Function of the lymph system
Main role is to balance the volume of interstitial fluid by returning it and excess protein molecules to venous circulation. Absorbs protein, fat and fat soluble vitamins through intestinal lymph vessels. Recognizes foreign cells, microbes, and cancer cells.
Lymphatic system what kind of system is it, what does it include, how many sections of the body is divided
Is a one way system. Travels from distal to proximal in one direction. Gravity is not helpful. Includes: Vessels, Lymph nodes, Ducts. Divides body into 2, slightly odd segments: Right lymphatic duct, Thoracic duct.
Parts of the lymphatic system
Primary lymphatic organs: Bone marrow, Thymus. Secondary lymphatic organs: Spleen, Lymph nodes (groin, armpit, behind the ears, back of the head, sides of the neck and under the jaw and chin), Mucosa associated lymphatic tissue (submucosal membrane sites such as the gastrointestinal tract, nasopharynx, thyroid, breast, lung, salivary glands, eye and skin), Peyers patches, Bronchus associated lymphatic tissue.
Lymphatic Vessels
Drain interstitial fluid, fat transporation and immune responses. Initial, Pre-collector, collector/lymphangion lymph vessel.
What is lymph
A watery, transparent yellowish fluid. Chyle (lymph collected in the Gi tract) has a milky appearance due to the fatty products collected. Carried by the lymphatic vessels. Major components: Water, Fat, Proteins, Lymphocytes, Cellular debris. Minor components: Viruses, Bacteria, Cancer cells, Coal dust, Glass dust (silica), Inorganic substances (dyes, metals).
Lymphatic Vascular system
A network of vessels extending to every part of the body except the brain and spinal cord. Runs parallel to the circulatory system. Lymph only moves in one direction, towards the heart. Transported along the system of vessels by muscle contractions, valves prevent lymph from flowing backwards.
Right Lymphatic duct
Located in the right upper quadrant. Joins the right subclavian vein. It drains into: Right arm, Right chest, Right side of face, Right lung, Lower lobe of the left lung and heart, Upper surface of the liver.
Thoracic duct
Anterior to spine, starts at T12-L2 (cisterna chyli). Travels superiorly alongside the aorta through the diaphragm. @T5- goes left of the aorta and up the left side of the esophagus. @C7- joins the left subclavian vein. Receives 75% of the body’s lymph. In 24hrs, 1.5-2.5 litres of the lymph is returned to the blood via the thoracic duct.
Cisterna Chyli
The starting point of the thoracic duct. Sac like elongated structure, under the diaphragm. Receives and temporarily stores lymph from the right and left lumbar trunks (pelvis, kidneys, adrenals, abdominal wall, intestinal trunk, lower intercostal vessels).
Lymph nodes
Filter and clean lymph. Break down bacteria or other harmful cells. Concentrate Lymph. 50% of water is removed from lymph node via veins. Storage of non degradable substances: Dyes, coal dust, glass dust, metals. Fluid exchange. Regulates protein and water content in lymph. Activate the immune system. Produce lymphocytes for specific immune reaction. Vary in size. Can be as small as a pinhead or size of baked bean.
Location of lymph nodes
In major blood vessels. Approximately 800 nodes in neck, axilla, thorax, abdomen and groin.
Lymph collectors
Lymph capillaries combine to form larger afferent collector. Cell walls of the collectors are muscular and have one way valves to prevent backflow. Sections between these valves are lymphangions. Contract in response to autonomic sensory input and lymph volume. Collectors eventually lead into lymph nodes where the fluid is filtered. Filtered lymph fluid exits through efferent collectors.
Watersheds
What are the 5 watersheds: Median sagittal, Spine of scapula, Clavicle, horizontal/transverse, Gluteal. What are they: Major dividing lines between areas.
Anatomoses
What are the 3 anastomoses: Interaxillary, Axillo-inguinal, Interinguinal. What are they: Alternative pathways, inactive vessels that can be opened so lymph can be redirected to a different drainage point.
Treatment guidelines
Treatment with inflammation and muscle spasms. Inflammation: When the immune system recognizes and removes harmful foreign stimuli and begins the healing process. Can be acute or chronic. Muscle spasm that results from inflammation occurs when a muscle or ligament is overstretched or torn and becomes inflamed as the body responds to injury. The muscle stiffens and shrinks to eliminate movement. Unnatural muscle contraction can lead to spasms. Spasm can last longer than swelling and inflammation- days to weeks.
Acute Phase
To reduce edema, pain and discomfort. MLD before any general massage work to the affected areas. This helps reduce pain and congestion. To decrease sympathetic nervous system firing and treat compensatory structures. Begin with general Swedish massage. MLD on the edematous limb. PROM of proximal and distal joints. Swedish massage towards heart. *use cold hydro.
Early and late subacute phase
Early: reduce pain and prevent adhesion formation. Diaphragmatic breathing. Elevate area and apply cold hydro. MLD proximal to edema site, midrange PROM. Late: reduce pain, reduce further edema and increase ROM. Elevate. Diaphragmatic breathing. Contrast hydro. Increase MLD to proximal site. Local MLD. Mid to full range PROM.
Chronic
Elevate area. Diaphragmatic breathing. Use heat to increase circulation and flush tissues. Light fascial techniques and petrissage on proximal muscles. MLD over injured area.
Chronic phase other conditions
Swedish massage. MLD proximal moving distal.
Chronic phase Lymphedema
ONLY MLD TECHNIQUES USED. No hot hydro. Midrange to full PROM proximally and distally.
Treatment Frequency
- Acute and subacute: More frequent, shorter treatments. 30 min, 3x a week. 2. Chronic: Ongoing treatment required.
Seniors treatment
Shorter sessions. Monitor reaction. Be mindful of carotid stenosis.
