This limited case study shows potential for additional treatment options to manage swelling during the wound healing phases, which include treatment of the periwound and lymphatic system.
Negative Pressure Assisted Lymphatic Drainage: Improving Conservative Treatment Options
Mangion A. 2016. Asia Pacific Lymphology Conference, Program & Abstract book. pp. 49. May 26th-28th 2016. Darwin, Australia.
Abstract: Case study describing the effect of PhysioTouch for secondary bilateral leg lymphedema. The patient presented with a wound, grossly swollen leg and abdomen, lymph blister and functional deterioration. As treatment outcome, significant limb volume reduction was achieved by fourth session with wound closure by sixth. Improvement was observed also in pain, quality of life and functional ability. When compared with previous treatment models, the PhysioTouch approach did not require bandaging this patient. Also, the therapy was delivered with less therapist fatigue and resources.
The case is about a male obese client with secondary bilateral leg lymphedema with acute exacerbation of swelling in his right leg. Treatment Outpatient model of six therapy sessions occurring twice a week included PhysioTouch assisted lymphatic drainage, simple wound care and return to flat knit compression garment wear. 60 minutes of PhysioTouch therapy was administered with graduated suction dosage from 140-200mmHg on the abdomen, 20150mmHg on the anterior right leg starting proximally at inguinal nodes and 20-150mmHg to posterior right calf and around the wound border.

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Treatment Of Radiation Induced Fibrosis And Breast Oedema For Arm Lymphoedema Risk Reduction
Mangion A. 2016. Asia Pacific Lymphology Conference, Poster presentation. May 26th-28th 2016. Darwin, Australia
Abstract: This study highlights a case treatment of a female client of 54 years of age with post-breast cancer lymphedema in her breast. Lymphedema treatment started two years after the cancer surgery. For the first three weeks the treatments were done only with PhysioTouch. Each session lasted one hour. After the initial treatment sessions with PhysioTouch, the client reported a significant increase in comfort when completing daily tasks and felt confident to resume her exercise program. She also reported a significant improvement in her QOL.
Female client of 54 years of age who was treated for right breast cancer in May 2013 (invasive ductal carcinoma, Grade 3). Breast cancer intervention included surgery (wide local excision and full axillary clearance). Edema in the right breast was apparent immediately following surgery. Edema continued to be a persistent problem in the right breast, which increased post radiation with further blistering and hardening of the breast tissue. Discomfort around her chest was limiting her ability to complete functional task. Lymphedema treatment started in August 2015.
Client was encouraged to attend twice weekly, one-hour sessions for lymphedema treatment with PhysioTouch. PhysioTouch treatment protocol included central lymphatic drainage of the abdomen and drainage of the right breast using principles of MLD with proximal drainage first. The entire breast was treated over, including over the nipple. To reduce risk of arm lymphedema, adhesions in the right axilla were mobilized directly over with a focus on drainage of the abdomen and the swollen breast. Treatment dosage of negative pressure was increased slowly from 60mmHg up to 120mmHg with a pulsed application (2 sec on, 2 sec off) with a stationary hold technique. The client was treated in supine and in side lying.
As a result of PhysioTouch treatments, the client reported a significant increase in comfort when completing daily tasks and felt confident to resume her exercise program. She reported a significant improvement in her QOL. Shoulder ROM normalized to allow for further treatments to be completed with the arm relaxed in full abduction.
The breast had softened significantly with color beginning to fade gradually from dark brown to pink. The change in color was particularly of interest as the client reported being informed by her radiology team that the breast would remain brown considering the extent of her radiation. The change was that significant post treatment that the client booked an additional appointment with her radiologist to demonstrate the change in her breast color and ability of her breast to move on her chest wall.
Also, of interest was the palpable difference in temperature of the breast, which was palpably less warm after treatment (an observation not noticed routinely in other clients with breast lymphedema after standard MLD, and an expected result when considering that the tissues were being mobilized which would theoretically increase healthy blood flow to the area). Considering the inflammatory nature of lymphedema, further studies objectively assessing change in tissue temperature post PhysioTouch treatment in areas that are actively continuing to fibrose post radiation, would be interesting.
Observation Of Blood Inflammatory Markers In Chronic Lymphoedema
Mangion A. 2016. Asia Pacific Lymphology Conference. Poster presentation. May 26th-28th 2016. Darwin, Australia

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Abstract: This case observes an obese client's blood inflammatory markers through CLT intervention, following several admissions to hospital for cellulitis and a home management model of care. PhysioTouch treatment was administered once per week. Blood tests were taken on a weekly basis via GP home visits. Trends in the blood inflammatory markers were tracked over time, inflammatory markers decreased after several weeks of conservative therapy to rise when conservative therapy was halted.
The case describes 76-year-old bed bound overweight client with secondary bilateral leg lymphoedema. Oral antibiotics and weekly injections were part of the cellulitis management plan considering several lengthy inpatient admissions in 2014 for cellulitis.
A local lymphedema therapist completed home therapy on a once a week basis. Treatment consisted of PhysioTouch assisted MLD and skin care in one-hour appointments. Blood tests were taken on a weekly basis via GP home visits. Trends in the blood inflammatory markers were tracked over time.
PhysioTouch treatment protocol included central lymphatic drainage of the abdomen and drainage of both legs using principles of Manual Lymphatic Drainage with proximal drainage first. The entire lower legs were treated over including scarring on the right ankle and areas of tissue inflammation on the anterior shins. Treatment dosage of negative pressure was increased slowly from 20mmHg up to 80mmHg with a pulsed application (2 sec on, 2 sec off) with a stationary hold technique. The client was treated in supine on her home hospital bed.
Significant changes in the inflammatory markers was noted during the therapy. ESR levels were consistently over 40 H prior to therapy intervention, reaching 22 H (normal limits 1-35) during therapy. CRP levels were consistently over 10mg/L to decline to 8.2mg/L during therapy. Due to the therapist unavailability, the therapy was halted for 2.5 weeks. Subsequent readings demonstrated that the ESR had risen to 60 H and the CRP to 16.4mg/L.
Can Early Intervention With PhysioTouch®'s Mechanical Leverage In The Functioning Of Initial Lymphatic Vessels Help Promote Long Term Physiological Homeostasis As Well As Fluid Volume Reduction In A Locally Impacted Lymphatic Territory
Osborne, J. 2015. 25th World Congress on Lymphology. September 7th-11th 2015. San Francisco, USA.
Abstract: Case study that investigates how adding PhysioTouch to lymphedema patient treatment affects fluid reduction. Both circumferential volume and L-Dex BioImpedance measurements were taken. PhysioTouch was shown to create greater radial tension through to anchoring filaments to initial lymphatics (IL) than lymphatic manual drainage, thereby increasing fluid movement from the interstitium into the ILs.
Patient was diagnosed with breast cancer in 2012 and underwent mastectomy and expander placement, followed by external beam radiation therapy. At six months, expanders were replaced with implants. HR had immediate severe infection (R) implant. Implant was removed within 48 hours. IV antibiotics were administered. Two open chest incisions were surgically made to drain fluid. Drainage wounds drained for eight months. (R) UE developed Stage 2 lymphedema at onset of infection. CDT was initiated, but with minimally successful results. In 2014 Lymphoscintigraphy results revealed total obstruction of flow through axillary lymph nodes. In August 2014 HR underwent DIEP Flap surgery with Lymph Node Transfer of four nodes from abdomen to (R) axilla. Initial results of decreased (R) UE circumferential lymph volume measurements were positive. At six months post-surgery, circumferential volume reduction plateaued.
PhysioTouch was introduced into the treatment plan in January 2015. The specific effectiveness of PhysioTouch is its increased strength, greater than that of LMD (lymphatic

