Lymphatic techniques

Last updated: September 21, 2022

Summary

Lymphatic techniques use the respiratory-circulatory model to enhance lymphatic and venous flow. Lymphatic flow is mainly affected through extrinsic and intrinsic forces. Congestion and edema may accumulate in response to infection, tissue injury, or somatic dysfunction. Treatment aiming to restore lymphatic drainage has shown to augment the healing process.

Overview

Uses the respiratory-circulatory model
Treatment begins centrally and continues peripherally.
Lymphatic system drains into the venous system.
Treatment always begins with the thoracic inlet release.
Flow is affected by intrinsic and extrinsic forces, including:
- Smooth muscle contraction
- Changes in fluid pressure
- Skeletal muscle contraction
- Pulsation of adjacent arteries
- Excursion of the rib cage (negative intrathoracic pressure)
- Musculoskeletal manipulative medicine

Head

Frontal lift

Position: supine
Procedure
1. Grasp the frontal bone by placing hands anterior to the coronal suture and lateral to the eyebrows.
2. Interlock fingers and apply a gentle anterior-superior lift.
3. Hold until a release is felt.

Nasion spread (frontonasal lift)

Function: increase mobility between the frontal and nasal bones; increase lymphatic flow of the paranasal sinuses
Position: supine
Procedure
1. Contact the frontal bone with one hand.
2. Grasp the nasal bone with the index finger and thumb with the other hand.
3. Apply a gentle separating force by applying traction inferiorly on the nasal bone.
4. Hold until a release is felt.

Zygomatic lift

Position: supine
Procedure
1. Contact the zygomatic arch with the thenar eminences and interlock fingers.
2. Apply gentle anterior traction.
3. Hold until a release is felt.

Direct pressure & effleurage of frontal sinuses

Position: supine
Procedure
1. Place the thumbs on the frontal sinuses just lateral to the midline.
2. Apply 7–10 gentle compressions.
3. With gentle pressure on the sinuses, add 7–10 strokes laterally to the pterion.

Direct pressure & effleurage of maxillary sinuses

Position: supine
Procedure
1. Place the thumbs on the maxillary sinuses.
2. Apply 7–10 gentle compressions.
3. With gentle pressure on the sinuses, add 7–10 strokes laterally.

Drainage of the nasal passage

Position: supine
Procedure
1. Contact the nasal bone by crossing the thumbs on each side.
2. Apply intermittent medial pressure while traveling down the nasal bone 7–10 times.
  - Pressure should be applied on the bone and not cartilage.

Galbreath technique

Position: supine with examiner seated on the opposite side of restriction
Procedure
1. Stabilize forehead with one hand.
2. Contact the mandible with the other hand.
  - Contact the ascending ramus with the 2^nd and 3^rd fingers.
  - Contact the angle and body of the mandible with the 4^th and 5^th fingers.
3. Apply anterior-medial traction.
4. Repeat until a release is felt.

Post-auricular sternocleidomastoid muscle lymphatic drainage

Position: supine
Procedure
1. Turn the patient's neck away from the affected side.
2. Place the thumb on the mastoid process and follow the sternocleidomastoid muscle down the cervical spine with gentle pressure.
3. Repeat 7–10 times.

Cervical lymphatic drainage

Position: supine
Procedure
1. Turn the patient's neck away from the affected side and stabilize the head.
2. Stroke the cervical lymphatic chain by stroking in a downward direction from anterior to posterior of the sternocleidomastoid muscle.
3. Repeat 7–10 times.

Thorax

Thoracic inlet release (necklace technique)

Function: releases restriction in terminal lymphatic drainage into the subclavian veins; always the first step in lymphatic treatments
Position: supine
Procedure
1. Contact the thoracic inlet by placing palms over the trapezius muscle and fingers over the medial clavicle and proximal sternum.
2. Determine restricted barriers.
  - Flexion and extension: Gently place thoracic inlet into flexion and extension.
  - Rotation: Gently twist the thoracic inlet into right and left rotation.
  - Side bending: Gently place thoracic inlet into right and left side bending.
3. Place thoracic inlet into the restrictive barriers and apply lateral traction until a release is felt.

Thoracic lymphatic pump

Position: supine
Procedure
1. Place hands just inferior to the clavicles on the anterior aspect of the upper ribs
2. Optional: ask female patients to place hands onto the superior aspect of the breasts for comfort
3. Ask patient to inhale.
4. Upon exhalation, augment a downward movement of the ribs by applying posterior-inferior pressure.
5. Apply a vibratory compression at the end of exhalation.
6. Allow patient to inhale without resistance.
7. Repeat until palpatory sense of increased soft tissue compliance and decreased tissue congestion is attained.

Upper Thoracic Lymphatic Pump

Pectoral release

Position: supine with examiner at the head of the table
Procedure
1. Grasp the inferior border of the pectoralis muscles.
2. Apply superior traction.
3. Continue until a release of tension is felt.

Shoulder Girdle: Pectoral Traction

Upper extremity

Upper extremity lymphatic pump

Position: supine
Procedure
1. Flex the patient's arms 180°.
2. While grasping proximal to the wrists, apply vibratory traction, creating an oscillatory pump.
3. Continue for 15–30 seconds.

