Latest / The STA Clinician Podcast / STA203: 'Lymphoedema Management for Manual Therapists' with special guest Jane Wigg

Transcript

STA203: 'Lymphoedema Management for Manual Therapists' with special guest Jane Wigg · The STA Clinician Podcast

0:00
You're listening to the Sports Therapy Association podcast, putting evidence
0:04
back into soft tissue therapy.
0:07
Music.
0:17
Hey people, how are you doing? Welcome to the Sports Therapy Association podcast, episode 203.
0:23
My name is Matt Phillips, creator of OneChatLive.com. and
0:26
as always this episode is being recorded live on the
0:29
Sports Therapy Association YouTube channel and Facebook page
0:32
so if you are listening to the podcast thank you very much I hope you
0:35
enjoy the episode but if you do want to join us live then just head over
0:37
to one of those two locations on a Tuesday generally at
0:40
eight o'clock and you'll be able to mix with the other people who join us live
0:43
and also ask the guests questions directly if you fancy that so very shortly
0:49
in this episode entitled lymphedema management for manual therapists my special
0:52
guest will be Jane Wigg who is internationally acclaimed as being one of the
0:55
leading lights in lymphedema treatment development, research and education.
1:00
As Director of Lymphedema Training Academy, Jane will be discussing shortly
1:04
the anatomy, physiology and pathophysiology of the lymphatic system and how
1:08
you as a manual therapist can recognise and treat lymphedema and chronic swelling.
1:13
As always, if you have joined us live, then do please ask questions far away
1:18
because this is a great opportunity.
1:20
We're really lucky to have Jane along with us podcast tonight.
1:23
But before we begin, we are currently looking for STA members who work with swimmers.
1:30
Why, you ask? Well, because we'd like you to come on the STA podcast.
1:34
Now, don't let that sound too daunting for you. What we're talking about is
1:37
on the first Tuesday of every month.
1:39
If you're not aware, we do an Ask Us Anything episode, which is where we have
1:42
a panel of four or five STA members.
1:45
And next week, so Tuesday, July the 2nd, 8pm,
1:49
the topic is going to be therapy for swimmers so
1:52
if you are an STA member who works with swimmers and you'd like
1:55
to be on that panel do please message me on social
1:58
media or email me matt at thesta.co.uk even if you do work with swimmers but
2:02
you're not quite sure you're a little bit nervous that's totally normal just
2:05
message me and we'll have a little chat I'll tell you what it entail and we
2:09
can discuss it okay so look forward to hearing from some of you before next
2:12
week's episode talking of membership to the the STA,
2:16
there are still some 50% off membership discount codes left.
2:19
So basically, if you do sign up as a new STA member and you use the code 200.
2:25
You could, if there's any left, there's only 20 of them, you could get a 50%
2:30
discount on annual membership.
2:32
It is done on a first-come, first-based method, service, I can't remember the
2:37
word I'm looking for now, basis, that's it.
2:39
And there were only 20 of them available. So I still think there are a few of
2:42
them left. So, and they have to be claimed before July the 4th, 2024.
2:45
So a great chance, 50% off, to be part of the club.
2:48
Right then, let's start tonight's episode, Lymphedema Management for Manual
2:53
Therapists, with my very special guest, Director of Lymphedema Training Academy, Jane Latham.
2:59
Music.
3:13
Hello. Brilliant. Thank you. Thanks for having me. An absolute pleasure.
3:17
I've already absolutely thoroughly enjoyed the 10, 15 minutes we've had talking off air.
3:21
So I'm very excited about being able to share you with everybody of the podcast.
3:25
I do appreciate you coming along. And great to hear as well.
3:27
You're going to hopefully be at Therapy Expo as well.
3:30
Yeah, absolutely. We've got a trade stand for Lymphedema Training Academy and LymphVision.
3:34
And we're also presenting in one of the theatres and also the Hands-On Hub.
3:39
So we'll be looking forward to that. that yeah excellent that's
3:42
gonna be really good i didn't realize that until now so that's made it even more special
3:45
right fantastic so we're going
3:48
to crack on straight into it if that's okay with you the first thing i think
3:52
it would be interesting to know is how you ended up being a specialist in this
3:55
topic and and launching or finding the the training academy yeah well first
4:01
of all thank you everybody that's here if you're turning up live because i know
4:04
there's quite a big match on tonight.
4:06
So I appreciate you coming on or tuning in after as well. So I'm a nurse by background.
4:12
I trained a long, long time ago back in 1986.
4:15
And from training as a nurse, I then went into breast cancer treatment, breast care.
4:20
And of course, people that have had breast cancer may develop a lymphedema.
4:24
So that became an interest for me in understanding why is it that people can
4:28
develop lymphedema following cancer treatment or breast cancer.
4:32
And then a specialist role became available. one of the first in the country
4:36
really as a lymphedema nurse specialist and I was successful in achieving that
4:40
role I always say I managed to con myself into it and get myself that job and
4:45
then I became a lymphomaniac and that became my passion.
4:49
Wow very good and that's what I've done ever since so what I realized back in
4:57
1994 when I first started to train is that there was There's lack of training available.
5:02
So I then set up a training academy. We started the first one in 2002 and then
5:08
continued. And as we do now.
5:10
So originally part time around my full time job and now it's full time, of course.
5:15
So I'm interested to know, this happens quite a lot, but was your reason for
5:20
setting that up because you felt that there was like a lack of information out
5:23
there already in healthcare then?
5:25
Yeah, absolutely. I was very fortunate in that a consultant,
5:29
a breast care consultant at the time, paid for me to go and attend a course
5:33
at the Royal Marsden in London.
5:35
And so I attended that and then the job became available and then I managed
5:40
to do that. So, yes, it was driven by just understanding that there was lack
5:44
of treatment available and lack of good treatment available.
5:48
And I have to say, unfortunately, that's still the case. We keep teaching,
5:52
we keep training and incidences of lymphedema are increasing.
5:56
So incidences of needing more therapists is also the same, really.
6:01
And, yeah, we need to do more to do better and get some good therapists out there.
6:07
And what's the i mean you said it's on the increase i read and i
6:10
was surprised as well because i'm not obviously as i'm so
6:12
thrilled to have you here tonight i'm not clued up enough at all but i was interested to
6:15
read that um statistics show it's reported to
6:19
affect about six people in a thousand depending on age yeah absolutely
6:22
so if you think that as we all get older this
6:25
comes under anatomy really but bits and pieces start to wear
6:28
out a little bit so our lymphatics start to not work as well
6:31
so the incidence is higher as we get older in that
6:34
population so it can be you know 12 in
6:37
in a thousand and it increases with age as
6:40
well so there's 250 000 250
6:44
million people worldwide that suffer
6:47
with lymphedema and because there's lots of different causes which we'll talk
6:50
about later on primary and secondary and so about 100 000 worldwide that have
6:55
primary lymphedema but in the uk it's about 200 to 400 000 people that are living
7:03
with lymphedema every day yes so a big number.
7:08
And you've made it sound like these people could be looked after better then
7:12
if they saw the right person.
