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It really depends on what caused the edema in the first place. By contraindication, we mean that it is a caution sign, and that more detailed questioning needs to take place so that we can adjust our techniques accordingly.

For example, pitting edema could signify deep vein thrombosis, which is a complete local contraindication and only feather light strokes should be used in this area to avoid causing an embolism. Simple, non-pitting edema may be a sign of inflammation, and we need to investigate the cause of the injury, draining proximal to the edema is beneficial, but avoid circulatory work distal to the injury. The swelling creates a blockade and we want to avoid damaging blood vessels by forcing blood through. We also want to avoid complicating the injury.

Lymph edema can be reduced by manual lymph drainage proximal to the site, but requires advanced education.

When in doubt, refer them out to a more experienced therapist, or get some HIPPA paperwork together and consult their primary care doctor.

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