AN OSTEOPATHIC APPROACH TO LYMPHATIC CONDITIONSRyan Christensen DO Mary Goldman DOOsteopathic Health Care Associates

Michigan Osteopathic Association Spring 2018

LIVING WATER

“LYMPH”

1. Anatomy, Physiology. a clear yellowish, slightly alkaline, coagulable fluid, containing white blood cells in a liquid resembling blood plasma, that is derived from the tissues of the body and conveyed to the bloodstream by the lymphatic vessels.2. Archaic. the sap of a plant.3. Archaic. a stream or spring of clear, pure water.

From Latin; lympha water; earlier *limpa; limpidus- limpid- clear, transparent, free from obscurity, completely calm)

Flathead Lake, Montana

“LYMPH” from Latin also see “NYMPH” from Greek both imply LIMPID CLEAR CLEAN

myth> LYMPH or LOVE MADNESS was probably induced by any number of tempting WATER NYMPHS

latin LYMPHATICUS = LOVE MADNESS LYMPHA WATER note evolution toward

latin LIMPA GODDESS OF SPRINGS see> NYMPH sp LIMPIA CLEAN as in LIMPID

Hylas and the Nymphs (1896) by John William Waterhouse

LYMPH = “Living Water”

VS “Dis-ease”“Ease"

Kitch-iti-kipi, Michigan’s largest natural freshwater spring

Flint Water Crisis- 2015 Samples

WATER AND THE HUMAN BODY

“We strike at the source of life and death when we

go to the lymphatics.”—Philosophy of Osteopathy, p. 108

“No space is so small that it is out of connection with the

lymphatics, with their nerves, secretory and excretory ducts.

The system of lymphatics is complete and universal in the

whole body.”—Philosophy and Mechanical Principles of Osteopathy

~Dr. Andrew Taylor Still DO

LOOKING FROM THE PAST TO THE FUTURE:ROLES OF OMT IN LYMPHATIC TREATMENT

• How can I best help my patients?

• What can I do when antibiotics quit working?

• What can we do to shorten Length of Stay?

• How do you keep those functioning who are unable to move or exercise?

• What is the role of the lymphatics in Aging, Dementia, Fatigue, and other poorly understood conditions?

WHAT THIS IS AND ISN’T

• Intended audience: Practicing osteopathic physicians with basic skills in OMT

• Not meant to re-hash the basics but to build to next level of skills and serve our patients

• Introduce to emerging research on lymphatic roles in conditions such as dementia, chronic fatigue syndrome, fibromyalgia, head injury/concussion,

http://files.academyofosteopathy.org/convo/2017/Presentations/Willard_LymphaticSystem.pdf

(From Monahan FD, Neighbors M: Medical

surgical nursing: foundations for clinical

practice, ed 2, Philadelphia, 1998, WB

Saunders.)

In the lumbar region flowing up to the cisterna chyli and thoracic duct, the diameter of the thoracic duct and lymphatic channels is

under sympathetic control similar to blood vessels. Hypersympathetic activity can reduce lymphatic flow capacity.

--Kurt P. Heinking and Robert E. Kappler, Pelvis and Sacrum, in Foundations, 3rd edition, p. 581

Peripherally compromised lymphatic drainage has been linked to the pathogenesis of atherosclerosis and to the development

of hypertension --Korr IM. Sustained sympathicotonia as a factor in disease. In: The Collected Papers of Irvin M. Korr. Newark, OH: AAO 1979:77-89. from Foundations, 3rd Edition, chapter 41.

! Primary: ! Bone marrow (production of B and pre-T

cells + B cells differentiate there) ! Thymus until late adulthood (differentiate

pre-T cells into T cells, then learn to differentiate into “self” and “non-self”

! Secondary: ! Lymph nodes ! Spleen ! MALT (Mucosa-Associated Lymphoid Tissue)

!Peyer’s patches (submucosa of distal ileum)

!Tonsils !Vermiform appendix !Epithelium-associated lymphoid tissue

The Lymphoid Organs

THE DELIGHTFUL DIAPHRAGM

1&2 Lumbar trunks3 Cisterna chyli4 thoracic part of thoracic duct5 cervical part of thoracic duct (empties into left internal jugular, with variation)8 left venous angle11 azygous vein12 hemiazygous vein (12a accessory)13 diaphragm14 right thoracic duct

The Thoracic Duct: An Overview

DIAPHRAGMS“A thin sheet of material

forming a partition.”

http://lelaccarney.com/wp-content/uploads/2013/01/7-Diaphragms-+-pranic-body-copy.pdf

THE 8 OSTEOPATHIC DIAPHRAGMS(CAUDAD TO CEPAHALAD)

DR. FULFORD’S SHOCK RELEASE“To heal is to bring an individual to a state of wholeness and well-being.