7:14
Yeah absolutely not to
7:17
be you know saying that treatment's not
7:20
great but of course within the NHS system then
7:23
limited resources exist so maybe
7:27
we could provide better treatment better care more
7:30
frequently seeing patients or different
7:33
treatments if more funding was available and I
7:35
think that rises the need of patients that
7:39
are seeking elsewhere for private care for lymphedema management
7:42
as well so there I there is I'm
7:45
going to say basic treatment available in the NHS and it's very variable that's
7:49
the problem there are some amazing fantastic lymphedema clinics and services
7:54
that have fantastic resources and carry out lots of different types of treatment
7:59
and there are others where it's very much a postcode lottery where there's basic treatment,
8:04
giving somebody a compression garment and waving goodbye for six months.
8:08
And it needs to be better, unfortunately. There needs to be more,
8:12
Right, okay. For people who aren't aware, maybe can you give us a little definition
8:17
of what, there might be totally different types I'm sure, but what are we talking
8:20
about here and what are some of the symptoms?
8:22
So a classic example of what lymphedema is, is an accumulation of protein-rich
8:28
fluid in the interstitium of the subcutaneous tissue due to a failure of the lymphatic system.
8:33
So it's a high protein edema that sits in the tissue,
8:37
usually because of a failure of the the
8:39
lymphatic system and it's a failure either because you
8:42
don't have enough lymphatics so maybe you're born without
8:46
enough lymphatics that's known as a primary lymphedema or there's
8:49
a genetic mutation meaning that the lymphatics don't grow or develop properly
8:53
so that would be classified as a primary lymphedema and then there's secondary
8:57
lymphedema where something external goes wrong where you may have a normal lymphatic
9:02
system it may be functioning okay but now something's come and triggered it
9:07
to not be able to drain as well.
9:08
So that's classified as a secondary lymphedema.
9:11
And those are the types of things where you develop swelling,
9:14
usually in arms and limbs, but it can be in the genitals and head and neck as
9:19
well, quite often as a consequence of cancer treatment.
9:23
So it may be that the lymph nodes have been removed that filter the fluid.
9:27
It may well be that the system has been cut through and damaged.
9:31
It may well be that in obesity, for example, all that and diabetes and arthritis
9:36
we're not moving as much and therefore we're not pumping that fluid to drain
9:40
away so many many different causes we can talk about in a bit more detail definitely.
9:46
Are there many people, in your opinion, who are coming into our clinics or clinics
9:50
of our listeners and they don't even realise they've got lymphedema or is it
9:54
normally characterised where you know you've been to the GP, you've been diagnosed?
9:59
Yeah, so I would say that many people will develop a swelling and maybe let's
10:06
say it's a post-traumatic injury,
10:08
so they've damaged their ankle and following that you've treated them and the
10:13
edema is reduced but then they've gone out
10:15
the next week and they've damaged their ankle again and that repetitive damage
10:18
to the lymphatic system means that they may be left with a permanent
10:21
damage a chronic edema now that won't resolve
10:25
and won't go away because you've put continuous pressure onto a lymphatic system
10:30
to be able to drain so i think they're possibly the types of people that you
10:34
may see and i'll always when we're teaching say just imagine that somebody's
10:38
had an ankle injury they go out on a sunday play football and it repairs or
10:42
they don't let it heal properly they go the next week they play football again,
10:45
and then they come back and they end up with a permanent lymphedema,
10:48
as it would be after that period of time.
10:51
So they talk about a lymphedema being anything above 12 weeks,
10:55
but we'd say six weeks post-operatively, something should be resolved with the
10:59
correct input and rehabilitation following that.
11:02
So yes, I think that you possibly see many different causes of edema that become
11:08
chronic over a period of time and justify it.
11:12
People justify or go on on a plane and my legs swell i go for a long walk or
11:18
it's hot and my legs swell and they don't think about that being a cause of
11:22
edema or lymphedema they just think it's going to go and they're going to ask
11:26
you about that because there's a couple of interesting things there so first of all.
11:29
I think a lot of our listeners and people who are in the live lounge correct
11:33
me if i'm wrong but a lot of lists are probably in lymphedema i was going to
11:35
be an old person with with compression socks and and it's because their secondary
11:39
lifestyle and that but already you've started suggesting that it could be somebody,
11:42
well, anybody of any age who has been,
11:45
who's had a, maybe a sporting or occupational injury, and it's just developed because of that.
11:50
Yeah, absolutely. And I think those are the common things. So go-to is not always
11:56
potentially the older person who's not very active.
11:59
If we talk about anatomy, we know that we need exercise for lymphatic return and venous return.
12:06
And that's so important. And as people get older, we'll always say something
12:10
like, and it's not strictly true, of course, but somebody retires.
12:13
And now instead of walking around the factory or walking around where they were,
12:16
they're now sitting on the TV with a remote control.
12:19
And so they start to develop swelling because their lymphatics were used to a level of activity.
12:24
And when you take that level of activity out, then the lymphatics start to fail
12:28
because it is muscular activity that is that.
12:31
So we tend to go to that older population. Maybe someone's seen their grandparents
12:35
or someone and their legs have started to swell. well.
12:38
But of course, that can be related to cardiac problems, heart problems.
12:42
And it's not technically what I would call a pure lymphedema.
12:46
It's a combined or a mixed lymphedema. And then you've got, of course,
12:50
the other end where you have got patients who have had a primary lymphedema
12:54
and they've been born with it.
12:55
And those will be your young, I'm going to say generally females, but not always.
12:59
You may have a young female who's doing some sporting activities.
13:03
Playing football ball or playing rugby and they may have another lymphatic
13:07
condition and there's many many others clippy triorni syndromes
13:10
one where you get overgrowth of the muscle and the bone and
13:13
they may have a more swollen leg because of that
13:16
but go on and do their normal activities sporting activities and
13:19
it doesn't hold them back but they'll have that and it will
13:22
reduce maybe their performance levels a
13:25
little bit and they might not know about this or
13:28
is it something that shows up up in bloods or when they kind of go and see
13:30
their gp yeah they they may not know about it
13:33
so showing up in bloods we've just started to
13:36
find genes for the first time it when maybe 15
13:39
years ago we had 20 genes and well we
13:42
had two genes obviously or one gene to start off with and
13:45
now we're on about 25 and latest saying
13:49
that we've got 40 genes because they're all interconnected now we're
13:52
seeing so there's definitely a change of people that have
13:55
a family history or a genetic abnormality that bloods
13:59
can be picking up that genetic component to
14:03
but it may well be that without a
14:06
family history then somebody would be thinking why have
14:09
I started to get swelling on this leg or or both legs and not link it to anything
14:14
else and I think sometimes people make the excuses of our family has big legs
14:18
you know my mom had it my my sister has it and so this is this is what our families
14:24
like and they therefore don't get maybe seek the treatment that they could do because of that.
14:29
Really interesting. And I feel like, and I always feel guilty about this,
14:33
but it feels like we need to add a few questions maybe to the subjective kind
14:37
of medical parquet, which we're giving clients when they come in,
14:40
especially if they're coming with swelling.