Abdomen

Doming of the diaphragm (anterolateral attachments)

Position: seated
Procedure
1. Contact soft tissues just along the inferior costal margin with finger pads.
2. Monitor respiratory excursion of the diaphragm.
3. Gently resist downward motion of the diaphragm during inhalation and follow superiorly through exhalation.
4. Repeat with slow, deep breathing of the patient until a release is felt.

Doming of the diaphragm (supine)

Position: supine
Procedure
1. Place finger pads on the outer aspect of the inferior border of the ribs.
  - Thumbs should point medially, directly under the xiphoid process.
2. Ask patient to inhale and then exhale.
3. Upon exhalation, apply a posterior-superior motion (augmenting motion of the diaphragm).
4. Resist inferior motion of the diaphragm upon inhalation.
5. Repeat for several respiratory cycles.

Abdominal lifts

Position: supine with knees bent at 90°
Procedure
1. Contact lower quadrant of the abdomen (just superior to the inguinal ligament).
2. Gently lift in an upward and opposite direction.
  - Special attention should be focused on the internal organs.

Mesenteric release (supine)

Position: supine
Procedure
1. Place both hands on the anterior abdominal wall.
2. Apply clockwise and counterclockwise rotations with a downward compression.
3. Repeat until a release is felt from the small and large intestines.

Mesenteric release (prone; known as Marian Clark drainage)

Position: prone in knee-chest position
Procedure
1. From just above the pubic bones, lift the internal abdominal contents superiorly in an oscillatory motion.
2. Shift hand placement to localize treatment.
  - Cecum: right lower quadrant
  - Sigmoid colon: left lower quadrant
  - Pelvic organs: suprapubic region
3. Repeat until a release is felt.

Marian Clark

Ganglion release

Position: supine
Procedure
1. Contact the skin overlying the ganglion with five finger pads.
  - Celiac ganglion: 1/3^rd between xiphoid and umbilicus
  - Superior mesenteric ganglion: 2/3^rd between xiphoid and umbilicus
  - Inferior mesenteric ganglion: just above the umbilicus
2. Gently meet resistance of tissues.
3. Hold resistance during inhalation.
4. Add posterior pressure on exhalation.
5. Repeat until a release is felt.

Liver and gallbladder pump

Position: lateral recumbent with the right side up
Procedure
1. Contact the rib cage with both hands on the posterior lower ribs and the anterior costal arch.
2. Ask patient to take deep breaths.
3. Apply a gentle downward compression during exhalation.
4. Allow the rib cage to expand during inhalation.
5. Repeat alternating compression-relaxation as necessary.

Splenic drainage

Position: lateral recumbent with the left side up
Procedure
1. Contact the rib cage with both hands on the posterior lower ribs and the anterior costal arch.
2. Ask patient to take deep breaths.
3. Apply a gentle downward compression during exhalation.
4. Allow the rib cage to expand during inhalation.
5. Repeat alternating compression-relaxation as necessary.

Thoracolumbar spine

Rib raising

Position: seated with arms crossed
Procedure
1. Reach behind patient and contact rib angles with finger pads.
2. Shift weight posteriorly and pull patient toward you to stretch intercostal spaces.
3. Apply anterior-lateral traction.
4. Repeat throughout thoracolumbar spine.

Rib Raising

Lumbar paraspinal inhibition (rib-less rib raising)

Position: supine
Procedure
1. Contact 12^th rib or just inferior to the thoracolumbar junction.
2. Place finger pads lateral to the transverse processes.
3. Apply anterior force.
4. Hold until a release is felt.

Pelvis

Pelvic diaphragm release (prone)

Position: prone
Procedure
1. Contact ischial tuberosities bilaterally.
2. Place fingertips just medial to the tuberosities to reach pelvic diaphragm.
3. Monitor respiratory excursion.
4. Resist downward movement of pelvic diaphragm during inhalation and follow superiorly through exhalation.
5. Repeat through slow, deep breathing of the patient until a release is felt.

Pelvic diaphragm release (lateral recumbent)

Position: lateral recumbent
Procedure
1. Contact superior ischial tuberosity.
2. Place fingertips just medial to the superior tuberosity to reach pelvic diaphragm.
3. Monitor respiratory excursion.
4. Resist downward movement of pelvic diaphragm during inhalation and follow superiorly through exhalation.
5. Repeat through slow, deep breathing of the patient until a release is felt.

Lower extremity

Lower extremity lymphatic pump

Position: supine
Procedure
1. Apply a superior force that dorsiflexes the feet in a vibratory pattern, creating an oscillatory pump.
2. Continue for 15–30 seconds.

Popliteal fossa release

Position: supine
Procedure
1. Grasp the medial and lateral aspect of the popliteal fossa .
2. Determine fascial restriction in each cardinal direction.
3. Apply an anterior force with the fingertips and engage fascial restriction until the resistance is met.
4. Continue until a release is felt.

References

Seffinger M. Foundations of Osteopathic Medicine. LWW ; 2018
Destefano L. Greenman's Principles of Manual Medicine. Wolters Kluwer Law & Business ; 2015
Nicholas A. Atlas of Osteopathic Techniques. LWW ; 2015

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Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer