Biomedical

BiomedicalFuzzy

Fuzzy Systems
Systems
Association
Association

IJBSCHS(2009-14-el-14)

Biomedical
SoftComputingand Human Sciences,
Vol,14,No.1, pp,109-I15(2009)

article]
[Original

Copyright@1995 BiomedicalFuzzy Systems Asseciation

on 2008.10.16>
(Accepted

Effectsof Lower Limb and Dorsolumbar Massages

on Edema in Postpartum Women

Hanachiyo Nagatai'8),EiichiroTanakai),MasasukeTakefu2)Takeshi Sato3),

,

Masahiro Nakano4),MasatosiMorimoto5), Akiko Fukushima6),NorioAkaike7),

i)Department
2)
3)

SchoolofMedicine,

ofPhysiology,

Kurume University

CenterforCorpprehensive
Community Medicine,Faculty
ofMedicine,
Healthcare Center,Saga
University

4)

InforrnationScience

and

Physics,University ofOccupational

Saga University
Environmental Health, Japan

and

S)

FacultyofHealth Science,Dep. ofRehabilitation, Kurnamoto HealthScienceUniversity

6)
DepartmentofDirector Nursing,FukudaHospital,
Kumamoto, Japan
7)
Department ofHealth
Sciences,
ResearchDivision fbrLifeSeiencesKumamoto HealthScienceUniversity
g}Matemity
Nursing,Aso Nursing and MedicalCollege

(Thepaper was
Abstract:Edema

may

on

June4, 2008.)

hcrnds,
and
lowerlimbsin 20-40% ofposipartum
women
duringthe
face,
711re
elevation
limbsisthe most e6feetiveway to treatlowerlimbedema in
of'lower

occur

earlypuerperalperiod

posipartumwomen.

received

New

on

methods

have been'recently

iower limb edema,

of'the

introducedfor the care

such

footbaths,
forthelower limbs,HbweveL the qfi2]ctof
massage
on reducing
lowerlimb eclema is not connyJietely accepted
T7ieobjective ofthis
stucb, is to evaluatethe change inthe louserlimbedema qfierlowerlimb or donyolumbarmtxssage with 30-min elevation
were
dividedinto two groups, the tower limb massage
oj'the lower limbs. Mneteen posipartum women
and
the dbnsoiumbarmassage
Both groups showed
reduction
in the lowerlitnb
group ei=9)
grotp ()i=Ia),
volume
lower legand the big toe, and an increase in the cutaneous
as well as the circuinjlerence ofthe
bloodflow in the tibialis anterior mt{scle. 77ieseresults suggest
that lowerlimb or dorsolumbarmagsage
with elevation
lowerlimbsreduces lowertimbeclema.
ofthe
qfier-birthexercises,

as

Keywords

and

aromatic

oil massage

Lower Limb, Massages, DorsolumbarMassages,Postpartum WOmen

lowerlimb edema havealso complained oflower

back pain. No usefu1 treatment other thanelevation of
the legshasbeen reported fbrlower limbedema. New
with

1.Introduction
In 2040%
on

of

postpartumwomen,

the hands, face, lower limbs.

and

edema

appears

feet,2-3 days

treatments have

delivery.
Although the edema
naturally
disappears in the due course of time, postpartumwomen

limb edema,

after

with the

edema

experience

significantly

more

lackof sleep than thosewithout edema.D2)

authors'
institution,
most
of the postpartum
and

and

fatigue

such

aromatic

oil

However, the

At the

limb edema
compared

been introduced for Iower

footbath,
after-birth
exercises,
4) 5}
massage
for the lower limbs.3)
as

effects

of rnassage

isnot completely

In thisstudM

women

recently

with

the effects

on

reduction

of

lower

accepted.
of

lowerlimbmassage

are

those of thedorsolumbarmassage,

The
thelower

lowerlimb volume and the circumference of

leg and the big toe, as well as the cutaneous
blood
flow in thebig toe and lowerlimb were measured be-