14:42
There's probably questions which maybe listeners aren't asking,
14:44
which our listeners tonight should be.
14:47
And part of that maybe is trigger factors, because one of the things we always
14:52
ask women is when did you start your periods?
14:55
What age were you when you went through puberty? did you
14:58
have any swelling in pregnancy or have you increased any
15:01
swelling or have any swelling during the menopause so we
15:03
believe that to be hormone related but there's
15:06
no pure evidence on that but they're
15:10
always triggers particularly for a slightly different
15:13
condition which is known as lipoedema or lipoedema which
15:16
is the abnormal laying down of fat and that
15:19
is present in women men predominantly women
15:23
and it kind of starts with uneven fat
15:26
distribution usually from the hips to the ankles but sometimes just below knee
15:30
or the hips to the knees and around the buttocks as well and very tiny waists
15:35
and sometimes you get that on your arms as well so they have no fat to the rest
15:39
of the body but these bigger legs yeah so that's lipoedema slightly different.
15:44
So what's sort of i mean there's so many questions got in my head now
15:47
and i think gary is don't forget people if you're listening live
15:49
and feel free to drop some comments and gary said i have no idea that the
15:52
numbers of sufferers were so large yeah i think a lot of listeners are
15:55
going to have that same reaction so i
15:58
mean having taught on especially mainstream
16:01
massage sports massage
16:04
courses you're talking with
16:07
anna maria tomorrow aren't you she's got a different course she's putting everything yes
16:10
i'm sure hers is impeccable but mainstream courses it's interesting
16:13
because as anatomy you have to learn the lymphatic system quite a
16:16
lot i mean the exam will have some pretty tricky questions you
16:19
need to learn your stuff but then it's not doesn't seem to be mentioned again
16:22
it's like you've learned that although and instead you're concentrating on your
16:26
ligaments and and and kind of tendons and going into all that sort of stuff
16:30
so it feels like there's something missing there from education where the limb
16:33
system should be involved a lot more in preparing people are going to.
16:37
Potentially working with injury? What sort of things should be involved?
16:40
Yeah, I would say so, because one of the things that's changed over the last
16:44
decade is how important the lymphatic system is.
16:47
And you'll know this, but the lymphatics fight infection and they drain fluid.
16:52
And even when I started 30 years ago in lymphology, I was informed there's no
16:57
need to worry about the immune system part of it. You just need to worry about
17:01
where we're draining to.
17:02
And of course we do because we're lymphedema therapists. is so we're draining the fluid away.
17:06
Of course, what we know now from lots of chronic illness is that the first thing
17:10
that happens is that inflammation takes place.
17:14
And that is so much more prevalent now in our education and everything that we're talking about.
17:19
Prevalent of inflammation within the gut as well and diet and the food advice
17:25
that you may be giving to people as well.
17:28
So what has happened over that period of time as well is that we've learned
17:32
about something in the blood vessels called the glycokylax.
17:35
I don't know if you've ever heard about this, but the glycokylax is responsible
17:38
for stopping fluid leak out of the blood vessels.
17:42
It's a layer on the endothelial cells that form the blood vessels.
17:46
And the glycokylax is kept healthy by movement, by muscles pushing and pushing
17:51
the blood above the glycokylax.
17:53
And when people become inactive, whether that be following a road traffic accident
17:58
and they're in a cast or something, or they're on on bed rest or people are
18:02
in the cardiac unit and their legs are up and so on, then the glycocalylax breaks down.
18:07
And by the glycocalylax breaking down, more fluid leaks out into the skin.
18:12
Now, what we know is that the lymphatic system, in fact, removes 100% of all
18:17
fluid that gets into the skin.
18:19
And that's different to the Starling's law equation that we talked about 10
18:24
years ago, which was that the lymphatics take 10% and 90% is reabsorbed to the vein.
18:30
That's completely wrong. And we've known that since 2010. Oh,
18:33
wow. That's still being taught a lot.
18:35
Yeah, well, we've known that since 2010. Yeah.
18:38
That hasn't quite worked its way down to it. That's interesting to me.
18:42
So that's what we've been teaching since 2010. So that changes everything because
18:46
now any fluid that is in the skin has got to be removed by the lymphatic system.
18:51
Of course, it does get back to the venous system, but it gets back when it gets into a lymph node.
18:56
So you're pushing the fluid through the skin, it manages to get into functioning
19:00
lymphatics in a lymph node,
19:01
and then some of it will go into the venous system and the rest of it
19:04
will continue you through the lymphatic system so that's
19:07
changed everything and that's what is so important
19:10
about education about massage about understanding
19:14
treatments as well so that part of the
19:16
anatomy essential and pathology yeah
19:20
so i mean i understand now my
19:23
original question about yeah why you set up the the training academy
19:26
it makes sense i want to often i don't mention
19:30
courses and things till the end because people start thinking oh the only reason
19:32
you've got the guest obviously talk about courses but it seems so fitting now with
19:35
the information you've given that there is you know
19:38
up to date some education that needs to take place so we
19:42
will mention the courses so i'm just going to bring up a little shot for the
19:45
people i've joined us live of the website if you are interested in anything
19:48
we're going to talk about now then go along to the website lymph.org.uk wonderful
19:55
website beautiful that i made that congratulations very nice and you'll find
19:58
loads of information on there.
19:59
And when it gets to the courses, there's plenty of courses for different healthcare
20:03
practitioners, depending on what you're involved in. But the one I wanted to
20:07
concentrate on today, and one which you've set up, and I'll ask you why you felt.
20:11
You know, you specified so much with manual therapists, is this one,
20:14
which is the lymphedema management for manual therapists. So,
20:17
tell us a little bit about that course.
20:20
So, we, of course, train healthcare professionals and healthcare professionals
20:24
being nurses, physios and OTs and osteopaths and so on.
20:28
But there's a great need for manual therapists.
20:31
And that's manual therapists. We take degree trained level therapists,
20:35
degree level three diploma trained or degree
20:38
trained therapist depending on what your background is it
20:42
is really important from my perspective i
20:45
like to think i train everyone the same so if you're doing
20:48
if you're a healthcare professional you get exactly the same training and the
20:52
healthcare professionals won't like this as the manual therapists do because
20:56
i want to know if my mom comes to someone you all have the same or similar knowledge
21:02
in order to be able to provide expert care because because that's what we want at the end of the day.
21:06
Our kind of strapline for the training academy is because people living with
21:10
lymphatic conditions deserve better.
21:12
And it's so important that we can manage that.
21:15
So our manual therapists will come on and they'll do massage,
21:18
first of all, manual lymphatic drainage.
21:21
So they'll be carrying out MLD. They'll understand lymphedema treatment protocols
21:25
and carrying out MLD as part of that.
