Lymphatics

Question 1

• What are some indications for lymphatic treatment?

Answer 1

• Acute somatic dysfunction
• Sprains/strains
• Edema
• Tissue congestion, lymphatic/venous stasis (mild CHF)
• Pregnancy
• Infection
• Inflammation

Question 2

• What are the contraindications for lymphatic treatment?

Answer 2

• Anuria and necrotizing fascitis are absolute contraindications
• Malignancy
• Fracture/Dislocation
• Certain infections (mono, abscess, chronic osteomyelitis)
• Certain circulatory disorders (venous obstruction, embolism, hemorrhage, anticoagulated patient)

Question 3

• Where are the fluid pumps located?

Answer 3

• Thoracic inlet
• Thoracic diaphragm
• Pelvic diaphragm

Question 4

• What is the Zink “Warmth Provacation Test”? What does it indicate?

Answer 4

• Testing for warmer areas (indicating a potential somatic dysfunction in that area)
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Question 5

• When palpating lymph nodes, what is normal?

Answer 5

• Pea-sized
• Round
• Spongy
• Non-tender
• Mobile
• Baseline adjacent areas

Question 6

• What is abnormal when palpating lymph nodes?

Answer 6

• Larger
• Irregular
• Hard, matted
• Tender
• Fixed (low mobility)
• Red or pale, warm

Question 7

• Where should you evaluate lymphatic function?

Answer 7

Question 8

• What do you need to do before performing any lymphatic treatments?

Answer 8

• Open the thoracic diaphragm

Question 9

• How do you perform thoracic inlet MFR?

Answer 9

• Patient is supine with doc seated at head of the table
• Index fingers above SC joint/angle of rib 1, thumbs over T1 transverse processes bilaterally
• Press towards pt feet and twist hand to feel for restriction of motion
• Perform direct MFR

Question 10

• How do you perform doming the diaphragm?

Answer 10

• Pt supine
• Doc places hands in infracostal region below xiphoid process with fingers pointing toward pt head
• Pt takes a deep breath while pressing posteriorly and superiorly
• Push further on exhalation and resist on inhalation
• Repeat 3-4 times
• Last time, move thumbs under the rib cage

Question 11

• How do you perform ischiorectal fossa release (aka doming the pelvic diaphragm)?

Answer 11

• Pt is prone
• Doc seated at side of table and places thumbs medial to ischial tuberosities bilaterally
• Apply cephalad and lateral force, increasing force during exhalation and maintaining force on inhalation

Question 12

• How do you perform pectoral traction?

Answer 12

• Patient is supine with doc standing at the head of the table
• Grasp inferior border of pectoral muscles at anterior axilla
• Extend arms and lean back to apply cephalad traction
• Pull when patient inhales and resist on exhalation

Question 13

• How do you perform seated rib raising?

Answer 13

• Pt crosses arms and leans toward doc
• Doc grabs posterior/inferior rib angles (lateral to TP)
• Start with T12 and apply anterolateral traction while pulling towards you

Question 14

• How do you perform supine rib raising

Answer 14

• Stand on side to treat
• Contact rib angles starting at T12
• Apply anterolateral traction by rocking backwards and continue up the ribs
• Can use respiration to assist (apply pressure with inhale, release with exhale)

Question 15

• How do you perform thoracic pump (repetitive/oscillatory)

Answer 15

• Place thenar eminence of each hand over pectoral muscles, just inferior to clavicles on ribs 2-4
• Rhythmic pumping at rate of 110-120 bpm
• Appropriate pace should provide a rebound force at hands

Question 16

• How do you perform thoracic pump (vacuum/atelectasis modification)

Answer 16

• Pt supine
• Doc places thenar eminence of each hand over the pectoral muscles just inferior to clavicles on ribs 2-4
• As patient exhales, apply compressice force downward and resist during inhalation
• Continue for 4-5 breaths
• Midway through last inhalation, briskly remove hands to allow for rapid, deep inhalation (inflates atelectatic lung)

Question 17

• How do you perform abdominal pump?

Answer 17

• Place palms on abdomen with fingers towards patient’s head, thumbs side by side
• Push posteriorly at a rate of 20-30 x/min

Question 18

• How do you perform sacral rocking?

Answer 18

• Patient is prone
• Heel of cephalad hand on sacral base with fingers pointing down
• Apply gentle downward pressure to gap SI joint
• Inhalation: Move sacral apex anterior
• Exhalation: Move sacral apex posterior

Question 19

• How do you perform pedal pump?

Answer 19

• Patient is supine, doc at feet
• Passively dorsiflex feet
• Apply on and off cephalad force to hyperdorsiflex the feet, watching for nose movement and feeling rebound at feet
• Pump at 100-120 x/min

Question 20

• How do you perform lung tapotement?

Answer 20

• Hacking
• Cupping
• Slapping

Question 21

• How do you perform effleurage?
• How do you perform petrissage?

Answer 21

• Stroking force distally to proximally
• Kneading/twisting force distally to proximally

Question 22

• How do you perform IT Band Effleurage?

Answer 22

• Start halfway between greater trochanter and knee
• Apply pressure and stroke distally to proximally

Question 23

• How do you perform anterior tracheal/deep cervical soft tissue lymphatic treatment?

Answer 23

• Place fingers lateral to trachea
• Move trachea from side to side, working cephalad to caudad

Question 24

• How do you perform suprahyoid and infrahyoid release?

Answer 24

• Pt supine
• Place fingers lateral to hyoid bone
• Move hyoid from side to side
• If there is crepitus, can flex and extend head to decrease friction
• Can also use swallowing to help release restrictions

Question 25

* How do you perform cervical stroking?

Answer 25

* Pt supine with doc at head of table * Place hands along paravertebral muscles * Stroke in caudad to cephalad direction

Question 26

* How do you perform cervical chain drainage?

Answer 26

* Pt supine with doc at head of table * **Locate the anterior and posterior border of the SCM's superior portion** * **Place thumb along anterior margin and other fingers along posterior region** * **Lift and milk anteriorly until you note relaxation, working caudad along the SCM** * **Treat one side at a time**

Question 27

* How do you perform submandibular drainage?

Answer 27

* Patient supine with doc at head of table * **Apply raking motion under the angle of the manubrium towards the mentum**

Question 28

* How do you perform mandibular drainage (Gallbreath technique)?

Answer 28

* Patient supine with doc at head of table on opposite side to treat * Stabilize patient's head with cephalad hand and place fingers of caudad hand posterior to ramus * **Slow, repetitive and downward midline traction on the mandible**

Question 29

* How do you perform pre-post auricular drainage?

Answer 29

* Place index and middle finger in front of ear and fourth and fifth finger behind * Apply clockwise and counterclockwise rotation to auricular lymph nodes

Question 30

* What is a normal compensatory pattern?

Answer 30

* R,L,R,L