Lymphonet / Method / MLB

 

MULTILAYERD BANDAGES (MLB)

The use of bandages is the second step in the treatment of oedema. InitialIy MLD should be used with specific exercises. If this does not lead to any improvement then bandaging is used as the second step in treatment. How do we know when bandaging is indicated? This would usuallv be when after ten sessions of MLD and exercise at a frequency of 3 to 5 sessions a week result in no improvement at all (no softening of the skin, no decrease in pain, no functional improvement).

In this situation the second step should be started, this is divided into Phase A and B.   Phase A   MLD + mobilisation + IPT + MLB frequency 5 / week Phase B   MLD + mobilisation + IPT + stocking frequency 5 / week, progressively diminish

Durig phase A we add IPT and MLB to the MLD. The use of MLB is not a treatment on its own, but will complete the treatment. Phase A continues for 2 to 3 weeks.  During phase B we replace MLB by a stocking. From then on the physiotherapist  will progressivelv diminish the frequency of the treatment.

Experiment in our lab showed that ( 5, 6 ) : 1. The bandages used in the treatment of lymphoedema behave as a non-elastic rigid casement. Muscle contractions cause pressure in the limb, and the use of bandages increases the power of the contractions and the internal pressure. A non-elastic (short-stretch) bandage which is resistant to stretching results in higher pressure on movement than long-stretch bandages, this was tested on patients and on simulated limbs. 2. Using several layers of bandages, as in the case of MLB, results in lower pressures on the skin when at rest than if using, normal long,-stretch bandages. 3. During movement, MLB with short-stretch bandages causes a higher pressure in the same area than long stretch bandages. Therefore the massage effect is better. The massage effect can be defined as the difference between maximum and minimum pressure values at the junction of skin and bandages caused by muscle activity. 4. The use of MLB increases the lymph flow ( 6 ). 5. Isodynamic muscle contraction under MLB results in a significant increase of the resorption of the edema. These experiments were done on the upper limbs, and are described in « Traitement physique de l'oedème du bras » (Masson, Ed. 1991 7).

A cotton tube stretch embraces the limb. Thiswise the skin is protected against full contact with the latex bandage (thickness 5 mm, length 2m; type Komprex Binde - Lohmann = KLB). The latex bandage is placed in a way that it is half covering, and without any tension. The non-elastic bandages (Durelast-Lohmann = DL) are likewise applied on the limb from the distal toward the proximal region. Note that we use several bandages, so that we can apply them criss-crossing to provide axial rotation of the whole MLB.