Background: Indocyanine green (ICG) lymphography has been relied upon extensively in lymphedema management. Its utility extends from diagnosis and severity staging to treatment planning and outcome tracking. When performing ICG lymphography, a delayed scan following ICG injection is necessary due to the delayed emergence of lymphographic dermal backflow patterns. The need for delayed scan, however, makes ICG lymphography a time-consuming study. We conducted a prospective study with the primary goal to decrease the overall study time by applying the known phenomenon of exercise-induced lymphatic acceleration, and the secondary goal to further improve the study's accuracy and reproducibility. Methods: Following standard ICG injections, patients were exercised on a recumbent cross-trainer at five-minute intervals at specific, controlled intensity. Delayed scanning was performed following each exercise interval, and sequential changes of lymphographic patterns were recorded. The cycle of exercise/ scan continued until achieving plateau, or when no further lymphographic changes were observed for two consecutive cycles. Following the point of the plateau, further delayed scanning was performed every hour to identify the time point when the lymphographic patterns started to recede. Twenty-three limbs in 9 patients (10 arms, 13 legs) with unilateral and bilateral lymphedema were studied. Results: Following ICG injection, the lymphographic patterns evolved continually until plateauing after three cycles of exercise (15 minutes of exercise in total) in all limbs studied, and the dye was shown to start receding after 4 hours. Patients preferred exercising to speed up ICG studies compared to the traditional method which involves waiting between six to 14 hours between initial and delayed ICG lymphography scans. Conclusion: ICG lymphography is the current gold standard in lymphedema diagnosis. The study can be accelerated to only taking 15 minutes while further increasing the accuracy and reproducibility of the study with the addition of exercise.

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Dilator stretching is often a frequent part of treatment for multiple disorders involving the pelvic floor muscles and it is unknown what the time and duration of dilator use is until patient goals are achieved. This paper looks at studies involving patient use of vaginal dilators with the diagnoses of vaginismus, dyspareunia, and pelvic pain to begin to answer the question. It was determined the recommendations given to UIHC physical therapy patients with these diagnoses change to increase the daily time and frequency of dilator usage.

Introduction: Lymphedema is the abnormal accumulation of protein-rich fluid due to a damaged or insufficient lymphatic system. Lymphatic vessels can be mapped using indocyanine green (ICG). The purpose of this case report is to demonstrate anatomical changes after 1 year of conservative care as demonstrated through ICG for the first time to the authors' knowledge. Case Description: The patient was a 53-year-old woman who reported a 7-year history of left lower extremity swelling. She completed a short course of physical therapy elsewhere and wore a thigh-high compression garment of 20 to 30 mm Hg. She noted worsening of swelling over time and no longer got resolution of swelling with elevation. She presented to a multidisciplinary clinic for further evaluation and treatment. Objective Findings: The patient completed ICG lymphography demonstrating bilateral disease states in her lower extremities: Campisi stage II with lymphographic stage IV in the right lower extremity and lymphographic stage V in the left lower extremity. Bioimpedance scores, body mass index (BMI), and circumferential measurements were documented as well. Interventions: The patient underwent physical therapy including manual lymphatic drainage (MLD), increasing compression garment to 30 to 40 mm Hg, beginning use of a compression pump at home, exercise, and instructing the patient in self-MLD. There were 6 treatment sessions over a 3-month period. Assessment: At 1-year follow-up, the patient had positive changes in her bioimpedance scores, circumferential measurements, BMI, and ICG lymphography studies. Her ICG lymphography demonstrated increased “linear” patterns instead of diffuse or stardust patterns, suggesting improved lymphographic staging. Discussion: These findings imply that conservative therapies positively affect anatomy and physiology in a compromised lymphatic system after 1 year, allowing the system to work more effectively. These changes indicate lymphangiogensis, recanalization, or tissue recovery, but a causal relationship cannot be drawn at this time. These conservative therapies include complex decongestive therapy (MLD, compression, exercise) and weight loss.