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Edema

I had a client contact me with the following info (pasted below) about Edema in her ankles. I have basic MLD training from my core massage school, but no specialty training. Are there any other important questions I should ask? It has been a while since my MLD training, are there any resources with reminders? Any other tips or suggestions I can share with her? I think the key is that she has been treated for hypothyroidism. Are there any natural remedies I can share with her?

Here is the e-mail:

I have , pretty much all of the time, swelling in my left ankle. I've not (to my knowledge) injured it nor have I had surgery or an illness (that I know of) that would cause this. And i've had it for years. It's not painful but it is uncomfortable.  I am current on all of my bloodwork and nothing is unusual . I am (and have been for over 25 years being treated for hypothyroidismism but, my medication and thyroid levels are currently stable . I also have fibromyalgia and  was on medication for that but it caused side effects that were not desirable so I stopped taking it. 
Additionally I have constant pain/numbing/tingling in my feet - they hurt all of the time even when I am not on them. And as i said my blood-work is normal so no one knows what the heck is going  with the swelling and foot pain. Not sure there is any connection in all of this. But it was suggested to me by some of my  friends who work in alternative therapies that a massage may be helpful  and someone also mentioned lymphatic draining .  

Thanks for all the help!

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Permalink Reply by Gordon J. Wallis on June 15, 2015 at 3:25pm
This is how I think on this, and its only my opinion. Over the years I've learned it's often best not to over think. When I read about her problem.. I know she has trigger points( and I bet a whole bunch ). As a professional massage therapist that is something I can address and deal with while staying within my license. It sounds like she is under medical care and that all the mean nasty stuff has been ruled out or not discovered. Well one thing not discovered or ruled out in her case is trigger points. If she was my client. I would focus on eliminating those trigger points. Fibromyalgia to me means TRIGGER POINTS. If you can eliminate those trigger points, you will help that client a great deal.. And who knows? Maybe even the ankle swelling will go down. Trigger points cause a plethora of problems that she does not need. As a massage therapist, thats what I would focus on. The one thing that can make a huge life changing difference. Trigger Points.
Permalink Reply by Coby Dulitzki on June 15, 2015 at 4:13pm

Hey Gordon,

I appreciate your enthusiasm for Trigger Points as I use them quite often myself (I'm trained in TCM Acupressure) and it is a much favored technique of mine. Nonetheless, my training indicates that MLD (Manual Lymphatic Drainage) is a much lighter, superficial approach that targets the lymphatic system--more appropriate for draining edema--rather than the deeper trigger points which target the neuromuscular system. I fear that the direct pressure on an already swollen area may cause further discomfort. Although I may incorporate trigger points elsewhere in the session, I would like to hear about more specific treatments available for Edema as may be caused by hypothyroidism--especially any type of drainage technique.

For any sequential users that come across this post in need of similar advisement, I've discovered some links that have already proved useful:

Holistic clinical article of hyper- and hypothyroidism entitled:
The Clinical Picture of Hypothyroidism
|--> http://holisticprimarycare.net/topics/topics-h-n/healthy-aging/94-t...

Manual Lymphatic Drainage (MLD) video entitled:
"Leg & Thigh Lymphatic Massage For Swollen Feet & Ankles, Advanced Massage Therapy Techniques"
|--> https://www.youtube.com/watch?v=hznLNVsspfo

Ayurvedic video entitled:
"Swollen Legs Tips - Swollen legs feet ankles treatment -Quick health tips by Sachin Goyal"
|--> https://www.youtube.com/watch?v=Qn3wUzDNoDw

Pain solution article entitled:
"Ankle Edema: Causes and Natural Ways to Get Rid of Swelling of Ankles"
|--> http://www.epainassist.com/joint-pain/ankle-pain/ankle-edema

Permalink Reply by Gordon J. Wallis on June 15, 2015 at 5:19pm
Well, my experience has shown me that Trigger Points can and do cause swelling. Contricted muscle fibers can block lymph flow and cause swelling. And with the diagnosis of Fibromyalgia, she has trigger points. You can certainly try MLD, and I could be wrong, but with the presents of Trigger Points, I don't think it will be very effective. And most if not all Trigger Points can be eliminated with only a light touch via a distal point. Any way, I hope the MLD works for her.. I'm just giving my opinion.. Ive been able to help a surprising number of people because I've been the only one that ever thought Trigger Points.
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Permalink Reply by Therese Schwartz on June 16, 2015 at 8:12pm

My first thought about the pain she's experiencing is neuropathy; has she been checked for diabetes?  I wonder if that would cause the swelling as well.  There was a really good article in Massage and Bodywork Magazine about massage for neuropathy.  However, that won't address the swelling.

I'd suggest that it depends on the degree of swelling whether or not you do lymph work; when I took LDT (Lymphatic Drainage Therapy) through the Chickly Institute they wanted us to be very, very cautious about working with lymphedema. 

Permalink Reply by Therese Schwartz on June 16, 2015 at 8:36pm

I tried to edit this but it didn't work.  

She said her bloodwork was normal but I'm wondering if they included a diabetes check.

Other edits:  I took LDT 1 (left that 1 out originally).  And they recommend that people be lymphedema certified before working with lymphedema.

This probably now makes less sense than it could!


Therese Schwartz said:

My first thought about the pain she's experiencing is neuropathy; has she been checked for diabetes?  I wonder if that would cause the swelling as well.  There was a really good article in Massage and Bodywork Magazine about massage for neuropathy.  However, that won't address the swelling.

I'd suggest that it depends on the degree of swelling whether or not you do lymph work; when I took LDT (Lymphatic Drainage Therapy) through the Chickly Institute they wanted us to be very, very cautious about working with lymphedema. 

Permalink Reply by Gordon J. Wallis on June 17, 2015 at 4:52am
Some info I found on the net. Next two attachments.
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Permalink Reply by Gordon J. Wallis on June 17, 2015 at 4:52am
Second attachment.
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Permalink Reply by Gordon J. Wallis on June 17, 2015 at 5:07am
I'm assuming the medical docs ruled out all the mean nasty stuff that could cause her adema, like an infection and so on? I wounder if they ruled out trigger points?
Permalink Reply by Gordon J. Wallis on June 17, 2015 at 3:39pm
The swelling involves only one ankle. That could mean that same side Sacroiliac involvement. If it was both legs or ankles that could mean a more systemic involvement( heart, cirulation, lymphatic system ). You might want to palpate the affected side Sacroilliac area and compare it to the none affected side. If the affected side is more sore( TPs )... You will want to loosen that hip area up.
Permalink Reply by Cath Cox on June 18, 2015 at 9:07am

In my experience when it comes to idiopathic edema, medical professionals are slow to find the cause until a serious problem occurs. Before working too deeply or aggressively, I'd want written clearance from a physician specifically ruling out DVT and systemic infection.

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