21:28
Then they'll move on and do advanced management, which allows them to do advanced assessment skills,
21:32
fitting of compression garments bandaging if that's
21:35
what they want to do in order to reduce it lots of
21:38
other alternative therapies as well like photobiomodulation so
21:42
laser therapy and different things like that and we'll we'll do that and also
21:47
manual lymphatic drainage for head and neck and midline so breast and genital
21:50
all forms part of that advanced training so that means they kind of do it back
21:55
to front they do MLD and then everything else to learn more about lymphedema whereas our
22:00
healthcare professionals do everything about lymphedema and MLD forms part of
22:04
a specialist with a bandage and everything else.
22:06
So on following on from that. So yeah, we, I,
22:10
think and I hope that we produce really, really highly skilled,
22:14
trained, competent therapists so that you can go out there into the workforce
22:18
and do what is so absolutely necessary for people living with lymphedema.
22:23
Fascinating. Could you go into a little bit of detail without giving it all
22:27
away, obviously, but what are we talking about with the manual therapy, with the drainage?
22:31
Because I get the sensation there's quite a few courses out there which maybe
22:35
if you did see them, you know, you're not going to slander them,
22:37
but they might not be teaching the same thing as you are?
22:40
Yeah, so manual lymphatic drainage has been around since the 1920s,
22:45
really 1940s, predominantly with different training schools.
22:49
And how we slightly differ from that, of course, everything's built on the foundations
22:53
of people that have gone before and have learned about the lymphatic system
22:58
and applied a massage technique, seeing that it reduces edema following that.
23:03
What we do, what we do is the other side of our patient side of the business,
23:09
which is called LimpVision, is that back in 2014, for the first time ever,
23:14
you could see lymphatics moving.
23:16
So a little bit like you might see things with an ultrasound,
23:19
but here we actually inject something called indesign in green.
23:23
It's a dye that's fluorescent with a near-infrared camera.
23:26
And for the first time ever, you got to see moving lymphatics.
23:29
This meant that we can now see what hand movements work when you're doing your
23:35
massage and what don't, what is pushing fluid along the the interstitium of
23:40
the skin, what's moving it in the lymphatic collectors.
23:43
We can also see where people are draining to naturally pathologically.
23:47
So we can say, ah, 70% of people that have got breast cancer related lymphedema.
23:52
Drain here 20% drain there 5% drain
23:56
there we can do the same with with arms and legs
23:59
so what it's allowed for us to do is actually make bespoke
24:02
treatment programs but also it's allowed
24:05
for us to through our research which is published has
24:08
allowed for us to say okay our understanding now
24:11
has changed and there's no point in doing this hand movement
24:14
because it doesn't have a suction effect and there's no point in
24:17
doing that hand movement because it doesn't move the fluid as
24:20
fast as doing this one and so we've now
24:23
put together a technique that's called fill and flush or it's
24:26
come from fluoroscopy fluoroscopy guided manual lymphatic drainage
24:29
but the technique's fill and flush it's an easy technique we
24:32
want to keep things simple but make it bespoke for all of your patients individually
24:37
or your clients individually so that's our focus is that research and evidence
24:43
and that being published has allowed for us to really make treatment the best
24:49
it can be at this point in history.
24:51
I think that doesn't mean it won't progress and change as we're just now starting
24:56
to see lymphatics with ultrasound with very, very small air bubbles going in.
25:01
But it's really high spec ultrasound at the moment.
25:04
It may change. And at the moment for fluoroscopy, we see patients in clinic
25:09
and give them a bespoke plan.
25:11
But we don't need to do that for everyone because the evidence that we've got
25:15
from the hundreds of patients is that we know kind of what works in different pathologies.
25:20
So am I right in did you say back then that there's some kind of anatomical
25:26
variance or people will drain to different areas depending on the person you're
25:28
working with thanks to being able to detect this now what is that just natural
25:31
anatomical variance it just happens or is there reasons for it depending on health or?
25:36
Yeah I think one of the things historically was if you look at a map of the
25:40
lymphatic system which which you will have done, you can see that lymphatics are all over the body.
25:44
And one of the myths was, ah, well, we can push it from the leg,
25:49
for example, up to the armpit, but the body takes its natural choice.
25:53
And the natural choice is it decides it's going to take it to the inguinal nose,
25:57
there's a groin, and then drain deep and it's back up on its normal pathway, on a deep pathway.
26:02
It doesn't need to go superficial because it's easy to go deep.
26:05
And that's just like us getting on the motorway and deciding to go on the main
26:09
road. And then if you can't, you get off on a diversion pathway or you stay,
26:13
you try and get back on the main road as much as you can.
26:16
So I think that, I forgot what your question was, Matt.
26:19
Is it just natural that some people will drain to different areas than others?
26:24
It's just. Yeah. So the majority of people will drain.
26:28
To the different types that we find and there's a small amount so
26:31
for example three percent of people will drain
26:34
their leg to their axilla but it's that means you've
26:37
got to have a hundred people on your treatment couch and decide which three
26:40
are draining to the axilla or you're wasting time taking them
26:43
there when you can be working on the leg doing great things rather
26:46
than taking everything back up to the axilla so we
26:49
can say in breast cancer related lymphedema x
26:52
amount tend to drain here if they're not draining there they're draining to
26:55
the other we can also do the same with cancer patients
26:59
lower limb gynae patients for example we have incidences
27:02
of occurrence so how often it
27:05
happens following surgery but also where the preferential route
27:08
is in that in that type of pathology for drainage
27:12
which is generally most people still go to the
27:14
groin even if lymph nodes are removed and the same with arms regardless
27:17
of number of nodes removed and some
27:20
will go across to the opposite inguinal nodes but very
27:24
few very few will drain their arm across to the opposite side
27:27
which historically that's what we thought happened so it's
27:30
changed everything it's made treatment easier simplified except
27:34
for when you're learning stats how about we
27:37
talked briefly about this off air but in in we were missed kind of and it's
27:41
a good thing that the massage in particular is kind of slowly evolving to embrace
27:47
more kind of evidence-informed approach and we've got some great research now
27:51
showing how massage can affect the nervous system it helps with anxiety anxiety and depression.
27:56
So obviously, it's obviously working in ways which probably before traditionally
28:01
when we were saying breaking down scar tissue and that it wasn't really doing.
28:05
I'm interested because in the
28:07
search for a more evidence-informed approach, a lot of people will read.
28:11
Linked to the difficulty in increasing circulation
28:14
via massage that also the idea of
28:17
increasing lymphatic circulation is limited as well for
28:20
the same reasons but what you're saying here especially with
28:24
the discovery of this liquid which can show that
28:26
with the right technique you can move lymph around
28:29
the body yeah absolutely i mean we
28:32
can see by moving your hands that lymph moves i could have
28:35
if i'd thought about it puts videos up to show you and demonstrate
28:38
that and one of the other things that we we know and
28:41
we've learned through fluoroscopy icg imaging is is
28:44
that if there's edema in the tissue you need a little bit
28:47
firmer pressure whereas it's always been thought that
28:50
you need a very gentle pressure with lymphatics when
28:54
you're working with lymphatics which is correct if there's not a problem
28:56
but not if you've got to build up a fluid sitting in the skin we
28:59
need to use a little bit more force not a great deal of
29:02
force but a little tiny bit more in order to move that
29:05
and we can see that with our hands so and the
29:08
other thing that we do is we kind of use a ball into the
29:11
axilla to empty the lymph nodes or into the groin or
29:14
a rolled up flannel put into the groin and what
29:17
that does is it's not only emptying the lymph nodes but
29:20
it's emptying the venous system and getting the venous system to
29:23
work and it's working if you've had an inguinal node dissection
29:26
on the scar tissue there as well through the
29:29
manipulation of that so when we're working with.
