Re: Question for Mike Murray

[inconnu]

On Tue, 08 Jul 2003 23:17:18 -0500, EP wrote:

>
> And, does localized massage stimulate the lymph system as stated
by one of the CSC trainers during a Frankie Andreau interview?
>
>

Most certainly it does, Emma

The article here will give you some idea about it. And Lymphoedema, in
addition to surgery and radiotherapy can also be caused by trauma, eg. a
fall from ones bike.

The slant of this article is toward women with breast cancer, but
its wisdom is no less valid. Lymphoedema (basically the swelling of the
glands from any liquid in the lymph glands) is Lymphoedema no matter how
it is caused.

http://www.wessexcancer.org/support/lymphoedema_arm.htm

[Mike Murray]

"EP" > asked:
"Based on this photo, please speculate on what the CSC staff are doing to
keep Tyler Hamilton in the Tour:

http://www.cyclingnews.com/tour.php?id=photos/2003/tour03/stage3/olympia/HAMILTON59
What does this photo reveal besides a lot of tape?

And, does localized massage stimulate the lymph system as stated by one of
the CSC trainers during a Frankie Andreau interview?"

It is hard to tell from that picture what they are doing but I would imagine
that they are attempting to stabilize the fracture using a figure 8 type of
arrangement. A figure 8 is a dressing that wraps around the front of the
shoulder and then crosses in the back holding both shoulders in an extended
(shoulders back) position. This can be done with a strap type dressing or
with tape as it appears they may be doing with Hamilton. Since the clavicle
breaks in compression the fractured ends generally overlap. The extreme
shoulder extended position decreases the amount of overlap and decreases
motion at the fracture site. A figure 8 dressing has, in past, been
standard treatment for clavicle fractures although many doctors are not
recommending them now based on studies that show that patients treated with
slings alone heal just as quickly and in the same position as patients
treated with figure 8s. In addition, studies show that patients treated
with figure 8s complain of more pain relative to patients treated with
slings. My personal experience is that most people get some pain relief by
using the figure 8 at least occasionally. When I see patients with clavicle
fractures I give them both a sling and a figure 8 and I tell them to wear
either, both or nothing at all depending on what makes them most
comfortable.

They may also be taping over the skin in an attempt to increase stability of
the fracture, similar to what is often done with an ankle sprain.
Interestingly, although people generally feel some relief from instability
using tape, it is difficult to show that tape adds much stability.
Basically it stretches out with use pretty quickly. The thinking is that
the sense of increased stability doesn't actually come from structural
support provided by the tape but more from the increased proprioception
(sense of position) provided by the increased feedback from the taped skin.

I am not sure the statement "stimulates the lymph system" is sufficiently
precise but it is correct. Message increases flow of lymphatic fluid.
Lymphatic fluid is the fluid in the body that is not inside the vessels and
not inside the cells. Traumatic swelling is caused mostly by increased
fluid in this space. Lymphatic fluid flows though the lymphatic channels
and eventually is returned to the venous circulation. Fluid moves from
areas of higher pressure to areas of lower pressure. Massage is one way to
put increased pressure on this fluid to push it out of the area of swelling
and back towards the venous circulation. In fact, this is probably the
major reason why massage has any benefit. Compression, e.g. an ACE wrap on a
sprained ankle, and elevation are 2 other ways to accomplish the same thing.

--
Mike Murray MD