Decreasing Lymph Volume With the Use of Deep Oscillation Therapy

Candice D. Young E.d.S., COTA/L, CLT

Lymphedema, a diagnosis caused by increased lymphatic fluid, can cause long-standing effects without intervention affecting daily living. Categorized by primary or secondary causation, lymphedema creates swelling in the limbs, unilateral or bilateral, causing discomfort, pain, tightness, skin changes, and non-healing wound formation. Because of its various stages, prevention to severe (0–3), treatment interventions depend on the severity, availability of treatment options, and underlying comorbidities. The gold standard of treatment is complex decongestive therapy (CDT) that includes manual lymph drainage (MLD) to reduce the lymph volume and is minimized in two phases using best practices (Curlett et al., 2020; Dayan et al., 2018). Dayan et al. (2018) believe that compression alone minimally affects the outcome of increased lymph volume seen in clients but should be introduced with MLD and other novel therapies. Integrating additional treatments that maximize lymph volume reduction while decreasing the symptoms of discomfort from tightness, non-healing wounds, and skin changes is effective with deep oscillation therapy (Curlett et al., 2020). With an increasing rise in Americans diagnosed each year, the impact of quality of life consistently affects millions and is a biomedical burden (Dayan et al., 2018). 

Deep oscillation therapy dates back to the early 18^th century to create non-traumatic effects post-surgery and increase healing time because of its deep penetration of the skin's tissue of 8cm. (Locheva et al., 2019). Today, deep oscillations are further used to decrease pain, promote wound healing, manage skin tissue, and increase lymphatic flow, stimulating a cyclic motion for fluid to move within the tissue allowing redistribution (Bergmann et al., 2020). The HIVAMAT® 200 uses electrostatic deep vibration techniques in various settings, 5-250 Hz, for specified diagnosis and treatment (Teo et al., 2016), requires minimal training, and is like typical physical agent modalities training. To use, the therapist is connected to electrodes on their forearm while the client holds the titanium bar. To activate the system, the therapist starts the prescribed settings based on the expected outcomes and then applies a vinyl transmitter (gloves) to activate the vibration between the contact surface (the affected client’s limb). The therapist performs a gradient pressure of massage from distal to proximal using MLD hand placement and movements to facilitate lymph reduction ( Teo et al., 2016; Bergmann et al., 2021).

Previous studies have shown that deep oscillation therapy alone does not allow for maximum results; however, increased lymph volume, wound, and fibrotic tissue reduction are evident in conjunction with MLD. Hernandez et al. (2018) performed a study on 401 women diagnosed with fibrotic breast disease. The women were divided into three treatment groups that received different therapy treatment methods to address their fibrotic tissue (Group 1, deep oscillation five days a week; Group II, non-steroidal anti-inflammatory, every 12 hours for three weeks; Group III: medroxi-progesterone, 150mg total dosage prescribed during treatment). While positioned supine, the treatment group received 12 minutes with alternating frequencies in each treatment phase, facilitating vibration to dissolve fibrosis, decrease pain, stimulate lymphatic draining, and increase interstitial lymph flow driven by the frequency set on the HIVAMAT® 200. The result of the study indicated that the change in fibrotic tissue using the HIVAMAT® 200 promoted tissue relaxation. 

In another study, Teo et al. (2016) recruited five participants with lipoedema and lymphedema diagnosis in bilateral lower extremities in a three-week study to understand the effects of the HIVMAT® 200 that produces deep oscillation to decrease swelling in the lower limb in conjunction with MLD. Each participant's limb lymph volume was measured circumferentially at 4 cm intervals distally (malleolus) to proximal (groin). The intervention consisted of MLD and the HIVAMAT® 200 on one lower extremity while the other limb received MLD alone two times a week for three weeks while wearing compression garments between sessions. Although the study’s results were insignificant, the outcome of treatment of the limb that received the deep oscillation therapy had more significant lymph reduction (920 ml) than MLD alone (707 ml) on average.  

Further studies have promoted CDT, and MLD phased treatment, including compression wrapping with short stretch bandages followed by a maintenance phase of skincare, elastic, or inelastic compression garment, self-MLD, and follow-up. However, implementing deep oscillation therapy with MLD and short-stretch multi-layer compression is most beneficial to achieve the desired results. Compression therapy is designed to promote more significant “resorption and improve muscle pump” while minimizing the effects of fibrotic tissues that develop in clients with lymphedema (Bergmann et al., 2021, p. 3). The desired outcome is achieved when combining deep oscillation therapy with the gold standard treatment. 

In conclusion, clients with increased lymph volume can benefit from deep oscillation therapy using the HIVAMAT® 200. Its clinical effects stimulate the tissue's deep layers at an 8cm depth. The desired outcomes are achieved if used during the phased gold standard treatment in therapy sessions. Deep oscillation therapy promotes the reduction of lymph volume, discomfort, tightness, wounds, and skin changes seen with long-standing swollen limbs. 

References

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