Department of Physfology, Scheol of Mcdicine, Kurume

University,
67 Asahi,Kururne,Fukuoka 830-OO]1 JAPAN

109

NII-Electronic Library Service

Biomedical
BiomedicalFuzzy

Fuzzy Systems
Systems
Association
Association

Biomedical Soft Cornputing and Hurnan Sciences,Vol.14,No. I (2009)

S)
protocolsused in earlier reports.4} The massage was
with
the fbllowing
given in proneand supine positions

foreand after thelower limb or dorsolumbarmassage

with 30-min elevation
of the lower limb,Both the
lower 1imb and dorsolumbarmassages
enabled
a reductionin the lower ]imbvolume and circumference
of the lower leg and big toe, and an increase
in the
cutaneous bloodfiowin thelowerlimb.

mstructlon:

Stroking:
lower1imbs(1Otimes)
(1)(2)(5
Stroking:lower limbs and popliteal
fossae
times)

Friction:sural and femoralregions (5times)

(3)(4)(5)(6)(7)
Stroking(thrice)
Kneading: lowerlimbs(twice)

2. Materialsand Methods
2.1.Participants
This

was

study

2004. Nineteen

cember

postpartumwomen
in

veries

from Septemberto De-

conducted

Stroking:heel,lateral
surface

2-5 days after natural deli-

within

took partin thisstudy. All the participants

shewed

lowerlimbedema

tum

women

with

complications,

varices or an excess
were

The

excluded.

(the

29.8 years
mean

age

number

randemly

were

amount

such

of

age of

range

was

ofdays

after

and

theoriginal instructions
fbr lower lirnbrnassage
introducedby Yanai (TbkyoMedical School)4},the
massagein was performedwith aromatic vegetable
oiis
the prone position.In thisstudy, the lowerlimbsof
'
the particlpantwere covered by an ordinary soft bath
towel, and the lower limb massage was subsequently

the participants
was

18-39 years),and

a whole

In

blood loss(>500ml)

mean

heel,

Stroking(thrice)

lower limb

as

the

Ibe press
Wlirming:foot (ankle,
plantararch,

dividedintotwo
received
lower
limb massage with
groups: one greup
30-min elevation
of the lower limbs (n=,9)
and
the
other group received
dorsolumbar massage
with
30-min elevation of the lower limbs(n-10).
Postparand

of

(10times each)
Foot press
(8)(9)(1O)toes)(11)
heelas

and

City,Japan,

in Kumamoto

clinics

obstetric

Stroking (5times)

participants,all

yoluntary

the

givingbirthwas 3.5days.

performed in the prone

2.2.Measurement

'aromatlc

and

supine

without
positions

oils.

Before applying
tumbar

lower limb massage

the

or

the parameters for evaluation

massage,

lower limb edema

dorsoof

The processforthe dorsolumbarmassage

fo11owed
the back massage
proceduresoutlined in earlier re7)
In
this
study,
three new procedures(massage
ports,6)
'des
forboth si of the ilia,
the back,and the abdomen)
were
added
as a part ofthe dorsolumbar
massage. The
dorsolumbarmassage was given at a decubitus posi7)
tion fbllowing these instmctions
1 and 2):6)
(Figs.

the

includingthe circumference
of the right big toe and the right lower
limb,thecutaneous
blood flow intheright bigtoe and
right lower limb (in
the skin on the tibialisanterior
rnuscle),

the

were

and

measured,

volume

the

of

participants.Afterthe massage,
elevated
were

for30 min,

The

circumference
at

20

cm

lume of the right

was

lower limb

ofthe

thelower limbswere

subsequently,

(1)Gentlymassage

the parameters

7th

again.

measured

measured

and

right

fi11edwith

(1Omin,
of

the

water,

and

then the

right

weighed

determinethe volume

of

by tracing a

figureon both

spiral

vertebra

(15min,

Fig. 1,(2)).

fbot and

(3)

Gentlymassage

bothsides

of

the ilia
(7min,

Fig. 1, (3)).