29:32
Our hands we're always talking about the lymphatics but we
29:35
keep trying to drum into people yes it's lymphedema
29:38
it's a lymphedema training academy but we're also working on the
29:41
veins on the arteries on the scar tissue on the myofascia when we're working
29:46
and so that's very important as well absolutely incredible sounds like i'm hoping
29:51
that we'll get feedback and i do thank everybody who sends me emails but i'm
29:55
hoping we'll get some feedback from here maybe again Again,
29:58
maybe from therapists who have done courses and they're still being taught things which you say.
30:04
Have actually now moved on a little bit. Not totally changed,
30:07
but like you're talking about.
30:08
So people, I know some listeners probably listen to Vogue Course,
30:11
you're going to get angry. You might have done a course yesterday.
30:13
You might have paid a thousand pounds plus for it.
30:15
Don't freak out. I know the first emotion normally is anger or depression,
30:18
but what would you say to these people who have done a course and it wasn't
30:22
kind of, it was given to them in good faith.
30:24
It's just they weren't as up to date. How do you pacify these people?
30:27
Well, I think that first of all, we're all starting
30:30
out aren't we and we're all learning every day we're learning different
30:33
things even today my first aid course still learning and so
30:37
I would say that absolutely everything is a good foundation
30:40
and what we're teaching may change tomorrow there
30:43
might be a new research paper that comes out and we go oh my
30:46
goodness we need to modify this and change from
30:49
that so and just body working so
30:52
first of all one of the things when you're working with edema is
30:55
is that compression work so having your hands
30:58
on someone and moving your hands is so valuable in
31:01
moving that fluid anyway if we can do it a
31:04
little bit more effectively okay and a lot
31:07
of them still work on the foundation from the
31:10
basis of where we are today so I can't say
31:13
that we're better I might have my own opinions on whether we are or
31:16
we're not in what we're doing it's just because we've seen it.
31:19
And we work with it I think also it's not that the.
31:22
MLD that we do particularly leads magic it is amazing
31:25
and we've learned so much from fluoroscoping it's
31:29
the added things that we do as well so it's the understanding of
31:32
emptying the lymph nodes working with the venous system adding in
31:35
mobility getting your patients to be doing
31:38
self-drainage how they do their self-drainage how
31:41
frequent they do that and all the other add-ins that
31:44
therapists come away with rather than thinking that lymphedema
31:48
treatment is just MLD is just massage
31:51
there's so much more that they can advise on and support the
31:54
patient in even going back to diet again healthy eating
31:57
taking on good you know drinking water
32:00
we all know that we should do that i'm terrible for it so there's
32:03
lots of other things that add into training and understanding
32:06
of health how to help people better so uh
32:09
yeah absolutely i think what is probably
32:13
important is to know that if you are working with
32:15
lymphedema a one-day course doesn't cut it it's not
32:18
going to give you the information in order for you to make a big
32:21
difference for a patient and you do need a proper
32:24
reputable course not only ours but anybody's that that
32:27
is doing that not thinking you can treat well from
32:30
a one day short course hey there
32:35
matt phillips here sorry to interrupt the podcast just 60 seconds to remind
32:39
you that if you're looking for beard grooming products there is a sports therapy
32:44
discount code that will get you 15% off at the Brighton Beard Company website.
32:52
Thebrightonbeardcompany.co.uk.
32:54
Yes, I am biased, what with Brighton being my hometown,
32:57
the Brighton Beard Company really do offer an absolutely amazing selection of
33:02
luxurious beard balms and impeccably scented oils all handmade in small batches
33:08
with 100% natural ingredients their current spring collection for example contains bergamot, coriander,
33:14
thyme and lavender giving you a fresh and energizing essence with both citrusy
33:19
and peppery notes making it the perfect gift for you a family member or any
33:24
friend with facial hair go to the brightonbeardcompany.com
33:27
and get 15% off now by entering the discount code STA15.
33:35
Doesn't include already discounted bundles.
33:39
Like you say, it's lovely to hear. We hear this time and time again with most manual therapy.
33:45
It's not just what you're doing with your hands. It's also the communication
33:49
you're having with the patient. It's the advice, the self-care you're giving them.
33:53
So maybe tell me a little bit more about that, aside from the manual therapy
33:57
to help move the lymph around, what other kind of typical advice do you find
34:01
yourself giving different populations to help manage this themselves?
34:05
You mentioned nutrition, for example.
34:07
Yeah. So depending on cause,
34:10
I mean, if you think that some people that develop a lymphedema can be a chronic
34:15
edema, and a chronic edema is what we say is above 12 weeks,
34:19
and that chronic edema can be because somebody is obese,
34:22
they're not as active, and you may see
34:25
that their legs are very chronic they start to develop skin changes
34:28
wound care maybe develop a cellulitis or red
34:31
legs so of course that is completely different advice to someone who may have
34:36
a cancer-related lymphedema or someone who may have a post-sports ankle or sports
34:41
injury lymphedema or rta or something like that so depending on that but i think
34:47
key ones are being active.
34:49
Maintaining a good health health and weight
34:52
is very important some of the activities that
34:55
we'd recommend is of course walking if they
34:58
can walking and exercise and running is
35:01
good pool i heard you say that you're doing some things on
35:04
swimming well gravity is really good for patients so walking feet down in a
35:09
pool has got high compression at the bottom of the pool in a meter length height
35:13
pool so that type of activity gives an impression of compression to the venous
35:18
and the lymphatic system and can be assisting as well. So exercise is good.
35:23
Diet, yeah, what do we recommend? There's no lymphedema diet as such. Not yet.
35:30
Not yet, no. Anti-inflammatory is very good for patients.
35:34
So the more that we can do with an anti-inflammatory diet is going to help everything
35:39
with the joints as well, getting them more active, help with the gut health as well.
35:43
But no specific lymphedema diet as yet some
35:46
of the patients are doing things like zoe you've probably
35:49
heard of the zoe plan and looking at their own
35:52
gut health and inflammation the other thing
35:55
that we do as well we've got some very small studies
35:58
on is ozone so we do ozone therapy maht i know that there's different thoughts
36:03
around that where we're putting ozone into blood and re-infusing it back in
36:08
as a whole body anti-inflammatory effect as well and antimicrobial so but that's
36:13
relatively new but but we've presented over the world on it as well.
36:16
Compression is mainstay treatment. It's so you can do manual lymphatic drainage
36:21
as many times if you'd like, 12 hours you could do it for.
36:25
And if you don't put a compression garment on after, it will come back because
36:29
all that you're doing is supporting the compression that is supporting the lymphatic
36:33
system, but you're not actually changing what the problem is.
