- Hi, I'm Bob, physical therapist.
Hi, I'm Brad physical therapist.
And together we are the most famous
of the physical therapists on the internet,
in our opinion, of course.
Well, Brad, what's the subject today?
Well, Bob, I thought we were gonna talk
about swelling and Lymphedema.
What is the difference?
Bob, you're looking a little sick today
and as a matter of fact,
I know you've been feeling a little ill lately,
so we're gonna put you
to bed and I'll just go through the video, okay?
Okay, Brad, whatever you want.
Okay, lay down, take a nap.
Thanks Brad.
Okay, so Bob's not here today.
He's been feeling a little under the weather
but I'm gonna go on with the show anyways.
So we're gonna talk about Lymphedema versus swelling.
A lot of times in the clinic,
we have patients come in with swelling legs or swollen arm
or they think it's swelling up or is it Lymphedema?
What is the difference?
Swelling versus Lymphedema.
So swelling occurs, for example, you fall down,
you bang your knee, you go skiing, you twist your knee.
People talk about their knees swelling up like a watermelon
or that ache of swelling up from being twisted,
that's more swelling.
Now, when we talk about Lymphedema or Edema,
that's what people that say,
for example, it's very common after a mastectomy,
a cancer treatment where they remove the lymph nodes
from the armpit area
and the whole arm will become swollen.
That's Edema, that's fluid under the skin that is not
from trauma, well it is from trauma,
but it's not like an impact, like the swelling you get
from an ankle sprain, but fluid that cannot go back
into the system as it normally does.
So if you do, and I work a lot with people
with swelling in Lymphedema from the knee down,
a lot of times in the ankles,
you'll see the swelling and the ankle be puffed up
and I'll get orders from the physician.
We need to do something to treat the swelling
and get that swelling down to a manageable level.
So we're gonna back up a little bit
and we're gonna talk
about if you have swelling in your legs,
what are you gonna do?
How do you know if it's something you need
to see the doctors?
Can you self treat it?
So that's what we're all
about here is people 40 and over,
'cause very few people under 40 get Lymphedema
unless you had some other treatment,
but how do you treat that swelling?
Or how do you know if you should go to the doctor?
All right.
So three red flags to know.
If you've got swelling in your ankles
and you're not too concerned about it
but your wife is saying, geez, George,
I think we should maybe go see the doctor about that.
And you say, oh no, it's not, just swelling up.
So three things, number one is pitting.
When I say pitting, I'm not talking about the pits
in a plum, but I'm talking about in your leg.
If you can push down with your finger
and you come up and there's a dent left in there
and you gotta push down kind of hard,
you can get it to come up.
Now, obviously I don't have Edema,
so I don't have a good case here,
but you will see a clear dent and it will stay there,
that's called Pitting Edema.
And if you have that,
that's one thing that's a red flag
that maybe you should go see a doctor.
The second one, if it looks hard and polished.
Now I do have it, get over here.
Excuse me Bob, can you see this Nancy?
Right here, if you can zoom in,
I have a spot on my leg and I'm not sure why I have this
but I've had it for all my life, but I have no hair here
and it's a little shinier actually.
Now, if you've got Edema in your leg from the knee down,
everything is a little bit swollen,
and it's shiny like that,
it's puffed out a little bit and you can push on it,
it's hard and you got Pitting Edema
and it's shiny and swelling,
that's your second red flag is the polished look
or the hard feeling to it.
And also the third red flag is if it's red in color
and painful, then for sure you want
to get to a doctor, okay?
If you have all three of these red flags,
definitely see the doctor, don't take any time.
Get down there and get it taken care of,
get some treatment with that.
So it's pitting, hard and polished look,
and red and painful,
the three things you wanna watch out for,
those things, get to the doctor, get it checked out.
If you just have swelling, it's not hard,
you can push on it, it's soft,
but you can tell it's swelling,
it's from the foot all the way up to the knee, perhaps.
Couple things you can do is lay down,
elevate your feet,
so I don't have my pillows with me,
what are we gonna do, Nancy?
(Brad sighs)
All right, sure, we'll just take this roll.
This is for our next video.
But you just want to elevate your legs.
Now, normally you're gonna elevate 'em higher than this.
You might have two or three pillows
underneath your calves and get 'em up about this high,
so they're higher than your heart, okay?
Now let's talk about a little bit of what Edema is,
it's fluid, just underneath the skin
and it goes through the lymph pathways,
which go up along your skin, through your legs,
and up through the lymph nodes here in the femoral creases,
and it goes up into your stomach
and it goes into your system
and back in your system and bloodstream right here.
They talk about this as being like the drain
for the lymph node.
Like in your bathtub where all the water goes down
into the drain?
It's right here.
So you want to elevate it so things can flow down in there
and to make it even more of a pump,
so you have some pump moving that fluid,
you're gonna do ankle pumps like this.
I'm gonna use Bob here for a pillow.
Now you're just gonna work those ankle pumps like this,
you do 20, 30 of 'em and then relax
and for a few minutes and then do some more ankle pumps.
'cause you'll get tired ankles if you do, 'em consistently.
But the muscle contraction acts as a pump
to help move that fluid forward.
And there are some massage techniques that you can do
from your stomach.
And one thing I'm gonna talk about is we're not gonna get
into the massage,
'cause that's kind of a whole 'nother topic,
we'll make another video on that.
But when you're laying here,
do some diaphragmatic,
see if I can pronounce this, diaphragmatic,
help me out Nancy.
Diaphragmatic, you gotta breathe in your diaphragm.
So you're gonna breathe in and fill up your lungs.
And that diaphragm is right in here and it's gonna push out
and that's gonna help get that fluid
to go down to that drain we talked about right in here.
And just relax and give that deep breathing
diaphragmatic, I cannot say it, breathing,
but for sure it's gonna help get that fluid
to move some more.
You're gonna do that a couple, three times a day.
And you wanna avoid sitting with your legs down.
If you got a recliner, elevate 'em up
because when you have 'em down,
gravity's pulling all that fluid down
and then those legs will swell up.
I mean, it's amazing if this gets bad,
how bad legs can get, it's actually pretty scary looking.
So, catch it early,
do these three simple techniques, elevate the legs,
ankle pumps, and breathe deep
to get that fluid to come back down into that center drain
and get it back into your system.
All right.
So there you go.
Lymphatic breathing, lymphatic breathing...
lymphatic versus swelling.
I think it's all boiled down, Bob, how you doing over there?
You're feeling better?
He's still sleeping.
So, all right.
Very good, have a good day.
And remember we can fix anything except
for what do you think, Bob?
All right, A broken heart.
Take care.