Stiffness and Decreased Range of Motion (ROM) After Liposuction

I have found that Manual Lymphatic Drainage (MLD) helps to reduce edema in the days and weeks after liposuction surgery, but the client may also present with other surgery-related issues. 

Clients have come to my office complaining that they cannot

• Bend over to the ground easily
• Rotate their torso to practice hygiene after using the restroom
• Stand straight up
• Move comfortably without feeling tightness in their torso
• Awake from sleeping without feeling tight in their torso

Tightness in the areas that have been liposuctioned can affect our client’s abilities to perform Activities of Daily Living. In The Tumescent Technique, Jeffrey A. Klein MD states that “over the next several days, after drainage has ceased and as the inflammatory healing process progresses, there is a gradual onset of swelling. This subcutaneous abdominal swelling can restrict bending forward; for example, tying shoes becomes a minor challenge”  (Klein, 2015). 

The client may also have some limitations in their range of motion in the glenohumeral joint and ability to side bend after liposuction, possibly as a result of liposuction on the flank and bra roll. 

Watch Dr. Hughes during a liposuction procedure on these areas:

Bra Roll Liposuction from Three Different Approaches with Dr. Hughes

(2:30 minutes) https://youtu.be/9o8mHtb_L4s 

To reduce these side effects, I add myofascial massage strokes to the client’s massage session as soon as they feel comfortable to the client. If a client is too sensitive for myofascial massage strokes, a combination of MLD, hot stones and negative compression (lymphatic cupping) may help reduce the sensitivity. 

Should we be giving painful deep tissue massages after plastic surgery?

Why take the time to ensure that the massage feels comfortable to the client, especially if they TELL YOU they are supposed to have a painful, deep tissue massage and have opioids at home to help them recover?

In the article ‘Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon,’ Barker et al. state that “optimal pain management ... have been shown to reduce postoperative complications and expedite recovery. However, postoperative pain is still inadequately managed. Opioids remain the mainstay of perioperative pain management, despite well-recognized adverse events including nausea, vomiting, pruritus, sedation, constipation, respiratory depression, and opioid-induced hyperalgesia” (Barker et al., 2020).

Pain management is important because it improves recovery. Relying on opioids is not necessarily the best choice, though. Does it surprise you that nausea, itching and constipation are possible side effects if the client has to take an opioid to ‘get through’ their postop massage? 

For between 5% and 13% of people after plastic surgery, nausea, itching and constipation are the least of their opioid’s side effects. Barker et al. state that “opioid misuse and abuse has reached epidemic status” and “the most common reason for new opioid prescriptions is for acute postoperative pain. They continue, stating that “the creation of chronic opioid addiction in postsurgical patients who were previously opioid naive, (is) termed “new persistent use.” For patients undergoing plastic surgery, specifically, the rates of new persistent use have been reproducibly demonstrated to be between 5% and 13% across a variety of plastic surgery procedures” (Barker et al., 2020).

Let me repeat - according to this research article published in the Plastic and Reconstructive Surgery Journal in May 2020, between 5% and 13% of patients taking opioids for the very first time to control pain after plastic surgery will end up with a chronic opioid addiction. 

When I hear that, I can understand why my clients tell me they stopped taking pain pills as soon as they could after surgery and are scared of their first postop massage. They bravely tell me that they want me to do what I have to do and they will handle it. They are VERY relieved when they feel that the Vodder-style lymphatic massage actually makes their skin feel less sensitive and the hot stones and lymphatic cupping make them feel comfortable. There is NO painful deep tissue massage and none of my clients have to take an opioid pill to feel better after their session.

Let’s look at some evidence for Manual Lymphatic Drainage, Hot Stones, Negative Compression and Client Positioning first, then go in depth with this style of gentle Myofascial Massage.