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manual drainage), in creating radial tension through the anchoring filaments of the ILs, thereby increasing fluid movement from the Interstitium into the ILs. This success in treatment can be objectively measured by both circumferential volume using a tape measure and L-Dex BioImpedance, the latter giving a more accurate clinical picture of relative fluid volume in a limb. Based on L-Dex BioImpedance measurement, PhysioTouch introduction to the treatment plan resulted to nearly 50% reduction in the arm volume in six months.
A Clinical Audit To Demonstrate The Use Of A Negative Pressure Device In An Mld Sequence To Improve Both Clinical and Patient Perception Treatment Outcomes
Whitaker, J. C. 2015. 25th World Congress on Lymphology. September 7th-11th 2015. San Francisco, USA.
Abstract: Case study that investigates how PhysioTouch in conjunction with Manual Lymphatic Drainage improves lymphatic drainage compared to RCT Bandage studies. The case showed that PhysioTouch with MLD achieved in just four days comparable change in excess limb volume being than RCT Bandage studies performed over 19 days. (Badger et al, 2000).
65-year-old lady with unilateral Primary Lymphedema. PhysioTouch was used on four consecutive days to perform the Casley-Smith MLD method. The lady completed a simple patient self-reported rating scale questionnaire on skin, tissue, visual improvement and range of movement. Limb volumes were recorded using the 4cm tape-measure technique
The change in excess limb volume was 39% and absolute limb volume was 5%. The patient's self-valuation showed improvement in all areas questioned and comments noted were very positive.
Overall the treatment outcomes measured showed favorable results with the change in excess limb volume being comparable to RCT Bandage studies performed over 19 days. (Badger et al, 2000). Tissues were notably softer and visually reduced in size. Range of movement and fit of clothing from a patient's perspective were also improved. PhysioTouch was found to improve both clinical and patient perceived treatment outcomes.
The Benefit Of One Session On A Negative Pressure Device When Used In A Manual Lymphatic Drainage (MLD) Sequence In Primary Lymphoedema
Whitaker, J. C. 2015. 25th World Congress on Lymphology. September 7th-11th 2015. San Francisco, USA.
Abstract: Case study that investigates how PhysioTouch in conjunction with Manual Lymphatic Drainage improves lymphatic drainage for primary lymphedema patient. After one-hour treatment, 19% of lost lymphedema was recorded using 4cm tape-measure technique. Also, based on subjective observation tissues were softer and shape improved.
A 65-year-old lady with unilateral Primary Lymphedema - stage IIb, was given a one-hour MLD session using the Casley-Smith technique with a NPD. The NPD was set at 80mmHg. Limb volume measurements using the 4cm tape-measure technique were taken and volumes were recorded in milliliters. Measurements were taken immediately before and directly after the treatment.

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Actual changes in excess limb volume was measured at 198ml, which indicated that 19% of the lymphedema had been lost in only one hour. Case study concluded that introducing PhysioTouch to MLD substantially reduces the change in limb volume after just one session. Also, the patient rated the treatment very favorably and requested the continuation of future treatments with this device.
Clinical Observation Of Postoperative Swelling Of Lower Limb Fracture
Ping, W., Yindi, S. & Nong, W. 2014. The 21st National Symposium On Integrated Traditional Chinese And Western Medicine Orthopedics And Traumatology And The Compilation Of Papers Of The General Meeting Of The New Branch Of Orthopedics And Traumatology 2014.
Objective: To explore the clinical effect of PhysioTouch lymphatic drainage apparatus in the treatment of postoperative swelling of lower limb fracture.
Methods: PhysioTouch lymphatic drainage technology is a new technology that makes use of vacuum principle to precisely control the working negative pressure, pulse time and vibration, and produces negative pressure to stretch and expand the skin and subcutaneous tissue, pull the fiber filament of capillary lymphatic vessels, expand endothelial opening channel and promote blood circulation and lymphatic reflux. 72 patients with postoperative limb swelling after fracture were selected for rehabilitation treatment and were divided into treatment group and control group according to the even number of inpatient signs. There were 38 cases in the control group and 34 cases in the treatment group, with no difference in age and gender. The patients in the control group were treated with air wa nve pressure therapy combined with active function training and the patients in the treatment group were treated with lymphatic drainage technology combined with active function training. The two groups were treated once a day in the morning and evening and the early intervention time was 36 hours later. The degree of limb swelling before and after treatment was measured by the observation indexes five and ten days later, respectively 10 cm above the patella and 10 cm below the patella, and the intra- and inter-group comparisons were made.
Results: (1) compared between the two groups (P<0.05), the degree of swelling of the affected limb decreased before and after treatment in both groups, and the degree of swelling was improved, there was no significant difference between the two groups. (2) compared within the group, the degree of swelling of the affected limb in both groups decreased before and after treatment (P<0.05), indicating that the method of the two groups has a significant effect on eliminating the swelling of the affected limb.
Conclusion: Through the clinical effect analysis of the two groups, the methods of the two groups can reduce the postoperative limb swelling degree of lower limb fracture, can achieve the purpose of treatment. PhysioTouch technology has a good development in the field of orthopedic rehabilitation.
A New Vacuum Suction Device For Management Of Lymphedema
Vuorinen, V.-P. & Airaksinen, O. 2009. 22nd International Congress of Lymphology, Program & Abstract book pp. 121. September 21st-25th 2009. Sydney, Australia.
Introduction: Lymphedema of the extremities is a general problem for many medical conditions (post-operative, post-traumatic and after radiotherapy). Manual lymphatic drainage, intermittent pneumatic compression treatment and compression garments are used generally for management of the edema of extremities. However, the efficacy of these therapies has not been established, and depends a lot on the expertise of the caregiver. Aim of this paper is to present a new vacuum suction device for assisting in the therapy of lymphedema.

