Center IMT - Integrative Manual Therapy and Diagnostics

The Influence of Endermologie® and Bone Bruise Technique on Shoulder Joint Range of Motion: A Case Study

Author: Kris Roy, PT and Laurie Blackwood, MT

Abstract: This article will provide the objective measurements of shoulder joint range of motion, prior to and following total-body Endermologie® sessions for lymphatic drainage. Measurements of bilateral shoulder joint flexion were taken from two female adults, four sessions each. Results indicate significant short-term increases in degree of shoulder flexion, except in one shoulder that required the Integrative Manual Therapy Bone Bruise Technique to the humerus in order to improve shoulder flexion. The authors submit that lymphatic congestion can inhibit shoulder flexion range of motion, that Endermologie® has short-term positive effects on shoulder flexion, and that the presence of humeral Bone Bruises inhibit this increase of range of motion.

Key Words: Endermologie®, Shoulder, Bone Bruise, Lymph, Lymphatic Congestion, Range of Motion (ROM)

Discussion

The authors embarked on this study of the outcomes of total body Endermologie® sessions for lymphatic drainage in order to examine the possible effects on range of motion of shoulder flexion. A review of the literature on Endermologie® revealed no research studies specific to changes in range of motion. Endermologie® has been in development in France since 1986. LPG® Systems developed Endermologie® as a therapeutic modality, which has been approved in the USA for the treatment of cellulite (1). The motorized machine is equipped with a twin-roller head, three active auxillary heads, and three passive auxillary heads, which cause mobilization of the tissues by rolling and unrolling and suctioning skin folds. According to LPG® Systems’ website, Endermologie® is widely used in the field of functional physical therapy in Europe, with both human athletes and horses to optimize performance and reduce periods of immobilization (2). Research indicates that Endermologie® can "increase local blood circulation and relieve minor muscle aches and pains and muscle spasms"(3).

One study demonstrated that Edermologie® caused improvement in the recovery rate from stiffness in athletes from five days to two days after exercise. In addition, during the study, athletes reported less discomfort than usual and an absence of edema following exercise (4). Another study by the same authors proved that Endermologie® treatments decreased lactic acid production in athletes, resulting in reduction of muscle fatigue (5). James Watson, MD, and associates at UCLA studied the physiological effects of Endermologie®. They examined blood and lymphatic flow recorded before and after Endermologie®: "3-fold increase in Lymphatic flow lasting 3 hours after treatment, 4-fold increase in cutaneous blood flow, lasting 6 hours after the Endermologie® treatment" (6).

History

For this case study, the authors used themselves as subjects. Subject "A" was a 30 year-old female with a history of widespread muscle and joint pain, for which she has occasionally been treated for shoulder dysfunction with various manual and movement therapies over the last eight years. Subject "B" was a 40 year-old female with a history of widespread muscle and joint pain, for which she has occasionally been treated by various manual and movement therapies over the last thirteen years.

Evaluation

The clients wore the nylon Endermowear® suit that is manufactured by LPG Systems. The same goniometer was used for the measurement of each Subject. Subject "A" and Subject "B" measured each other for all four sessions. The first two sessions for each Subject were one week apart, the third and fourth sessions were performed six months later, one week apart. Measurements were taken of right and left shoulder flexion (see table 1).

Treatment

Each session consisted of 60 minutes of Endermologie®, at the therapeutic bloodflow setting, using pulsating suction, levels 1 through 3. Both the CelluM6 and the auxillary treatment heads were used, consistent from Subject "A" to Subject "B".

Outcome

Measurements of the left and right shoulder flexion of each Subject were taken with the same goniometer immediately following each treatment (see table 1).

Subject "A" showed increase in right shoulder flexion after each of the four Endermologie® sessions. Right shoulder degrees of improvement: (first session) 20, (second session) 17, (third session) 25, and (fourth session) 8. Subject "A" showed increase in shoulder flexion only after the third session, no change after the first session, and a decrease in shoulder flexion after both the second and the fourth sessions. Left shoulder degrees of change: (first session) 0, (second session) -6, (third session) 27, (fourth session) -6.

Subject "B" showed increase in right shoulder flexion after each of the four Endermologie® sessions. Right shoulder degrees of improvement: (first session) 9, (second session) 2, (third session) 23, (fourth session) 18. Subject "B" showed increase in left shoulder flexion after each of the four sessions. Left shoulder degrees of improvement: (first session) 25, (second session) 17, (third session) 20, (fourth session) 2.

