Discussion
type-1 lymphedema, MLD, fatigue, contracture, pain, tissue stiffness, cramping, lymphedema, STM, NRS
SYNDROME, MLD, STRETCHES, LYMPHEDEMA, COMPLICATIONS
The purpose of this study was manual lymphatic drainage versus soft tissue mobilization for managing pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome. A total of 36 participants were included in the study who met the inclusion criteria, out of which 32 completed the study. Baseline exercise therapy was the same in both groups. The mean age and BMI of the participants were 47.34 ± 10.67 and 27.96 ± 3.78, respectively. Both treatment plans were clinically effective; only two outcome measures, DASH and PSFS in the manual lymphatic drainage group showed significant effects. Limb circumference was measured initially and at the end of the intervention period (4th week). There was little change in measurement like 1-2 cm as there was type-1 lymphedema.Therapeutic exercises (stretching, strengthening and range of motion exercises) were performed in both groups as a baseline treatment therapy. Intensities were adjusted between mild to moderate to avoid complications like fatigue, cramping and soreness. Stretching exercises were incorporated to improve tissue flexibility and mobility, with 7–10 repetitions, with each stretch held for 5 s beyond the available range. According to the literature, the most fundamental benefit of stretching exercises is tissue mobility, as stretching initiates changes in contractile and non-contractile elements of the tissues, thus lowering tissue stiffness and preventing contracture formation [In previous studies, manual lymphatic drainage was mainly used for axillary web syndrome. Self MLD and physical exercise was also used for the treatment of lymphedema and showed good results [In comparison to the recent study, the effects of MLD were seen in a study for the treatment of AWS. DASH, NRS, arm volume, quality of life questionnaire, and shoulder flexor strength were measured after a 4-week intervention. NRS and arm volume showed significant results with PT in combination with MLD [Soft tissue mobilization (STM) is also beneficial in treating AWS, as it improves ranges by breaking the cord effectively and is helpful in pain reduction [Physiotherapy treatment was considered to be a conservative method for axillary web syndrome. With combined multiple interventions, of PT treatment plan was designed that includes lymphatic drainage, manual therapy, stretches, strengthening and ROM exercises and soft tissue mobilization/massage that proved to be an effective protocol for axillary web syndrome patients [