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Methods: According to literature, increasing negative pressure of lymph capillaries, and stimulation of lymphangiomotoricity via deformation of tissues increases the lymph flow and lymph drainage. Based on this theoretical foundation, a new vacuum suction device called LymphaTouch® (HLD Healthy Life Devices Ltd, Helsinki, Finland) was developed. The device consists of a main unit and different sized treatment heads. The main unit is computer controlled which enables constant or pulsating treatment modes and measurement of changes in skin elasticity. With these properties the therapy can be optimized. Controlling the treatment intensity based on the tissue response is also possible.
Conclusion: During classical lymphatic drainage therapy it is difficult to control the compression and suction phase. By using this new device, the pressure conditions in the tissue will be controlled exactly. Also, the therapist induced variability will be reduced. All these facts will influence the quality of treatment. Well controlled clinical trials will be needed to document these theoretical facts.
Management Of Post-Mastectomy Lymphoedema By Novel Vacuum Suction Device, A Case Report
Vuorinen, V.-P. & Airaksinen O. 2009. 22nd International Congress of Lymphology, Program & Abstract book. pp. 118.September 21st-25th 2009. Sydney, Australia.
Abstract: Case study was performed on a 56-year-old female who had overcome mastectomy with lymph node evacuation. In 2002, lymphedema started to develop in patient's right arm and had progressed to stage 2. The patient has received CDT annually and wears a compression sleeve.
The patient was treated with LymphaTouch. The manual part of CDT was replaced by therapy given with the LymphaTouch device, except for the handling of lymph nodes which was done manually. The patient received a series of ten treatments lasting one hour each. Arm circumference was measured before and after treatments. Whole body tissue composition was measured by InBody® 720.
InBody measurement showed 185 ml reduction in the edematous arm and whole-body fluid decreased by 900 ml (3%). Based on circumference measurement, edema reduced by 3%. The patient graded the treatment as pleasant.

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RESEARCH REPORTS
LymphaTouch And PhysioTouch Treatment As A Part Of Active Physiotherapy: Effect On Pain And Swelling
Hietanen, S., Puustinen, T., Jouhki, I., Palomäki, K. & Taskinen, T. 2014. Internal report.
Abstract: The target of this study was to chart the effectiveness of LymphaTouch® and PhysioTouch® as part of active and conservative physiotherapy. The study focused on examining the change in pain during the treatment period and in the change in swelling. In addition, the need for pain medication and the change in the need for pain medication was defined.
As a basis for the study, preliminary research carried out in 2010 was used. The results of this previous study showed that it was justified to expand the study to this second phase. A total of 37 rehabilitation and physiotherapy professionals participated in the study in Finland. Altogether 202 patient cases were reported from different treatment areas with upper groups of leg, arm, mid-body, and the neck and shoulder area which were then divided in more detail into subgroups based on symptoms. The treatment periods and treatment session durations of the patients varied according to the real treatments.
The results have been reported from situations corresponding to heterogeneous and actual treatment situations. The changes in the VAS scale was the factor studied with the most detail in this study. The result was that the VAS change in all the patients groups was significant; 30%. The individual patient experiences of using PhysioTouch and LymphaTouch as part of the treatment course were primarily positive.
Influence Of LymphaTouch-Treatment Method For Pain And Edema In Context Of Active Physiotherapy
Airaksinen, O., Vuorinen, V.-P. & Raittila, S. 2011 Internal Research Report.
Abstract: A pilot study that concentrates on analyzing how LymphaTouch treatment influences pain and edema in conjunction with active physiotherapy. Total of 18 patients were analyzed. For some patients over 50% pain reduction was recorded.
The purpose of this study was to investigate how the introduction of a 20-minute LymphaTouch treatment to a standard active therapy session changes edema and pain. Pain was recorded with the standard VAS scale and edema with measurement bands, by palpation, and by visual observation. The study included 18 patients with neck-shoulder, knee, wrist, and elbow pain. Three wrist patients were excluded from data as their therapy did not include LymphaTouch treatment. Each patient had a doctor's referral for active physiotherapy.
Research data from a total of 66 therapy sessions were analyzed for all the indications. Researched showed that already 20-minute use of LymphaTouch was effective and for some patients even 50% pain reduction was recorded.
Effect Of PhysioTouch Treatment On Perception Of Doms And Recovery After Heavy Resistance Exercise
Nummela, A. & Mikkola, J. 2013. Research Institute for Olympic Sports -KIHU, Jyväskylä. Vuorinen, V.-P., Iivarinen, J., Jurvelin, J. & Airaksinen, O. 2013.
Background: Delayed muscle soreness (DOMS) is a familiar experience for the athletes. A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to speed up the recovery of the muscles, but still exercise is most effective means of

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alleviating pain during DOMS. The present study was planned to investigate where the PhysioTouch treatment alleviates the severity of DOMS, speeds-up the elimination of muscle trauma and inflammatory markers and speeds-up the recovery of force production after heavy resistance exercise in recreational athletes.
Methods: A group of 14 recreational strength athletes performed 5 x 10 repeated maximum squat twice: with or without the PhysioTouch treatment (PTT and NOT, respectively) during four days of recovery. The maximal force production was measured with isometric leg press test and countermovement jump before and after the squat exercise and during four days of recovery. Furthermore, muscle trauma and inflammatory markers were measured before and after the squat exercise and four days during the recovery. The blood markers were leukocytes, CK, LDH, Mb, CRP and cortisol. Subjective perception of DOMS was rated on a visual analog scale from 0 to 100 mm.
Results: Maximal isometric force and the height of countermovement jump decreased significantly (P<0.001) but no significant difference was observed between NOT and PPT. Subjective perception of DOMS increased significantly after the squat exercise (P <0.001) and reached the highest value two days after exercise. DOMS was significantly lower in PTT than not three days after squat exercise (P<0.05). All blood markers except CRP increased significantly during squat exercise but there were no significant differences between PTT and NOT (P<0.05).
Conclusion: The result of this study indicate that PTT decreased the perception of DOMS after a strenuous squat exercise in recreational strength athletes. However, PTT did not speed up the elimination of muscle trauma markers after squat exercise and PTT did not influence on the recovery of force production in athletes who were to strength training.
Lymphatic Therapy Using Negative Pressure, A Clinical Study With The LymphaTouch Device
Vuorinen, V.-P., Iivarinen, J., Jurvelin, J. & Airaksinen, O. 2013. Research Report #5320003/221, Finnish Funding Agency for Technology and Innovation, August 2013.
Abstract: A clinical study comparing lymphatic therapy administered on breast cancer lymphedema patients with a negative pressure device to manual lymph drainage (MLD) therapy. Aim was also to verify the physiological effects of LymphaTouch therapy in swollen tissue and to establish the safety of lymphatic therapy administered with the LymphaTouch device. Research showed that LymphaTouch reduced over 3x more limb volume than MLD. Also, patient degree of disability (DASH) reduced by 30% and Quality of Life (FACT-B) improved by 14%.
The study consisted of 13 female patients, seven treated with LymphaTouch and six with MLD (Vodder method). Each patient had undergone mastectomy involving removal of the axillary lymph nodes, and been diagnosed with lymphedema of an upper extremity as a result. Both patient groups were treated 10 times by the same therapist. Total treatment time was 90 minutes, out of which 60 minutes was used for lymphatic therapy. The treatment also included arm measurements and standard compression bandaging. The only difference between the two groups was the type of lymphatic therapy administered, either MLD or LymphaTouch. The study was funded by European Union.
The results of the treatment were measured using various methods, including volumetric limb measurement, limb circumference, MRI measurement of limb volume, tissue stiffness, and body composition analysis (InBody). Additionally, patient degree of disability was assessed using FACT-B and Quality of Life using DASH questionnaires.
The study results showed significant improvement using LymphaTouch over MLD for both objective and subjective measurements. MRI measurement showed over 3x improvement in limb volume reduction (2% MLD vs. 7% LymphaTouch) and skin stiffness was improved by over 4x (2% MLD vs. 9% LymphaTouch). Patient's quality of life was improved nearly 3x

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DEGREE THESES
The Effects of LymphaTouch-Treatment Method After Ankle Sprain
Mäkinen, L. & Kosonen, S. 2019. Thesis for Degree Programme in Podiatry, Metropolia University of Applied Sciences.
Abstract: The purpose of this thesis was to provide a protocol for the use of the LymphaTouch treatment method in the aftercare of a sprained ankle for a case study. Another purpose was to consider other possible uses of the device in podiatry. The thesis was carried out in cooperation with LymphaTouch, a Finnish healthcare technology company.
Ankle sprain is one of the most common musculoskeletal injury, and we wanted to explore possible new ways to improve its rehabilitation. In our work, we used upper and lower ankle joint mobility and ankle circumference as measurements.
Based on our theoretical knowledge, we designed a protocol to treat ankle sprain and selected appropriate gauges for it.
The Effect Of The LymphaTouch® Treatment Method On Recovery After Heavy Hypertrophic Resistance Exercise.
Kuronen, S. 2014. B.Sc. Thesis for Degree Programme in Physiotherapy, JAMK University of Applied Sciences.
Abstract: The purpose of this study was to investigate whether LymphaTouch® treatment speeds up the recovery after heavy hypertrophic resistance training with men doing recreational strength training. This thesis was part of the LymphaTouch 2013-project which was implemented in cooperation with the Research Institute of Olympic Sports (KIHU), HLD Healthy Life Devices Oy and the University of Jyväskylä. The aim of the study was to gain reliable research data on the impact of LymphaTouch® treatment. The purpose of this thesis was to determine the impact of the LymphaTouch® treatment and the function of the lymphatic system. In this study, recovery was examined based on the muscle trauma and inflammation markers in the blood samples, force production and subjective recovery sensations. In addition, swelling of the lateral thigh muscle was examined by using ultrasound.
14 recreational athletes completed two research weeks. During one week, they were treated with LymphaTouch® device according to a strict recovery protocol after resistance training for three recovery days. On the fourth recovery day, only recovery measurements were performed. During the other week, the subjects did not receive any treatment. Hence, each subject also had the role of being a control subject and their recovery was compared between two weeks. The order of the weeks was randomized so that seven subjects received treatment on the first research week and remaining seven subjects on the second week.
The results of this study indicated that LymphaTouch® treatment did not speed up the elimination of muscle trauma or inflammation markers. The muscle trauma marker creatinine kinase (CK) was even higher on the third recovery day of the treatment weeks. However, the subject had less delayed muscle soreness (DOMS) and they felt more recovered during the treatment week. The treatment did not influence on the force production, and no explanations could be found for the athletes' personal recovery sensations.

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Perceived Recovery Of American Football Players After LymphaTouch® Treatment
Hyvönen, H. & Salonen, E. 2013. B.Sc. Thesis for Degree Programme in Podiatry, Metropolia University of Applied Sciences.
Abstract: The aim of this study was to examine if LymphaTouch® treatment method, which activates the superficial lymphatic capillary network, is suitable for the American football players' re-covery between practices. There was a need for this kind of study because more knowledge about the possibilities of LymphaTouch® treatment method is needed. The cooperation partners in our thesis were HLD Healthy Life Devices Oy, the developers of LymphaTouch® treatment method and Kir-Fix Oy who lent us the LymphaTouch® equipment. In addition, Vantaa TAFT was our cooperation partner and our study sample consisted of eight of the team's players. The treatment period was executed in April and May 2013 and the treatment was given in the team´s sport stadium facilities after practices. The suitability of LymphTouch® treatment method was estimated by players after the treatment: they compared their recovery after LymphaTouch® and without it.
Both quantitative and qualitative methods were used in this study. The material was collected by using questionnaires.
The results of this study showed that especially experiencing muscle stiffness but also muscle soreness decreased among players after LymphaTouch® treatment compared to recovery without treatment. The treatment did not seem to have any effect on performance. According to most players LymphaTouch® treatment is suitable for enhancing recovery.
The results of this study are quite promising but because of the small study sample the results can't be generalized. These results can be utilized by the users of LymphaTouch®, for example podiatrists, physiotherapists and lymph therapists.
Effect Of Lympha System Activation In Athletes' Recovery
Sanelma, H. 2013. B.Sc. Thesis for Degree Programme in PhysioTherapy, School of Healhcare, Rovaniemi University of Applied Sciences.
The aim of this study was to gather information of the positive effects of using lymphatic system activation for athletes recovery from daily training. Test subjects were athletes from Finnish junior and A- national team of Nordic combined. The activation of lymphatic system was done with LymphaTouch® device using recovery treatment protocol. The results of this study are based on subjective experience of test subjects. Purpose of this study was to give new information about using LymphaTouch® in sports for study commissioner, HLD Ltd.
Quantitative research method was used in this research. During the intervention, test subjects were answering to questionnaire for their daily experience of training strain, recovery and their subjective benefits from the treatment. The test subjects were 15-21year-old active national team level athletes. The intervention was carried out on the Finnish national teams last training camp preparing them for the season.
The results of this research show that the athletes felt the recovery treatment with LymphaTouch® device benefited their training with better recovery.
Is LymphaTouch-Treatment Effective For Shin-Splint? A Quantitative Study On Patients' Experience
Moilanen, T. & Päivänen, J. 2012. B.Sc. Thesis for Degree Programme of PhysioTherapy, Social Service, Health and Sports, Savonia University of Applied Sciences.
Abstract: The purpose of this thesis was to determine how LymphaTouch® treatment

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effects on anterior leg pain and physical exercise among research group. The aim of the study was to examine, whether research persons leg pain was reduced and whether their moving ability was increased during the treatment. Pain was evaluated during palpation, walking, running and on rest. Moving ability was examined by person's subjective disadvantage to exercise caused by shin splint, and by painless walking and running distance. The aim was also to gather experience of LympaTouch® treatment on general level.
Twenty research persons received six LymphaTouch® treatments in period of three weeks, all with identical treatment procedure. The measurements for the study were made just before the first, and after the last treatment. The instrument for this trial was developed based on previous studies and theory. NRS-scale was used for measuring pain. Research group consisted of women and men, aged mostly from 18 to 30. Persons exercised regularly and suffered from anterior leg pain, which was increased after exercise and had existed at least a week.
When compared the means of existing pain, there was reduction on every measured aspect, especially in cases of pain on rest and during running. Disadvantage to exercise caused by shin splint, was reduced. Painless walking distance was increased among 40 %, and painless running distance among 25 % of research persons. 65 % of research persons told that they experienced at least a little help from LymphaTouch® treatments as 10 % told they received no help at all.
The trial suggests that there might be use for LymphaTouch® treatment in care of shin splints though further study should be made with larger research group and more controlled trial.
The Effectiveness Of LymphaTouch-Treatment In Carpal Tunnel Syndrome
Röntynen, J. & Tuomainen, M. 2011. B.Sc. Thesis for Degree Programme of PhysioTherapy, Social Service, Health and Sports, Savonia University of Applied Sciences.
Abstract: The purpose of this study was to determine effectiveness of LymphaTouch® treatment in Carpal Tunnel Syndrome.
The study subjects were applied by advertisement and private persons who had very likely the carpal tunnel syndrome were included in the study. Ten study subjects were participating in this study, and six of them had the treatment in both wrists. Therefore, the sample size of this study was 16 wrists (n=16). Seven wrists were diagnosed by a doctor.
LymphaTouch® treatment was given six times to the study subjects with model of carpal tunnel treatment. Treatment was given 2-3 times a week on average. In first and last course of treatment the study subjects filled the initial and the final questionnaires and they were tested with the initial and the final measurements. After three weeks from the last course of treatment the study subjects filled another final questionnaire. The effect of treatment to the symptoms and hand function were determined in questionnaires and measurements. In questionnaires the study subjects evaluated the volume of symptoms with visual analogue scale. Hand function was measured with Jamar the hand grip strength meter, Pinch the thumb opposition strength meter, goniometer and Phalen's, Tinel's and Tetron's provocative tests. Numeric study material was analyzed by counting arithmetic means and ranges. Open questions were analyzed by itemizing the contents.
LymphaTouch® treatment effected individually and the differences in treatment effects between the study subjects were high. LymphaTouch® treatment reduced experienced symptoms (50 %) and hand function improved on average except hand grip strength. In addition the degree of disability to symptoms in daily living reduced (51 %).
LymphaTouch® treatment reduced the symptoms of carpal tunnel syndrome and improved

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the hand function at least in short-term. LymphaTouch® treatment is worth of trying as alternative conservative treatment. More research is needed because the sample size of this study was small.

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PROFESSIONALS' TESTIMONIALS AND ARTICLES

JeAfcfrtiveey NeTgautcivke-ePrress- ureATchteirvaepy: ENnehganactiinvgeL-yPmrpehsFslouwre
Therapy: Enhancing Lymph Flow

One of the most neglected systems of the body is the Lymphatic System. Despite

the lymphatic system's function to clear all the toxins and impurities in the body

and to maintain pressure in the system,it is only recently getting the attention it

deserves. The lymphatic system absorbs fluid, macromolecules, microorganisms, toxins, waste products and foreign substancesfrom the interstitial tissue.Numerous

Clinical Spotlight March

substances(electrolytes, proteins, hormones, toxins, debris) and immuno-competent cells (lymphocytes,

macrophages) pass through the regional lymph nodes, where this fluid is filtered, purified and

concentrated. Scar tissue, increased muscle-connective tissue thickening, and dense fibrosis are factors

that can lead to poor lymph drainage and poor treatment outcomes.

A patient's history will help you determine if the lymph systemhasbeencompromised.Commonsymptoms that suggestthe lymphatic system needsspecific treatment include bursting pains,tightnessor tension,limb heaviness,cramps, pins and needles,decreasedskin and joint mobility, increased limb circumference afantdigue. The most common noninvasive treatment technique is hands-onmanual therapy providing gentle, light-touch to influence the whole body. However with the popularity of super-pulsed laser (MultiRadiance), and now the negative pressure (decompression) devicessuch asLymphaTouch, it is well within the scopeof the Chiropractic clinic to offer thesepatients another therapy option. Usinga machine rather than `touch lymph' drainage can influence acute and chronic inflammation, tissue engorgement, plugged ducts, wounds, fissures, ulcerations, bruises and dermatitis (eczema).I especially like the device for pre- and post-surgical cases,scars,and other post-trauma cases.

With our increasedawarenessof the fascial systemit's important to note that new lymph vesselscannot grow through scar tissue or fibrosed tissues.
Cupping,which has becomevery popular, only offers static negative pressure against the skin in a very local area. The use of a negative pressure devicelike the LymhpaTouch allows gliding along the skin from `foot to face',which can facilitate and stimulate the natural peristaltic contractionsof the two to three
layers of muscleslocated along the lymphatic pathways, also called lymphangions (Mislin, 1961).

Many therapies are designed to remove stagnating fluid, toxins, and wastes, all of which will be drained through the flow of lymph. If you follow the biohacking community, there is an ever increasing discussion about our `toxic load' from the environment, poor food choices,metabolic waste, after-exercise overload, lactic acid build up, etc. Someof the approaches biohackers use include cryogenic chambers,ice baths, or cold showers. These are all meant to have patients feel invigorated. Other treatments include vibration plates (improves blood flow), and red (infrared and laser) lights to stimulate your mitochondria.

Anything that we can do aspractitioners to enhancethe flow of lymph via its passagethrough lymphatic nodes,will allow the body to generateproduction of more lymphocytes to reinforce the immune response and accelerate contact antibodies/ foreign substances.Throughout the course of my day as a hands-on practitioner I often feel like I am moving trapped fluids around. The useof LymphaTouch asa stand alone or in combination with `super-pulsed laser therapy' can reach trapped and excessfluid directly under the skin. The immediate goal of treatment is softening of the tissuesand reduction in the fluid.

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References: Carati, C.J.,Anderson,S.N.,Gannon,B.J.,andPiller,N.B.(2003). Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial. Cancer98, 1114-1122 Horvath, Z.,and Donko, Z.(1992). Possibleab-initio explanation of laser "biostumulation" effects.In: G.galletti, L ., Bolongnani, and G.Ussia(eds.). Laser ApplicationsinMedicine and Surgery. Bologna: Monduzzi, pp.57-60 Iivarinen, J.T., Korhonen, R.K.,& Jurvelin, J.S.(2016). Modeling of interstitial fluid movement in soft tissue under negative pressure­relevanceto treatment of tissue swelling. Computer methods in biomechanics and biomedical engineering, 19(10), 1089-1098. GrecoM, GuidaG,Perlino E, Marra E and Quagliareiello E 1989. Increase in RNAand protein synthesis by mitochondria irradiated with helium-neon laser. BiochemBiophys ResCommun163(3): 1428-1434. Moriyama, Y.,et al.,In vivo effects of low level laser therapy on inducible nitric oxide synthase.LasersSurgMed, 2009. 41(3): p.227-31. Schleip R.Fascialplasticity--a new neurobiological explanation: part 1. JBodyw Mov Ther. 2003;7(1):11­19. Schleip R.Fascialplasticity--a new neurobiological explanation: part 2. JBodyw Mov Ther. 2003;7(2):104­116. Tucker J.www.dynamicchiropractic.com/mpacms/dc/ pi/article.php?id=56846
Dr . Jeffrey Tucker , DC
Dr. Tucker's interest in putting together the arts and scienceof Pilates,yoga,stretching, medicine balls, stability balls, rubber tubing, balancetraining, chi gong,weight training, cardio training, endurance training, diet, chiropractic, performance enhancement,muscleand massagetherapy, has beenevolving for more than 30 years.
Dr. Tucker completed Chiropractic training at LosAngelesCollegeof Chiropractic. He has a post graduate Diplomate degreein Rehabilitation and is certified in chiropractic spinal trauma. Heis a past-president of the SantaMonica Chiropractic Society. Dr. Tucker is the current president of the American Chiropractic AssociationRehabilitation Council.He is a member of the California Chiropractic Association and the American Chiropractic Association. He won a KARMAaward and was named Chiropractor of the Year from the Los AngelesAlternative Medicine group. He is the designatedand selected Chiropractor for The MassageTherapyCenter in Los Angeles.He is author of numerous articles and publications on soft tissue injuries. He has been in continuous active practice for the past 30 years in the west LosAngelesarea. He hascompleted advancededucation and clinical training in rehabilitation, sports medicine,nutrition, and functional exercisetraining.
Dr. Tucker continues teaching other doctors speakingon biohacking, exerciseas medicine and current treatments to other Doctors around the country. He teachespost graduate training in the cervical spine, lumbar spine and temporomandibular joints (TMJ).His practice includes chiropractic, postural assessment/conditioning, gait analysis,therapeutic exercise,and muscle/ soft-tissue therapy.
Dr. Tucker serves the communities of SantaMonica, West Los Angeles,Beverly Hills, Marina del Ray,Encino, Brentwood and Los Angeles.

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Erja Kouri & Monica Ebneth-Pihlaniemi - Efficient Therapy Together With Active Exercising
We have used LymphaTouch in physiotherapy from 2010 as a part of therapy in musculoskeletal disorders, pain and fascial therapy, scars, and pre- and postoperative treatments of swelling.
Musculoskeletal disorders make up a large area of our physiotherapy practice. One part of this includes treating joint related pain disorders and the loss of mobility in acute and chronic phase in order to reduce pain, swelling and improve the range of motion. Proper functioning of the lymphatic system is critical to our body´s ability to regenerate tissue and recover optimally. Following traumas and sport injuries, for example ankle sprains, LymphaTouch treatment should be started as soon as possible and done preferably on daily basis for good treatment results and optimal recovery.
Our physiotherapy practice uses LymphaTouch also for pre- and postoperative treatments. One of our suggestions is a preoperative treatment one day before the operation. In case of our clients, these operations mostly include knee, hip or shoulder operations. Scar treatment consists of several treatment techniques and it is started after the stiches have been removed. Scars with poor mobility are sometimes treated even months after the operation.
Fascial treatments are one important part of manual therapy techniques and LymphaTouch is a great device for fascial system treatment combined with manual therapy. The device helps to reduce pain through fascial stretch and decompression of tissues; this is achieved through a suction combined with an upward lifting movement and rotation. With its really sensitive measures, LymphaTouch works extremely well also with low decompression and is often the best way to start fascial treatment as well as to help balancing recovery in sport injuries. In soft tissue problems, LymphaTouch gives a good pain reduction and it works efficiently together with active rehabilitation and training.
We recommend LymphaTouch for physiotherapists, who work frequently with musculoskeletal disorders, active rehabilitation after operations, sport injuries and traumas where swelling and scar tissue is an everyday problem.

Mike Voight & Ashley Campbell ­ Powerful Tool In A Toolbox For Hip Patients
At Nashville Hip Institute we have found the LymphaTouch to be a very valuable modality for decreasing soft tissue pain and dysfunction. It is very common for our hip patients to have quite a lot of soft tissue pain both near and distal to the hip joint and the LymphaTouch allows us to decompress and/or desensitize the tissues allowing for improved mobility and better neuromuscular activation. We are very excited to have this powerful tool added to our toolbox!

