Question for Mike Murray

EP said:

And, does localized massage stimulate the lymph system as stated

by one of the CSC trainers during a Frankie Andreau interview?

Quoted message said:

Most certainly it does, Emma

The article here will give you some idea about it. And Lymphoedema, in addition to surgery and
radiotherapy can also be caused by trauma, eg. a fall from ones bike.

The slant of this article is toward women with breast cancer, but its wisdom is no less valid.
Lymphoedema (basically the swelling of the glands from any liquid in the lymph glands) is
Lymphoedema no matter how it is caused.

"EP" <[email hidden]> asked: "Based on this photo, please speculate on what
the CSC staff are doing to keep Tyler Hamilton in the Tour:

cyclingnews.comtour.phpOpen ↗ What does this
photo reveal besides a lot of tape?

And, does localized massage stimulate the lymph system as stated by one of the CSC trainers during
a Frankie Andreau interview?"

It is hard to tell from that picture what they are doing but I would imagine that they are
attempting to stabilize the fracture using a figure 8 type of arrangement. A figure 8 is a dressing
that wraps around the front of the shoulder and then crosses in the back holding both shoulders in
an extended (shoulders back) position. This can be done with a strap type dressing or with tape as
it appears they may be doing with Hamilton. Since the clavicle breaks in compression the fractured
ends generally overlap. The extreme shoulder extended position decreases the amount of overlap and
decreases motion at the fracture site. A figure 8 dressing has, in past, been standard treatment for
clavicle fractures although many doctors are not recommending them now based on studies that show
that patients treated with slings alone heal just as quickly and in the same position as patients
treated with figure 8s. In addition, studies show that patients treated with figure 8s complain of
more pain relative to patients treated with slings. My personal experience is that most people get
some pain relief by using the figure 8 at least occasionally. When I see patients with clavicle
fractures I give them both a sling and a figure 8 and I tell them to wear either, both or nothing at
all depending on what makes them most comfortable.

They may also be taping over the skin in an attempt to increase stability of the fracture, similar
to what is often done with an ankle sprain. Interestingly, although people generally feel some
relief from instability using tape, it is difficult to show that tape adds much stability. Basically
it stretches out with use pretty quickly. The thinking is that the sense of increased stability
doesn't actually come from structural support provided by the tape but more from the increased
proprioception (sense of position) provided by the increased feedback from the taped skin.

I am not sure the statement "stimulates the lymph system" is sufficiently precise but it is correct.
Message increases flow of lymphatic fluid. Lymphatic fluid is the fluid in the body that is not
inside the vessels and not inside the cells. Traumatic swelling is caused mostly by increased fluid
in this space. Lymphatic fluid flows though the lymphatic channels and eventually is returned to the
venous circulation. Fluid moves from areas of higher pressure to areas of lower pressure. Massage is
one way to put increased pressure on this fluid to push it out of the area of swelling and back
towards the venous circulation. In fact, this is probably the major reason why massage has any
benefit. Compression, e.g. an ACE wrap on a sprained ankle, and elevation are 2 other ways to
accomplish the same thing.

--
Mike Murray MD