36:38
So compression garments become key in order for that.
36:41
And patients don't like them really. it's hot in this weather
36:44
who wants to wear a compression garment you know on the leg so
36:48
trying to support the client
36:50
through wearing compression garments which is quite good
36:54
in sports now because people are running in compression garments aren't they
36:57
as well to aid recovery so maybe that transition for your client group is not
37:02
so not so difficult and if they're already doing that maybe that will support
37:06
them as well is i was going to mention i just want to go back Back to the gut
37:11
microbiome, there's only thing you mentioned about,
37:13
because that's interesting, because we had a wonderful series of podcasts with Dr.
37:17
Lucy Williamson, who does an awful lot in trying to promote healthy eating.
37:21
So basically, it sounds so obvious, doesn't it? What's going to fix this?
37:24
Just avoid processed foods and go for variety.
37:27
I mean, that's what the podcast was in a nutshell. But people find that really
37:31
hard to do in today's society. So I think.
37:34
When people come to us and we know for example like you've identified look
37:37
your diet is really going to help with this with this
37:41
situation you've got how do you how do
37:43
you manage to have you any tips on how to have that conversation to
37:47
actually succeed in in starting that behavior change because
37:50
we've got this wonderful opportunity haven't we and we talk about this a
37:52
lot with massage therapists in particular you've probably got a wonderful therapeutic
37:55
alliance with that person they're probably more likely to listen to
37:58
you the members of their own family than the gp but you've
38:01
still all got to introduce that behavior change
38:04
in a certain way without just giving them orders which they're not going to do
38:07
so it's it's maybe slightly
38:10
easier for us because we're already talking about the lymphatic system
38:13
so we can easily get from lymphatics
38:17
in your legs to lymphatics in your gut to lymphatics in
38:20
your brain so when we're talking about the
38:23
lymphatic system of your gut it's easy for us to
38:26
say well here's a picture and look your lymphatics
38:29
are sitting around your gut and they drain away
38:32
all the toxins the rubbish food that you've eaten and
38:35
they're trying to take that back and the fat so they go from
38:38
the guts to something called the cisterna chyli which is the
38:41
beginning of the thoracic duct and drain back up and
38:43
recirculate so we know
38:46
that the lymphatics are responsible now for
38:50
the lack of drainage or becoming blocked for some of the
38:53
things like IBS irritable bowel disease or
38:56
you know chronic inflammation there so it's easy
38:59
for us to say if you have a good gut microbiome.
39:02
And time-restricted eating or intermittent fasting allows.
39:06
For the night good bacteria to be.
39:09
Coming out and chomping away at what we've done in the day and not done so well.
39:13
At then they we can understand that also we've got some of the genetic abnormalities
39:19
that our primary lymphedema patients have and they have gut problems so we can
39:25
We can start to relate all of that now.
39:27
So it's easy enough for us to say, hey, look, the lymphatic system is struggling.
39:32
If we need to get a reduction of inflammation, think about what you're putting in your body.
39:37
Every time you eat something, not every time, the bad things,
39:39
your body goes, whoa, let me fight that.
39:41
And we inflame our bodies and we need to keep that all at bay.
39:45
So let's just think about what we're eating.
39:47
And I do that when I say I'll drink a coffee and my body's then going,
39:51
ah, what are you doing taking coffee?
39:53
That's not natural. you know so think about
39:56
what we're putting into our bodies and thinking about what we
39:59
put into our gut and that is not easy to do
40:01
at all and again we see
40:04
a lot of people with fibromyalgia or lipoedema or
40:07
lipoedema again and we know that different diets react
40:10
differently with that group of patients keto being one of them so lipoedema
40:16
population a keto diet tends to work really well for them because with lipoedema
40:22
you've got increased adipocytes so they just get bigger and if we start to go on a keto diet.
40:29
So it is still high fat, but you're burning off and you're not converting those
40:32
sugars that are feeding the fat cells.
40:34
Then it can actually improve the lipoedema fat as well and the pain.
40:39
So that forms a big part of what we're doing. And it's this year,
40:42
really, that we've really added into our training on looking at gut microbiome
40:47
and how we can be advising and supporting patients in that way.
40:51
Very interesting. Yeah, it does seem, I don't know whether every generation kind of says this,
40:56
but it does seem with healthcare that things are starting to link together
40:59
in quite an exciting way now inflammation seems to
41:01
be a common characteristic with links with pain with
41:05
links with like you're saying now lymphedema and and
41:08
the whole gut microbiome thing it's all coming kind of coming together a
41:11
little bit i don't know whether that's you know whether we're looking for
41:13
it now whether it's happening naturally but it seems it's pretty it's
41:16
pretty healthy i think yeah i think it's it's a
41:19
really exciting place for us to be at the moment in lymphology as
41:22
well not only that but because of the link of the glycokylax being
41:25
on a venous system it fits into cardiology and
41:28
hearts and so therefore it's becoming a little bit more sexy for
41:31
people to understand about the lymphatics and the
41:34
other thing that's happened is is that the super micro surgery
41:37
that takes place has allowed for
41:40
surgeons to see that there's a place and i'm not saying it's
41:43
it's always the best thing for many patients but for
41:45
some people it may be and so now we've got
41:48
research papers that are going through the roof where they've been stable for
41:51
the previous decade and a bit before that so very interesting i've just been
41:58
told the facebook feed has ended well we're on youtube maybe put a little message
42:01
there gary thanks for letting me know but maybe let us know i think we're still
42:04
on youtube hopefully i wanted to go back to compression as well.
42:09
Can that be done wrong? Can advice be given which needs to be adjusted to really make it effective?
42:14
Yeah. So compression is mainstay of treatment, as I said, but you need to have
42:19
the right type of compression.
42:21
And sometimes it goes two ways. It's either that people will say,
42:25
oh, let me just put you in this little bit of compression and it doesn't work
42:29
because it's too light compression.
42:31
Or it can be that you're putting people into strong compression and you've not
42:35
assessed them properly for arterial problems, for example.
42:37
You wouldn't want to put a diabetic into a strong compression garment in case
42:41
it caused arterial problems and necrosis or something.
42:45
So there is a balance to getting compression right. We do talk about that in
42:49
training on the advanced training.
42:50
I treat quite aggressively with compression, depending on the tissues,
42:55
the fibrosis, the thickening that's there, and the length of time that the patient's
43:00
had it and the skin condition.
43:01
So compression has to be carried out right. It
43:04
has to have the right weight assessment as part
43:07
of it but if you think that you may be again you've
43:10
got people who may be running in compression it would probably
43:13
be what we would class as a class one and we would
43:17
be putting patients into generally if it's the lower limb a two or a three we
43:21
sometimes double layer it sometimes even triple layer it or put a rip on a wrap
43:25
on top of it depending on the severity so there's a there's a big you know wave
43:32
of what's appropriate for compression garments
43:34
for people and then sometimes if say just
43:38
trying to be general with the types of people you may
43:41
see you may have fitted say an ankle support and then
43:44
the toes and the foot has started to swell because you haven't got compression
43:47
from the foot all the way through so we would recommend a toe glove for example
43:52
or doing manual emphatic drainage to the toes and the foot in order to then
43:56
use your ankle support so yes it has to be fitted right and it's not any compression
44:01
garments it's bandaging.
