Osteopathic Approach to Drain the Lymphatic System

David Lintonbon DO PG Cert (clin ed)

Diagram of Lymphatic System

13

7

2

6

5

4

9

8

14

13

12

11

10

15

Lymphatic Drainage Routine

Lymphatic Drainage Routine 1

• Patient prone, spring the thorax to encourage maximum mobility of ribs and vertebrae prior to treatment

Lymphatic Drainage Routine 2

• Patient supine, clear the thoracic ducts. Stand to the side of the couch, place the patient’s hand on your shoulder and pull up gently and rhythmically on the clavicle to clear the thoracic ducts.

Lymphatic Drainage Routine 3

• Thoracic pump, compress the manubrium AP at bout two cycles per second, following patient’s expiration. Repeat 6 times. On the sixth, follow the expiration all the way through and just as you feel the resistance of the patient’s inspiration, suddenly release your hands, this will create a ‘vacuum’ in the thorax which will encourage lymph flow.

Lymphatic Drainage Routine 4

• Dome the diaphragm bilaterally. Knees bent, thumbs or tips of fingers under the borders of the ribs inhibiting the diaphragm. Follow the patient’s breath out and push upwards into the diaphragm. Take care not to press too hard, it might be uncomfortable but it shouldn’t be painful. Inhibit the diaphragm as the patient inhales. Repeat six times.

Lymphatic Drainage Routine 5

• Apply a pedal pump to the foot to flex the gastrocnemius, thus encouraging lymph flow

Lymphatic Drainage Routine 6

• Bend the leg (patient still supine) and stand at the foot of the couch. Move your fingers into the popliteal crease and rhythmically pump the popliteal nodes

Lymphatic Drainage Routine 7

• Externally rotate flexed leg and stretch saphenous opening (Hunter’s canal) along the medial border of the sartorius

• Gently move the abdominal contents towards the umbalicus

Lymphatic Drainage Routine 8

• Effleurage the leg to encourage lymph towards the heart

Lymphatic Drainage Routine 9

• Palpate L3 with the right hand while simultaneously flexing the hips.

• As you palpate motion at L3/4 there should be sufficient compression of the cysterna chyli.

• Gently pump the cysterna chyli, which has valves.

• Thereby encouraging lymph drainage toward the thoracic duct.

Lymphatic Drainage Routine UEX/LEX

• 1• Patient prone, spring the thorax to encourage maximum

mobility of ribs and vertebrae prior to treatment• 2• Patient supine, clear the thoracic ducts. Stand to the side of

the couch, place the patient’s hand on your shoulder and pull up gently and rhythmically on the clavicle to clear the thoracic ducts.

• 3• Thoracic pump, compress the manubrium AP at bout two

cycles per second, following patient’s expiration. Repeat 6 times. On the sixth, follow the expiration all the way through and just as you feel the resistance of the patient’s inspiration, suddenly release your hands, this will create a ‘vacuum’ in the thorax which will encourage lymph flow.

• 4• Dome the diaphragm bilaterally. Knees bent, thumbs or tips of

fingers under the borders of the ribs inhibiting the diaphragm. Follow the patient’s breath out and push upwards into the diaphragm. Take care not to press too hard, it might be uncomfortable but it shouldn’t be painful. Inhibit the diaphragm as the patient inhales. Repeat six times.

• 5• Stand at the head of the couch, locate and palpate the nodes

of the face and neck and apply light stroking movements towards the heart.

• 6• Place fingertips in the suboccipital groove and traction as the

patient breathes out. Repeat several times

• 7• Clasp the patient’s wrist to your side and gently grip the forearm,

keeping the elbow bent perform a ‘figure-of-eight manoeuvre to encourage lymph flow in the axillary and cubital nodes

• 8• Included in the above manoeuvre• 9• Gently flex and extend the wrist to encourage lymph flow in this

area• 10• Effleurage the forearm and upper arm to encourage lymph flow

towards the heart• 11• Rhythmically pump the inguinal nodes with the heel of your

hand to encourage lymph flow.• 12• Externally rotate flexed leg and stretch saphenous opening

(Hunter’s canal) along the medial border of the sartorius • 13• Bend the leg (patient still supine) and sit at the foot of the couch.

Move your fingers into the popliteal crease and rhythmically pump the popliteal nodes

• 14• Apply a pedal pump to the foot to flex the gastrocnemius, thus

encouraging lymph flow • 15• Effleurage the leg to encourage lymph towards the heart• •

Diaphragmatic Breathing Exercise

• To encourage diaphragmatic breathing in the patient.

• Hold your hand just above the patient’s diaphragm and ask them to try to touch it with the abdomen as they breathe in

• repeat several times.