(4)

the right lower

and

min,

Gentlymassage

down

(5)

massage

The processfor lower limb massage

Fig. 1, (1)).

bra throughthe levelof 5th lumbar

limb.
2.3.Instructions
of

by tracing a spiral figurefrom the

throughthe 5th lumbar vertebra

sides of the spine from the levelof 7th cervical verte-

limb ofthe panicipant

was submerged
in thiscontainer.
The water that overfiowed
from the container
was
to

vertebra

(2)Gently massage

right lower limb was

from the fioor.

Tb measure
the volower limb,a 30-cm high eontainer

warin

cervical

both sides

(5

Fig. 1, (4))

Gently

massage

min,

of

the back,up

the al)domen as

a whole

(3

Fig.2, (5)).

fbllowedthe

110

NII-Electronic
NII-Electronic

Library Service

Biomedical Fuzzy Systems

BiomedicalFuzzySystemsAssociation

Association

et al. : Effects
of

H. Nagata

Lower Limband Dorsolumbar Massages on Edema inPostpartumWomen

nificant

lower limb

.11:

in the circumference

reduction

the

after

the

of

right

Figure
(p<O.OO04).

massage

4A

illustrates
thecutaneous bloodflowinthe rightbigtoe
beforeand after themassage. Itcan be observed that
therewas no significant difference
in the cutaneous
blood flow in the right big toe beforeand after the

t.
t

'

l21

trpt,

Figure 4B shows

massage.

the

increase in

significant

bloed flow in the right lowerlimb afier

the massage
Figure 5 illustrates
thesignifi(p<O,03).
cant
the
the
right
lower limb
decreasein
volume
of
the cutaneous

.t"'s

1.1

t/:-l

t/
.
/./

Fig, 1 Dorsolumbermassage6)7)

lp<O.02).

the massage

after

Fig. 3 Changes in the circumference

toe

and

the

lower limb produced by the lower

right

Iimbrnassage.
The fi11ed
circle indicates
the circumference before
the lower limbmassage. The open circle indicates
the
circumference
after the lowerlimbmassage.

tt/ttt.tt/.ttlt...'
t/t

crn

[/1tr-1'
r

9gt6s.,['8:i

7,s

FlL
-x--

g,o8
2.4.Analysis

of

the right lower limb before

IIThe
paired-test between the two
was
used
fbr
comparison
of the circumference
groups
of the big toe and
the lower limb,and the cutaneous
blood flow in the big toe and the lower limb before
and

after

finedas

the massage.
a value

Statistical
significance

ofp<O,05,

was

L---

. ---r--..

-t---.--..ur----..-,

before

24oi'

after

cm

!t

35eg3e

de-

E-.T.-.=-or.
---t
-t.I------pt
s
=ts---.s

'

F--

indicated
otherwise.

unless

and

the massage,

after

Fig.3A Changes in the circumference of the right big

toe produeed by theIowerlimbmassage.

The Aspin-Welch t-testwas used fbrthecomparithe volume

i-

x--.

6.svfi

massage6)7)

son ef

--l'l

--x-boJ....

lt..ts-<"..

Fig.2 Abdomen

big

of the right

..-/

F.-"7

25:o
e

ny7rL-o

20komfo

3. Resuks

-'j

3.1.Changes in the parameters

before

the lower limb

atter

after

massage

Figure 3A
circumference
massage

shows
of

the

the significant
right

bigtoe

Fig. 3B Changes in the

in the
theiowerlimb

reduction
after

while Figure 3B
Cp<O.OOOI),

shows

circumference

of

the

right

lowerliml)producedby the lowerlimhmassage.

the sig-

111
NII-Electronic Library Service

Biomedical Fuzzy Systems

BiomedicalFuzzySystemsAssociation

Association

Biomedical SeftComputing

and

Human Sciences,Vol,14,No,1

producedby the lowerlimbmassage.

The fi11edcircle indicates
the volume beforethe
lower limb massage,
while
the open circle indicates
the volume after the lowerlimbmassage,

Fig.4 Changes inthe cutaneous bloodflow in the right

bigtoe and theright lowerlimbproduced by the lower
limbmassage,
The fi11edcircle indicatesthe cutaneous
blood flow
beforethelower limb massage,
while
theopen cirele
flow
indicates
the cutaneous blood
after the lowerlimb

3.2. Changes in the parameters

]umbar massage
Figures 6A

massage.