44:03
So if we're trying to reduce substantially, we would.
44:07
Apply a compression bandage to a patient and
44:10
again our treatment protocols are a little bit different to
44:13
what you may find in some of the UK we will do
44:16
intensive treatment so we'll bring a patient in they've got
44:19
a large lymphedema or maybe not a large one but we want
44:22
to just reduce it and improve it as much as we can
44:25
we'll bring them in for a bandage they will
44:28
then exercise so they're going out exercising and walking we
44:32
know at that point the bandage is loose so they come back to
44:34
us within an hour we put another bandage on top of it tighten
44:37
it all back up again some manual lymphatic drainage around
44:40
the knee or the thigh or the tops of the arm send them
44:43
off exercising again they come back we take it all off MLD to the whole leg
44:48
or arm and then put them in a wrap send them home so that they can self-tighten
44:52
the wrap themselves come back the next day do it all again and then we're starting
44:57
to reduce lymphedema quite substantially in three or five days compared.
45:02
To what we've historically done over two or three
45:04
weeks because bandages lose like if you can imagine
45:07
putting on a pair of jeans and the next day your jeans
45:10
are loose so if bandages are cotton you
45:13
put them on and you send them home and then they're loose and they're pointless the
45:16
leg refills so we've started to adapt our treatment
45:19
protocols and that's what we're presenting on throughout the world
45:22
as well so just in australia and in istanbul at
45:25
the european society of Lymphology and the British
45:28
Lymphology Society were trying to promote a different type of
45:31
treatment protocols and that's where manual therapists if
45:34
they do the advanced training really fit in because these are not really done
45:39
within the NHS because it's time consuming and it costs more money but if we
45:44
can really well train manual therapists with the support and the knowledge and
45:49
the education then they can provide in excellent care to patients that need this type of treatment.
45:55
Amazing yeah so definitely once again yeah
45:58
it's it's there's education that needs to
46:00
be put out there i love i love the fact you draw attention to the bandaging
46:03
how you can send them away thinking that's what you've done unless you're getting
46:06
back to review it and adjust it and check and and
46:09
help the client self-manage then yeah you're kind
46:12
of helping a little bit but not nearly as much as you could be yeah and
46:15
i think that's also what's changed with manual lymphatic
46:18
drainage because many times patients or clients
46:21
would come and be done too there's my arm off you go do your
46:24
job and then they go out they don't want to wear compression garments they
46:27
want to come back and have more manual lymphatic drainage
46:30
but it's the same as any chronic illness lymphedema is
46:33
not going to go away we can't repair the damage be
46:36
that genetic or be that from some
46:40
type of surgery or something or cancer treatment so we
46:43
can't repair that damage best we can do is manage it as well as we can and maintain
46:47
it and that takes input from the patients as well just if they were a diabetic
46:52
given insulin here they have lymphedema and they need to maintain by wearing
46:56
the garment or doing self-drainage or exercising or maintaining their body weight.
47:02
Where are we? Still got 10 minutes this is wonderful.
47:05
I want to go back to the sports person who you said may have had an ankle sprain
47:11
and then they're doing so they've actually damaged lymphatic system,
47:15
Can we go through that as almost as if it's like a case study of, first of all,
47:21
what the therapist should be looking out for to understand when it is actually
47:25
a lymphedema issue now and not just another ankle sprain and also how the treatment would therefore,
47:31
when the treatment would change, how it would change.
47:33
So you're more experienced in treating post-traumatic ankle sprains, I would say, than me.
47:41
So I tend to see more chronic people, of course.
47:44
So if it's coming in following an acute injury it
47:47
would usually be soft and more pitting you'd be applying
47:50
your your ice and your elevation and all of that
47:53
and some type of compression and then I guess you
47:56
get to a point and you'd think well the tissues are starting to
47:58
become thicker I'm palpating it it's not pitting anymore
48:02
it's becoming thicker and a bit more solid a
48:05
bit more permanent and I thought the compression would have
48:09
reduced this but it keeps coming back I'm doing my
48:12
lymphatic drainage or your massage and it
48:14
keeps coming back and so you've seen your client maybe three
48:17
times a week once a week however it is and now the ankle
48:20
injury is still there so at six weeks i'd be
48:23
thinking six weeks is a crunch time
48:26
here if we don't start to get this resolved soon
48:29
then we have the chance of a chronic edema and
48:33
what that means is is that the lymphatic system
48:36
removes proteins and proteins are good for bugs and
48:38
bacteria to breed in so and also they form
48:41
the fibrosis and the thickening so if we don't get
48:44
those out of the system as quick as we can you increase the risk
48:47
of cellulitis and fungal infections maybe athlete foot tinea pedis that type
48:53
of thing so the tissues start to change you should then be thinking okay well
48:58
do we need an x-ray number one which is probably what you do but number two
49:01
how do i treat this now and i would say it's more regular and.
49:06
Manual lymphatic drainage or massage. And it's also trying to get some surgical,
49:12
I'm going to call it surgical compression.
49:14
So getting them off to the GP, prescribing a compression garment,
49:19
which is going from toe to knee, for example, and getting them to wear that at that point, 24 hours.
49:26
So even though the box will say remove at night, you would still want that patient to be in that.
49:31
As long as they can tolerate it, they're sensible, they can take it off if there's a problem.
49:35
Them you want them to be in it 24 hours the same as you would
49:37
if they were in a cast following a fracture and then
49:40
hopefully that would support and reduce that and
49:43
if not then we need to be moving on to maybe the next stage
49:46
of treatment which may well be compression bandages or
49:50
something to reduce more sometimes if you've got do you
49:53
use compression pumps i'm sure some people
49:56
do i don't yeah so we also use pneumatic compression i've worked designed a
50:01
couple of the sequences the lymphatic drainage ones on some of those pumps for
50:05
lymphedema and so if you use a sports therapy pump that may be something that
50:10
you could at that point start to initiate with your patient as well to give
50:14
some good reduction therapy.
50:16
And in this case scenario, how is the performance going to be at this stage?
50:23
Is there going to be extreme amounts of pain or is there a chance
50:26
that the runner for example is still going out and running and maybe
50:29
even might be with with that exercise mobility
50:33
maybe reducing the situation but once they stop the activity then
50:35
it's just coming back again so is there a chance of that happening yeah absolutely
50:39
100 is that you're unlikely to
50:43
have pain they would generally say lymphedema is not painful of
50:46
course it's painful it's a nagging ache it's a toothache it's it's
50:49
there all the time for some people so that is painful in itself
50:52
but you're right if they were were wearing compression garments
50:55
and they were exercising the nature of that may well be
50:58
it goes down so exercise becomes a good thing but
51:01
when you exercise you bring more oxygen to the muscles that fluid is being pushed
51:06
back out into the tissue and then you've got a problem due to the inflammation
51:09
or the lymphatic still being traumatized not being able to drain that fluid
51:13
back and so after during exercise it may improve and after exercise it may reduce.