This is accomplished with breath and love.”

“When the life energy is jammed, the breath can not flow through the body. This problem is in part the result of the psychological and physical trauma people have suffered, including the

emotional element in which they grew up.”Robert Fulford DO from “Breath” Paper

Projection of the prevertebral plexus onto the abdominal wallFrom “Circulatory Techniques according to Kuchera”

http://musculoskeletalkey.com

DR. FULFORD’S SHOCK RELEASELINEA ALBA TECHNIQUE

Slide courtesy Dr. Kuchera- http://files.academyofosteopathy.org/convo/2016/Handouts/Kuchera_PhysLab.pdf

http://theboardman.org/dam-project/

Brown Bridge Dam Removal & Boardman River Restoration

Theory and Practice of Lymph Drainage Therapy, An Osteopathic Lymphatic Technique, 2nd Edition

Theory and Practice of Lymph Drainage Therapy, An Osteopathic Lymphatic Technique, 2nd Edition

OSTEOPATHIC LYMPHATIC TREATMENT(THE TECHNIQUES)

! Follow the natural rhythm of life, a gentle pulse in each part of the body (refers to lymphatic circulation which moves in waves). Your hands should be moved by the fluid

! Rhythm is standardly one stroke for every one to five seconds, but this varies ! Repeat on nodes about five to seven times, because the tissue resistance is

greater on the nodes than in the lymph vessels, where five repetitions is sufficient

!Use subtle, gentle pressure with the pads of the fingers and hands (palmar aspect), steady and harmonious; too light to increase capillary filtration !The weight of a feather; if you feel pressure back, you are pushing too

hard !Hands move progressively, like the sea as it comes in and out !Remember: you are moving a water-like substance a few millimeters

below the dermis; slightly more pressure on legs than face (skin thickness)

! Direction of flow is generally towards the heart !Above clavicles

flows inferiorly; below flows superiorly, except the upper abdomen which flows inferiorly

! Send lymph to nearest nodes draining the region

Theory and Practice of Lymph Drainage Therapy, An Osteopathic Lymphatic Technique, 2nd Edition

LIPEDEMA VS LYMPHEDEMA

•  Lipedema may affect up to 11% of women. • It happens when fat is distributed in an irregular way beneath the skin,

usually in the buttocks and legs. • Although it begins as a cosmetic concern (cellulite), it can eventually

cause pain and other problems. • Lipedema can be mistaken for regular obesity or lymphedema

“Scientists Discover Drain Pipes in our Brains”https://youtu.be/T9y_5vzJZtk

Date of download: 5/17/2018 Copyright © 2015 by the American Osteopathic Association.All rights reserved.

J Am Osteopath Assoc. 2016;116(3):170-177. doi:10.7556/jaoa.2016.033

From: The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine

Legend: Schematic macroscopic diagram depicts the glymphatic-lymphatic continuum system within the human brain. Interstitial soluble molecules such as amyloid-β are removed from the brain and received in the paravascular space along the intracranial sinuses. The superior sagittal, inferior sagittal, and straight sinuses meet at the confluence of sinuses and then travel primarily to the internal jugular vein. From here, interstitial solutes residing within the interstitial fluid are deposited within the deep cervical lymph nodes where they combine with the lymph nodes to follow a well-established lymphatic drainage system. Lymph enters the thoracic duct and right lymphatic duct, which then drain into the right and left subclavian veins. Ultimately, passage of interstitial solutes reenter systemic circulation through the superior vena cava. The 2015 finding of lymphatic vessels lining the dural sinuses and connecting to the deep cervical lymph nodes adds validation of a novel pathway for cerebrospinal fluid drainage in the mammalian brain.14 Additional lymph nodes are presented in the figure (eg, parotid lymph nodes). However, their relationship with the glymphatic system is unclear.

“Clearance systems in the brain—implications for Alzheimer Disease” Nature Reviews Neurology , 2015https://www.nature.com/articles/nrneurol.2015.119

Jessen NA, Munk AS, Lundgaard I, Nedergaard M. The Glymphatic System: A Beginner's Guide. NeurochemRes 2015;40:2583-2599.

Venous Sinus Drainage Technique- Dr. Viola Frymann DO

Compression of the Fourth Ventricle (CV4) - Dr. Viola Frymann DO

LYMPH = “Living Water”

THANK YOU!Questions?

Ryan Christensen DOdr.ryanc@gmail.comTwitter : @DrRyanC

Insta: @dr.ryanc

Mary Goldman DO1mary.goldman@gmail.com