A
au

soco48oo93cglien-28eiEH.Eo

.."e

the

of

f.

before

-.

6B

the dorso-

the significant

show

reduction

right

lower limb

the

after

(p<O.02).

massage

These results indicatethat both the lower limb and

dorsolumbarmassages are able to reduce the lower

...i

after

limb

Fig,4A Changes in the cutaneous blood fiow of the

right big toe produced by the lower limb massage,

edema

in postpartumwomen,

Fig.6 Changes in the circumference of the right big

toe and the rightlower limb produced by the dorsolumbarmassage.

au

and

after

in the circumference of the right bigtoe (p<O,OO1

)and
theright lower limb (p<O.O03),
respectively, after the
dorsolumbarmassage. Figure 7A shows the significant
decreasein the cutaneous
blood flow inthe right
big toe after the massage Cp<O.03)
Figure 7B
, while
shows the significant increase in the cutaneous blood
flowinthe rightLowerlimbafter the massage
(p<O.04).
Figure8 shows the significant decreasein the volume

sl7oe6ve.

(2009)

The fi11edcircle indicatesthe circurnference before

32.5

the dorsolumbarmassage,

the circumference

cates

the open

while

after

tndi-

circle

the dorsolumbarmas-

21.5

sage.
l/
A

1O.5

9e.g[........um....ww.

----

ssg
o

before

Fig. 4B Changes in the cutaneous

blood flow of the

lower limb producedby thelower lim b massage.

3500

ttt-

..l,,/
-tl

82;o

afier

-----

1.58S7:.E

right

--l

6.5g'ts
6eeo

tttttt-

----...L
-before

---1

t.rm..t..L2
after

3ooe

Fig. 6A Changes in the circumference

250D

toe

produced by the dorsolumbar

of

the

right

big

massage.

'so

2000
15DO

before

Fig.5 Changes inthe volume

after

of

the right lower limb

112
NII-Electronic
NII-Electronic

Library Service

Biomedical Fuzzy Systems

BiomedicalFuzzySystemsAssociation

Association

Limb and DoTsolumbar Massages on Edema inPostpartumWomen

H. Nagata et al,: EffectsofLower

cm4e.o

I35.e
t--

N,-

D.Ezm)Adi

r-'-

'/30.0

--

35ooEts

2500

before

after

,Il'

'"''

1500Bfo

-"

L...

.,r=

6 2ooOmEeo

ttt.-..

20.0
o

]i

--

3000lpO

FF
25.0

ttttttt.--..

ts8sge'gfi

...

s...

4000n

i'

before

Fig, 6B Changes in the circumference

of

.:'

---

after

the right

lowerlimbproduced by the dorsolumbarmassage.

Fig, 8 Changes in the volume

theright lower limb

of

produced by the dorsolumbarmassage.

bloodfiow in theright
lower limb producedby the dor-

Fig. 7 Changes in the cutaneous

bigtoe

the right

and

solumbar

The fi11edcircle indicates

the volume
befbrethe
dorsolumbarmassage, whi]e the open circle indicates

massage.

The fi11edcircle indicatesthe cutaneous

blood flow

beforethe dorsolumbarmassage, while the open circle

indicates
the cutaneous blood flow after the dorsolumbar

the volume

au

Edema

..r....A... .-... .
fr.]].a. .

C`edema"

mally

tttttt
tttt
t

"tttttttt

Fig. 7A Changes in the

right

-:
--/

-"-o

tttt
after

blood fiow of the

bigtoe producedby the dorsolumbarmassage.
3

au

['-''

B
' "-'--

cutaneous

"----

massage.

from the accumulation

results

of excess

in-

''" --'

as

fo11ows:Edema is a

1arge fluidvolume

condition

of

abnor-

in the interstitial
spaces, and

theswelling inthe tissuethatcan be visually noticed.8)

This condition can be caused by the excess intakeof
water
or an impaired body fiuid
and sodium,
regulation mechanism.9) Pathophysiological factors
foredema
include increased capMary
hydrostatic
pressure,
decreasedeelloidal osmotic pressureof plasma, increased capillary permeability,increased
colloidal
osmotic pressure
of interstitial
fiuid,
and obstruetion of
lymphaticvessels.iO) ii} postpartum women
with
lower
limb edema experience
some
minor
symptoms
or discomfbrt, such as numbness,
painduringwalking, and a

l''I

e-before

dorsolumbar

terstitial
fluidsin the tissue.Ohashi definedthe term
=

)8g:m..8gs.g3o

so-=[e-

the

4.Discussion

massage.

7654321e

after

'--,

)o2oOngE
2.5

sense
21.5

ofexhaustion

of

the

lower limbs.The lower limb

in postpartumwomen may result from maintaining the same body position

duringbreast-feeding,
from
a
tight
obstetrical
binder,
and fatigue
or
pressure
anemia
during delivery,i2)
Nowadays,
lower limb
edema

ig.J
1O.5
O]-oooE=H.[

massage
o

before
Fig.rightsage.
7B Changes in the

blood flow

cises,

of

aromatic

vegetable

oil, afier-birth exer-

thelowerlimbsare employed to
with
lower limb edema, In earlier
postpartum women
studies, the subjective symptoms
were
found to be
improved after the lower limb massage,
while
the cir-

after

cutaneous

with

the

lower limb producedby the dorsolurnbar

mas-

and

cumference

changed,5}

elevation

of
i2>

the

of

lower limb

This study

showed

was

not significantly

thatboth the lower

113
NII-Electronic Library Service

Biomedical
BiomedicalFuzzy

Fuzzy Systems
Systems
Association
Association

Biomedical
SoftComputingand HuinanSciences,
Vol.14,
No.l(2009)
limb

dorsolumbar

and

massages

limbedema.
4.1.Effectsof the lower limb
limb

reduced

on

massage

the lower

improvethevenous
both the massages

the lower

may

edema

[[breduce

sage)

may

lower limb

decreaseand the interstitial

fiuidmay flow into
the vessel. These supportive effects for the muscle
may
contribute
to the reducpump throughmassage
tion ofthe lowerlimbedema.
However, we did not observe a significant differflowin thebigtoe,During
ence inthe cutaneous blood
the lower limb massage,
the bigtoe was pressed, but
not stroked from theperiphery
to theheart.Therefbre,
the venous return was not increased around the bigtoe.
may

on

massage

postpartumwomen
from the 7th

was

cervical

of

through

the

nerves

zaki]

to the 2nd lumbar spinal

cord,

possiblethat dorsolumbarmassage
and

of

the

smooth

the blood fiow,which

fact,the cutaneous
creased

after

cutaneous

the

in the blood

muscle

may

reduce

[5] Rina

of

Effect of aromatherapy

et al.:

for

in the postpartum period,

33rd
ConjZrrenee Jbpanese IVitnsingAssociation, MLi2002: ]OO-102.

ternityMrsing

the

[6]Hachiyo

Nagata, Tatsuhiko Kawarabayashi:

Shouldermassages effective forbreastmilk secretion, 77ie
Jburnaifor Ml'civives,

vessels

In

.lapanese

massage,

56(6), 1996: 478-483,

the

although

[7]Hachiyo Nagata,Tatsnhiko Kawarabayashi

blood flow in the big toe decreasedafter-

reduction

Kawabe

lowerlimb ederna

spinal

lower limb

edema

was

et al.:

Concurrenteffects of breastand shoulder massages

fbrbreastfeeding,Perinatal CZire,l5(1O),

ward,

The

A{la-

ing,2002: 103-105.

blood flow in the lower Limb indorsotumbar

and

Kawabata, Koji Samijima, Kentaro

Onomura: Aromatherapy Hbndbook forHeaXth
Pflv2issionals,
2002:41-45.
[4] Takae Yanai, Kayoko Samejima, Atsuko Kohiyama:Effect of massage
by vegetable
oils for
postpartumlower limb edema, 33ni Coqference
Jbpanese NiirsingAssociation,
Minternity
?Vtzrs-

the

the edema.T4)

- Early postpartum

[3] Kazunaga

the

adjust

Troubles, Perinatal

lifestyleof postpartumwomen,
ternalHealth, 428(4),
2001 : 520-527.