51:20
Exercise is always controversial with lymphedema back in
51:23
the 90s it was you mustn't exercise don't get
51:26
your patients over exercising because of the reasons i've just
51:29
said it brings more oxygen and and more fluid to the area but some of the more
51:33
recent studies have demonstrated that exercise post breast cancer surgery for
51:37
example it may increase the edema at the time but it will resolve and go back
51:42
to normal after so if that's not
51:45
happening it becomes again chronic and i think you need to with fur on.
51:49
So at that point, you've treated them for six weeks, it's not working,
51:52
get them back to their GP, get them into a lymphedema service.
51:55
But that wait may be a long time, which is why we want lymphedema trained sports
51:59
therapists, lymphedema trained manual therapists that can be intervening without the NHS wait.
52:06
It's interesting. And purely from a personal kind of interest,
52:11
it sounds to me like it's something that, yeah, sports, people who work with
52:15
sporting populations probably haven't entertained the idea of being a little
52:18
bit more knowledgeable, but they should be because they might be missing something.
52:21
Yeah and i think you could you can repair injuries
52:24
faster so whether it's sports or whether it's um
52:27
post-traumatic injuries such as i don't know an ankle
52:30
or a knee replacement or something by doing
52:33
manual therapies manual lymphatic drainage getting your
52:36
compression on when it's comfortable using photobiomodulation
52:39
which is another great tool i love then you can
52:42
get somebody walking much quicker and the knees bent sooner and
52:45
they'll walk in back to the orthopedics some people the surgeon will
52:48
be like whoa what do you mean you're
52:51
walking in your knees not swollen and you can get that quick
52:54
recovery by treating differently but there's still
52:57
a lot of history around yeah put some ice on do this wait wait wait wait and
53:03
try and bend your knee to 90 degrees and and we can do that by removing it quicker
53:06
with your hands right that's amazing right but there's so much so much um there
53:12
if people are interested in doing the course let's just talk briefly about.
53:16
Accessibility for that it's a blended course isn't it
53:19
particularly we're going to talk about the lymphedema management for manual therapists so
53:22
how does that work out some of it is live interactive yeah
53:26
it's both yeah live interactive so almost certainly
53:29
all of them are live with myself or stacy or one of our trainers on those occasions
53:34
and there's also some recorded sessions so it will be live and then followed
53:38
on in the afternoon by self-learning which can be done at any point it's just
53:41
we give them a day to do it in but if you want to stop at lunchtime and go and
53:46
do something else and come back. You watch it as and when.
53:48
All has to be done before they get into the classroom. And then we've got three days in the classroom.
53:53
And so that is learning MLD, upper limb, lower limb, and then a feedback and
53:58
examination day and anything else that we're adding into that.
54:01
It's not just MLD, it's other things as well, but just adding into that.
54:04
And then that's it. You're trained over those five days for your manual lymphatic drainage.
54:10
And then it's another training course after for
54:13
advanced management where again online two days
54:16
in the classroom I love face-to-face I love being
54:19
with people so COVID we were already doing blended learning then but I love
54:23
to yeah be face-to-face and and be working with people that's where it happens
54:28
really I think it's interesting there's definitely a place blended work people
54:32
haven't got to travel they haven't got to stay if you can get that information
54:34
across without having to pay for accommodation and travel. That's great.
54:38
But it's a bit scary now. There's probably courses where it's 100% online now
54:41
and they're just, again, the pension just swung too far.
54:43
You need, obviously, with a topic like this, you need that face-to-face.
54:46
Yeah, you need hands-on.
54:48
Wonderful. Okay. Well, thank you very much. And like we said,
54:51
people, if you want to look up that information, then you just need to go to
54:55
the website, lymph.org.uk.
54:58
And nice that that was available. That's wonderful. That made you smile that
55:01
that was still free. If you want to follow you on Instagram, then it's at LTA Global.
55:07
And also on Facebook, if you do a search for Lymphedema Training Academy or
55:11
Lymph Training, then that will come up on Facebook as well.
55:13
Are they the best places for people to follow you? yeah live training we
55:16
do facebook we're very active on insta is
55:19
just the copy from that i'm absolutely rubbish
55:22
on linkedin but i shouldn't be and i don't
55:25
we keep having a debate about whether we should do tiktok and so we're not very
55:30
good on social media but we're great when you get to us hey that's not and don't
55:36
worry about tiktok it's no false economy false economy fantastic well thank
55:40
you so much for giving us your time and jane so much information they're really really interesting.
55:45
It's been a pleasure. Thank you for having me on as a guest as well. So thank you, Matt.
55:51
And yeah, and for us, it's very much don't assume that people don't want private
55:55
care. They don't want private lymphedema care.
55:57
Let's give them the best that we can to improve their lives.
56:01
Amazing. And people will be able to come and see you at Therapy Expo as well
56:05
to chat about this. You've got to stand there, like you say.
56:08
Yeah. And we'll make sure that we'll share posts
56:10
for that closer to the time right then people
56:13
it's nearly nine o'clock and so just leaves me
56:16
to say next tuesday what's happening next tuesday it's going to be
56:19
the first tuesday of the month we're going to be in july obviously you
56:22
know that because of the wonderful summer we're having so we're going to have
56:25
he said ironically so it's going to be yes ask us anything episode which we
56:29
do on the first tuesday nearly every month and that's where we're going to have
56:31
an sta panel made up of four or five sta members and in this episode like i
56:34
mentioned at the beginning the topic is going to be therapy for swimmers so
56:37
if you're listening to this podcast before next week.
56:40
And so if you're still in June then and you are an STA
56:43
member who works with swimmers then we'd love to
56:46
hear from you and for you to be on that panel just to discuss
56:49
what you do in your everyday work it's not going to be a test there's going
56:52
to be no marks for it it's just purely to hear about your experience some little
56:55
tips you've had along the way of working with people it's a wonderful way to
56:58
get your information out there and to mix with other therapists so do message
57:02
me or if you prefer email me matt at the sta.co.uk and like I say even if you're a bit
57:08
hesitant thinking oh can i do that is scary but believe
57:11
me it'd be fine if you know you haven't got to
57:13
worry about it but i'm happy to have a chat with you if you are a bit worried that'll be
57:17
next week if you listen to the podcast and thank you very much if
57:20
you'd be so kind as to leave a rating and a review if you've
57:22
enjoyed it because it just helps the good word of guests like jane
57:25
get out there which is what it's all about it's it's spreading this information
57:29
so it hits more therapists so ultimately we're doing better for our job and
57:33
helping more people which is why we're in the business so we'd appreciate that
57:36
so just once again thank you jane wick for joining us thank you for the messages
57:41
and nice messages as well so that's great i can't reply,
57:44
Fantastic. Take care, people. And hopefully we will see some of you joining
57:48
us live next Tuesday, 8 o'clock on either YouTube, Sports Therapy Association YouTube channel.
57:54
Music.