Mike Voight
PT, DHSc, SCS, OCS, ATC, CSCS, FAPTA

Ashley Campbell
Director of Rehabilitation, PT, DPT, SCS, CSCS

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Leena Vallin ­ Excellent Tool For Comprehensive Care
Sairaanhoitopalvelu-Leena produces service for pain management and manual lymphatic drainage in Porvoo, Finland. Operation started in 2007.
Leena Vallin, yours truly, is a nurse and entrepreneur but also the only person working at the company. I'm a nurse who is specialized in internal medicine surgery with working experience of 30 years in health care. I have finished my degree in Pain Management Expertise in JAMK University of Applied Sciences in 2000-2002. I graduated as a lymphatic therapist in 2009 when I also purchased my very first LymphaTouch device. Since then, I've used it every day with every single of my patients in treating both pain and swelling. It is impossible to count the hours used with the device anymore! Number of patients has been more over 900 treatment sessions per year at best. But now I've been consciously trying to reduce the number of patients.
LymphaTouch device is an excellent tool for comprehensive body care. Device works as a third hand of a nurse/therapist. It helps gently to treat tissues and structures that would be hard to reach with own hands (e.g. suboccipital muscles, intercostal muscles and joint spaces). However, it is important to understand some physiology, anatomy and biochemistry to justifiably support body functions with the device and choose proper settings and pressure values for treated area.
LymphaTouch helps me to activate tissue metabolism, mobilize skin, connective tissue and muscles and treat joints and fibrotic tissue easily and effectively. Negative pressure is gentler way to treat sensitive and fragile skin compared to hands. In terms of neuropathic pain, negative pressure might be the only method that painful area can tolerate without pain increasing unbearable. LymphaTouch is a game changer is reducing swelling. I can activate lymphatic system fast and effectively by pulling the tissue. I can redirect fluid with negative pressure according to watersheds. Negative pressure combined with high frequency vibration soften up and break fibrotic tissue, developed by swelling, better than manual treatment. LymphaTouch treatment is cost-effective, since LymphaTouch treatment fastens up the results of the treatments and shortens up treatment sessions.
I use LymphaTouch for acute (e.g. sprains, ruptures, bruises, postoperative pain, acute muscle related pain etc) and chronic pain (MSD, rheumatic pain, arthrosis pain, cancer related pain, metabolic diseases, diabetic neuropathy, CRPS etc.) management. Most of my patients are affected by lymphedema as a result of mechanical dysfunction of lymphatic system after cancer surgery or radiation, and also lipedema patients.
I recommend LymphaTouch-device for all therapists who deal with body care in their work.
Leena Vallin, Nurse, Specialist in Pain Management, CLT, Entrepreneur Sairaanhoitopalvelu-Leena www.sairaanhoitopalveluleena.com leena.vallin@pp.inet.fi

34 Justine Whitaker ­ Improving Veteran's Lives With LymphaTouch

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Natalie Perkins ­ From Big Hesitation To Great Impression
I am a physiotherapist with an additional degree in exercise physiology with nearly 30 years of experience almost exclusively in the treatment of musculoskeletal conditions.
I have travelled the world with a sport team for a decade, been involved with the treatment of Olympic athletes, professional football players, elite gymnasts, high level rugby players, low level soccer players and nursing home patients and assisted mums, dads, kids and grandparents with their pain and dysfunction so I've pretty much treated the full spectrum of the community and until recently I relied on my hands....and my hands alone.
Over the course of my career I have trialed a number of various therapeutic devices, all promising miracle cures for my patients with the touch of a button but, whilst a number of them did indeed have a positive therapeutic effect, they were never able to achieve the same results as I could achieve with my own hands......until I discovered the LymphaTouch.
I was shown the LymphaTouch by a colleague (the Director of Rehabilitation Services at a world renowned hospital) and on initial glance was not impressed. It looked like it was just a fancy, westernised form of Chinese cupping (which I had used previously in my career with some good effect but again, found better results with my own 10 digits with the added value of not leaving alien love-bite marks on my clients). More out of politeness and respect for my colleague, I agreed to trial the device as he was interested in my professional opinion and I suspect quietly smug that he knew, despite my well known distain for "toys" that I was going to be impressed. He was not wrong!
I was able to assess the soft tissue of the next few clients before and after the application of the LymphaTouch and had to reluctantly but excitedly concede that the device had indeed made a significant difference to the activity of the tissue. More than anything however I was impressed at how the result was achieved without any form of discomfort to the patient. Many times the manual soft tissue releases I have performed were incredibly effective but unfortunately also highly uncomfortable for the patient. I always maintained that if I could somehow achieve the same results that my hands did without the pain of treatment then I have hit the jackpot. With the LymphaTouch I have pretty much done just that.
I now have a team of staff, all of whom fight each other for possession of the LymphaTouch on a daily basis and, as a clinical educator for final year physiotherapy students from both Australia and the USA, each of them has left their clinical placement with me with the goal of getting a LymphaTouch into the first clinic they work is so that they can continue to provide clients with the same great results that they were achieving on their clinical placement. The application of the LymphaTouch is not only an asset for patient care (always the primary objective in my mind) but also alleviates stresses on the hands of the therapist. My hands wish I had discovered this device years ago and whilst it cannot reverse the arthritic changes that have already occurred in my fingers, it most certainly will minimise further deterioration and already has reduced the pain I previously experienced on a daily basis.
My single greatest criticism of the LymphaTouch is that previously patients would be in awe of the relief that my hands

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would give their aching bodies. They would tell me how amazing and skilled I was. Now they tell me how clever the LymphaTouch is and how much they love IT! The true genius of this device is that even the worst manual therapist will still get fantastic outcomes using a LymphaTouch!
Natalie Perkins Principal physiotherapist Bodyworks consulting Australia
Peetu Lehmus ­ Extra Boost For Athlete Rehabilitation
Olen käyttänyt LymphaTouch® -laitetta noin puoli vuotta yksityisellä fysioterapian vastaanotolla, jossa valtaosa asiakkaista on urheiloita. Käyttötarkoitus on ollut pääasiassa urheiluvammat jänne- ja nivelalueet sekä lihasrepeämät, mutta myös lymfakierron häiriöt sekä palautuminen. Laite on käytössä viikoittain kuntoutuksen ja hoidon tukena.
LymphaTouch® -alipainehoito on ollut toimiva hoitomuoto heti akuutin tulehdusvaiheen jälkeen aina kuntoutuksen loppuun niin kivunlievityksessä, turvotuksen poistossa ja vamman paranemisessa. Toki tutkittua faktaa kaipaa lisää omien kokemusten tueksi.
LymphaTouch® -laite on erittäin helppokäyttöinen selkeällä näytöllä ja ohjeilla. Säädöt ovat kaikki nopeasti ja helposti samaan aikaan saatavilla.
I have used LymphaTouch® for six months. I work as a physiotherapist in my own practice where I work mostly with athletes. I have used LymphaTouch® for sports injuries (specially tendon and joint related) but also for muscle injuries, lymphatic problems and recovery treatment. Device is used weekly to give extra boost in rehabilitation and treatments.
LymphaTouch® negative pressure is very capable treatment from after acute inflammation until the end of the rehab. It works for pain relief, increasing lymph circulation and injuries. More scientific facts still needed to support own experiences.
LymphaTouch® is very easy to use, simple with good instructions. You can adjust everything from pressure to pulsation quickly at the same time - easily.
Peetu Lehmus PT, Athletic trainer

37 Axis Fysio ­ A Great Tool In Lymph Therapy
PhysioTouch®atool in lymph therapy and osteopathy
IINNTTEERRVVIEIEWWAXAIXSISFYFSYISOIO
 

2

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PHYSIOTOUCH®
IN LYMPHATIC THERAPY
The most important function of the lymphatic system is to keep the colloid osmotic pressure in the interstitial space low by transporting away the plasma proteins. The lymphatic system elso transports dead cell rests, inflammation cells, bacteria's, extra fat cells etc.) away from the interstitial space. Removal of the proteins and reduction of inflammation in an early stage reduces the possible risks on target organs and furlher complications.
One of the main functions of manual Bymph therapy is to invigorate the lymphatic flow and reduce edema. Manual therapy consist of mild constant end rhythmical grips which activates the contraction of the lymphatic trunks.
The PhysioTouch® treatment activates the superficial parls of the lymphatic system stretching the anchor filaments which widens the endothelial holes of the lymph capillaries and enables the cell rests and lymph to flow into the lymph capillaries and improves the lymphatic circulation. The PhysioTouch makes a horizontal and vertical movement of the tissue which makes it possible for bigger sized particles and proteins to get into the lymphatic system and there by transported away from the interstitial space with the lymphatic system. The PhysioTouch is also very helpful treating lymphedema patients and fibrotic tissue which have occurred because of long term edema and changes of the tissue circulation.
The most important function of the lymphatic system is to keep the colloid osmotic pressure in the interstitial space low by transporting away the plasma proteins. The lymphatic system also transports dead cell rests, inflammation cells, bacteria's, extra fat cells etc. away from the interstitial space. Removal of the proteins and reduction of inflammation in an early staqe reduces the possible risks on target organs and further complications.
3

39 Hyvinkään Fysioterapia ­ Relaxing Treatment For Neurologic And Disabled Individuals
PhysioTouch®Treatment in Rehabilitation of Neurologically and DisabledIndividuals
PROFILE Päivi Tolppanen
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Neural tissue refers to nerve fibers and the structures immediately surrounding them. Such as connective tissue membranes, blood vessels and lymph vessels. Neural tissue is closely connected to other features of the body, Such as muscle activity, lymph vessels and fascial structure.
Under normal conditions, neural tissue can move freely between muscles, bones and various types of connective tissue membranes. Such as fasciae. The normal movement of nerve tissue may become limited as a result of restricted joint mobility or muscle tightness. causing symptoms Such as radiating pain. When a nerve is constantly compressed or stretched, the transport of nutrients inside it is impaired, increased secretion of causing inflammation mediators. The
PhysioTouch® treatment method can be used to release tissue structures and restore normal function to the neural tissue. At the same time, metabolic activity in the surrounding tissue is stimulated so that harmful particles are removed from the target area.
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University Hospital Queen Jovanna ­ Synergy Effect Of Combined Therapy

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PATIENT TESTIMONIALS AND ARTICLES
Susan's Story ­ The Impact Of Lymphedema

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Marina's Story ­ Back To Playing Flutes After A Serious Wrist Break And Painful Neuropathy
"The LymphaTouch machine has been a vital part of my healing from a serious wrist break, titanium implant surgery and many months of extremely painful neuropathy.
When I began my PT sessions, I had already had six weeks of Occupational Therapy, which had not helped much. My shoulder, elbow, wrist and fingers were all locked. My surgeon recommended that I should have Stellate Ganglion Blocks as pain management. He also said he didn't know if I would ever be able to play my flutes again. (I am a recording artist who plays wooden flutes.) I had no interest in nerve blocks or pain management. I wanted healing!
Then I started sessions with my PT on this amazing machine. It took time, sometimes two sessions a week and then down to one weekly, and finally, every 2-3 weeks. Together with my PT's gift of healing, the LymphaTouch and persistent homework on my part, I have recovered about 95% of my range of motion. I will continue until I am 100%. All of my nerve pain is gone completely, and I am able to play my flutes again!
My deepest gratitude to the developer of this marvelous machine. It has helped me to regain my life."
Marina Raye
Black Mountain, NC May 9, 2015
Tammy's Story ­ Head And Neck Cancer Survivor
"This device helped me, and it saved
my life. And I know it can help other people too.
-Tammy Woodham, cancer survivor
Tammy Woodham was diagnosed with stage III tongue cancer that relapsed two and a half years later with multiple metastasis in her head- and neck-area. She went through several surgeries, chemotherapy and radiation which all caused her major problems in both speaking and functionality of face, neck and upper body and activities of daily living. She worked long time with a physical therapist to treat the swelling that was caused by cancer treatments and found out that she has a disease called secondary lymphedema.
Eventually she met an occupational therapist Kathy Konosky from the University of Michigan who treated Tammy with several methods to reduce the swelling. Once Kathy used LymphaTouch on her, the effect was instant. LymphaTouch immediately released all the pressure that Tammy has had in her chest for a long time and she felt herself free again. She can move and talk much better than before LymphaTouch® treatments.
See Tammy's story full-length at https://www.lymphatouch.com/

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LEARN MORE ONLINE
Technical Note: PhysioTouch Adams, A. 2016. Rehabilitation Oncology, 34(1), 49-50. Manual Strategies: Optimizing Patient Outcomes In The Clinic Donahue, P. 2019. Performance Health Academy. LymphaTouch As A Tool For Manual Lymph Drainage: A Therapist's Perspective Kimball, K. D. 2018. Elizabethtown College. Emerging Technologies in Rehabilitation Medicine Marovino, T. 2018. Practical Pain Management. Negative Pressure Treatment Benefits Patients with Head and Neck Cancer Symptoms McGinty, K. 2019. Performance Health Academy. Lymphatouch Brings Therapeutic Excellence For Faster Recovery Rautiola, E. 2019. Innokas Medical Business Blog. New Approach To Thoracolumbar Fascia Pain Tucker, J. 2014. DC Practice Insights. Lymphatic And Fascial System Treatment: Time To De-Compress Tucker, J. 2014. DC Practice Insights. Negative Pressure Treatment: An Innovative Therapy Method For Faster Recovery Väyrynen, M. 2019. Omni-Athlete blog post.
READ THE ARTICLES FROM OUR WEBSITE LYMPHATOUCH.COM
REMEMBER TO CHECK OUR BLOG AT WWW.LYMPHATHERAPY.COM/BLOG
FOLLOW US IN SOCIAL MEDIA

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LymphaTouch Inc. Valimotie 13 A FI-00380 HELSINKI Tel. +358 10 423 7300 Fax +358 10 423 7309 contact@lymphatouch.com lymphatouch.com
Contact your local distributor for additional requests.
LymphaTouch® and PhysioTouch® units are CE certified and FDA Class 1 Exempt devices. RX Only. LymphaTouch Inc. is ISO 13485:2016 certified. Always read contraindications and user manual before using the device. If you are uncertain of the suitability of the device for the treatment, always seek advice from healthcare professional prior to starting the treatment. © Copyright 2020 LymphaTouch Inc. All Rights Reserved. MKTG-6-3