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Silent Waves: Theory and Practice of Lymph Drainage Therapy, ed 2

Chikly B. Scottsdale, AZ 85262, IHH Publishing, 2004, hardcover, 457 pp, illus, ISBN: 0-9700530-2-9, $75.

Part 1 begins with the history of the lymphatic system, continues with the embryological development of lymphatic organs and the structure of lymph pathways, and concludes with a segmental approach to lymphatic drainage therapy (LDT) for each region of the body. Detailed schematics, along with illustrations, describe pathways for lymph circulation (both deep and superficial) and nodal location. The schematics and illustrations, however, are not numbered, which makes it difficult to match the figure with any corresponding text.

Part 2 contains indications and contraindications for LDT. The author offers one chapter focusing on aspects that readers should learn or observe when providing lymphedema treatment. Another chapter outlines constructive tips for the practitioner and patient before, during, and following a treatment session. The remainder of part 2 focuses on manual lymphatic mapping (MLM) techniques that determine a natural, unobstructive pathway for lymphatic flow in congested areas and that provide alternate routes, allowing physical therapists to be more precise in treatment. Mapping techniques must be acquired through additional professional education. The author's examples illustrate how MLM guides the physical therapist in intervention by locating normal pathways and alternate routes. The author has expanded on the lymph drainage techniques of Vodder (and others) by providing additional concepts of rhythm, direction, and flow of lymphatic fluid.

Pathophysiology and etiology of edema and lymphedema are discussed in part 3. This includes hereditary and nonhereditary forms of primary lymphedema. Twenty syndromes associated with lymphatic dysplasia with extensive descriptions of clinical manifestations are provided, but seem unnecessary for the scope of this text. Secondary lymphedema etiology, diagnosis, progression, and complications are covered in this part as well.

Because there is no cure for lymphedema, part 4 addresses issues of lymphedema management. Medical compression bandaging, garments, and patient education support the gains provided by lymphatic drainage. Part 5 discusses alternate applications for LDT, such as chronic venous insufficiency, wounds, and burns, where, according to the author, LDT could be beneficial. The author states that LDT has been successfully used by "numerous therapists and clinics," although no scientific evidence exists to support its use in these contexts. The information is presented with hope that more research will be performed in these areas.

Part 6 is a review of basic science of cells, water, body fluids, and tissues. This segment seems misplaced at the end of the textbook. It appears that the author is bringing together the global picture of lymphedema by reminding the reader of the microscopic impact that each cell has upon life.

Each part of the book has a multitude of references. Many of these references come from secondary sources or are more than 10 years old. The references are not numbered, which makes it impossible for the reader to identify the source for particular information. The reader should be aware that the evidence presented in the text (ie, from a case-control study) is that published by the author and does not present valid and reliable ways to measure lymphatic mapping. Herein lies the biggest issue with lymphedema—there is limited primary, peer-reviewed literature available for practitioners.

In summary, the author provides a comprehensive look at lymphedema drainage. Students or physical therapists with no prior training will gain a theoretical foundation for this diagnosis. Physical therapists who have received additional training in lymphatic mapping would find this text a useful resource. Because of his contributions to the management of lymphedema, this author should be considered among other well-known authors on the subject of lymphedema (eg, Vodder, Földi, Casley-Smiths).

Terri Hoppenrath, PT, GCS, CLT

Ithaca College
Ithaca, NY

	Editor's Notes

 
Ms Hoppenrath is a Clinical Assistant Professor in the Department of Physical Therapy. She teaches soft tissue mobilization and physical agents. She is a geriatric clinical specialist and a certified lymphedema therapist.

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