Therefore, it is
may

Postpartum edema

edema

5th lurnbar

from the thoracic

Minor

Tlsutako
Miya[2] Kiyoko Kabeyama, Kaori[Ibrada,

Thistactualstimulation may passthrough the

afferent fibers
to the thoracic spinal cord, and the 1st
and
2nd lumbar spinal cord. Almost all the smooth
muscles
of the blood vessels are controlled by the
efferent

Kurokawa:

Care, SuinnierEdition,2003: 32-35.

vertebra.

sympathetic

edema.

[1]Sumie

(bymaking bigloops)

stroked

vertebra

the back

in postpartumwomen

References

edema

During the dorsolumbarmassage,

forthelowerlimb edema

2. A lower limb or dorsolumbarmassage with a

30-min elevation of the lower limbswas obseryed
te
reduce lowerlimbedema.
3. The massage
of the lower limbs and dorsolumbar
area
or the elevation
of the lower limbs is therefore
considered to independently
affect thereduction
of the

also

4.2. Etfects of the dorsolllmbar

mastreatment (dorsolurnbar

wasproposed.

rettrm
by the
promote thevenous
muscle pump, since the muscles are pressedpassively,
ConsequentlM the venous
pressure of the lower limbs

movement

edema.

l, In this study, a new

flow.i3)

cord

and
the

reduce

edema,

"muscle

lower limb

to

5.Conelusion

itisessential to improvethecirculation of theblood and 1ymph. The skeletal muscles

contract
and
compress
the bleod and 1ymph vessels to
fiow
faeilitate
the srnooth
of blood and lyrirph
toward
the heartby means ef valves in those vessels, through
a mechanism
known as the "muscle
pump." This
pump" may accelerate the blood and lymph
Massage

act

by gravity.In other words,

elevation of the lower limbs

return

observed

1996:909-915.

bothwith the lower limband the dorsolumbarmassage.

Afterboth types of massage,
the Lower limbs of the
for30 min; thus, it
were elevated
postpartum women
is also possibiethat the elevation of the lower limbs

[8]Toshio
swelling,

[9]Hiroko

Ohashi: Special feature - Lower

limb

Current Tlierapy,12, 1994: 207-212.

Usui: Human

Body - M,om the P7evvpoint

114
NII-Electronic
NII-Electronic

Library Service

Biomedical
BiomedicalFuzzy

Fuzzy Systems
Systems
Association
Association

H. Nagata et

aL : EffectsofLower

Limb

Dorsolumbar Massages on Edema inPostpartumWomen

and

Kodansha, Ltd.,2003: 106-114.

qflVitnses,
- LetisAdListerthnYuko Amemiya: NC special

[1O]

domentat Nitnsing
717chnology Igakugeijyutsusya,

Ltd.,7(8),2003.
1]
[1 Takashi Watanabe, Hisanori Mizukami, Ikuo Sato:

Edema, Obstetricsand

GynecologM

64, Sup-

ptement ]998: 274-275.

[12]Hatsumi Sensui,et al.: Changes of

temperature

thecutaneous

blood flow in the lower limb by

and

fbotmassage, 3ah CotderenceJopanese?Vlinsing

Association,
SOUGOU K4AJGO (General
M`rsing Practicel,
1999:89-91.

[13]Ybshihiro Ogawa:

Bandaging Tbchniques, lixpert

Mims'e,19, 2003: 108-113.

Tbshinori Hongo, Principles
[14]
ofPbysioiegr4 5th

Edition,
Igaku-ShoinLtd.,2001: 568,

115
NII-Electronic Library Service