Table 1

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Pre and Post-Treament Results
Treatment No.	Left Shoulder Flexion		Right Shoulder Flexion
	Pre	Post	Pre	Post
Subject "A"
1	115	115	130	150
2	136	130	123	140
3	106	134	130	155
4	138	132	122	130
*Subject "B"*
1	120	145	110	130
2	131	140	112	135
3	106	124	113	115
4	120	122	100	118

__________________________________________________________________

Further Treatment

The authors noticed that Subject "A’s" left shoulder showed inconsistent results and decided to investigate with further evaluation of the left arm and shoulder. Using the diagnostic skills of Integrative Manual Therapy (7), the authors detected numerous Bone Bruises within the left humerus of Subject A.

A Bone Bruise is categorized as a type of fracture, an area of bone that has lost its integrity due to a compressive force (8). Compression fractures can also be caused by osteomalacia, osteoporosis, and osteopenia (9).

Measurements of Subject "A’s" left shoulder flexion and extension were taken with the same goniometer by Subject "B". Left shoulder flexion was 105 degrees, left shoulder extension was 0 degrees. An Integrative Manual Therapy practitioner (not Subject "B") performed 25 minutes of the Bone Bruise Technique (10) (developed by Sharon W. Giammatteo, PhD, PT) to the left humerus.

Final Outcome

Measurements were taken by Subject "B" of left shoulder flexion and extension after treatment, using the same goniometer. Left shoulder flexion was 115 degrees, left shoulder extension was 25 degrees. By using the Bone Bruise Technique, range of motion improved by the following degrees: 10 of shoulder flexion, 25 of shoulder extension. Left shoulder ranges of motion were rechecked two weeks after the Bone Bruise Technique was performed, showing flexion of 120 degrees, extension of 25 degrees. The flexion actually increased by 5 degrees and the extension maintained the same degree of motion.

Conclusion

Based on the results of this study, the authors propose that the use of Endermologie® has a short-term effect of increasing shoulder joint flexion. Endermologie® affects lymphatic flow and blood circulation, temporarily reducing congestion of the lymph vessels and nodes. By reducing lymphatic congestion in the body, joint range of motion can improve.

This study also indicates that the presence of Bone Bruises seems to affect the outcome of Endermologie®. Integrative Manual Therapy for Bone Bruises will result in a long lasting increase in range of motion. Based on this study we conclude that the client will get the most effective increase in shoulder range of motion by combining Endermologie® with Integrative Manual Therapy. Possibilities for future studies include further research in the combination of Endermologie® and Integrative Manual Therapy, specifically using manual lymphatic techniques for vessels and nodes either before or after Endermologie®.

About the Authors

Kristine Roy, PT, IMP, C, is a licensed physical therapist and practitioner of Integrative Manual Therapy in Connecticut. She is the manager of the Glastonbury, CT, office of Regional Physical Therapy and a faculty member of Dialogues in Contemporary Rehabilitation.

Laurie Blackwood, CTP, MsT, NCTMB, is a certified Trager® practitioner and a licensed massage therapist in Virginia. She is a staff practitioner of Integrative Manual Therapy at Regional Physical Therapy in Bloomfield, Connecticut.

References

2. Ibid.

3. Ibid.

4. Portero, Pierre and Canon, Francis and Duforez, François, Effects of a New Massage Technique on Recovery from Stiffness. www.endermologie.com 1998.

5. Portero, Pierre and Canon, Francis and Duforez, François, Electromyographical and Biomechanical Approach of Muscular Fatigability. www.endermologie.com 1996.

6. Watson, James, MD, and Fodor, Peter Bela, MD, and Cutcliffe, Brian, BA, and Sayag, David, MD, and Shaw, William, MD, Physiological Effects of Endermologie: A Preliminary Report. www.endermologieusa.com/research.html, Aesthetic Surgery Journal; 1999; 19 (1) 1-7.

7. Integrative Manual Therapy© can be studied through seminars given by Dialogues in Contemporary Rehabilitation, 800 Cottage Grove Rd., Bloomfield, CT 06002.

8. Yao, I and Lee, JK, Occult intraosseous fracture: detection with MR Imaging.

Radiology 1988; 167:749-751.

9. Morgan, Virginia, PT, and Chevan, Julia, PT, MPH, OCS, and Giberto, Marjorie, RN,

PT, and Kofler, Michelle, PT, Compression Fractures due to Osteomalacia,

Osteoporosis, or Osteopenia. Physical Therapy Case Reports, Volume 3,

Number 4, pp. 181-187.

10. Bone Bruise Technique© can be studied through seminars given by Dialogues in Contemporary Rehabilitation, 800 Cottage Grove Rd., Bloomfield, CT 06002.

Pre and Post-Treament Results