OM309 OMT LYMPHATIC ACTIVATION.pdf

OM 309 OMT – LYMPHATIC ACTIVATION Diploma in Osteopathic Manual Manipulative Practice Disclaimer The information provided in this osteopathy course is for educational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the ad...

OM 309 OMT – LYMPHATIC ACTIVATION Diploma in Osteopathic Manual Manipulative Practice Disclaimer The information provided in this osteopathy course is for educational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The practices and principles discussed in this course should be performed by trained and licensed professionals. The course providers are not responsible for any injury or harm that may result from the application of techniques or concepts discussed in the course. Disclaimer TRAINING COURSE(S) IS REGISTERED UNDER HRD CORP CLAIMABLE COURSES SCHEME BY PEMBANGUNAN SUMBER MANUSIA BERHAD(PSMB). COURSE TITLE: DIPLOMA IN OSTEOPATHIC MANUAL MANIPULATIVE PRACTICE TRAINING PROGRAMME NO: 10001408615 TOTAL TRAINING HOURS: 168 HOURS Registered Trainers: 2 Person MARVIN YIP KENG YEONG NG CHIA CHOON Declaration of Understanding for Osteopathic Theory and Practices Course Licensing Limitations: I understand that completion of this course does not qualify me to apply for or obtain an osteopathic practitioner license. The course is not intended to serve as a comprehensive training program for becoming a licensed osteopath. Professional Title Restrictions: I am aware that I cannot refer to myself as an "osteopath" or "osteopathic practitioner" without obtaining the necessary qualifications and registrations as mandated by the relevant governmental authorities in my home country. Further Education Encouragement: The course is intended to spark interest in osteopathy and encourage participants to pursue further education in the field, potentially leading to a degree in osteopathy from a recognized institution.  OM309 : OMT – LYMPHATIC ACTIVATION LEARNING OUTLINE 1. Understand Lymphatic System work 2. Understand how the application in terms of Anatomy 3. Understand the Do’s and the Don’ts 4. Understand the tools, technique and treatment method applies.  OM309 : OMT – LYMPHATIC ACTIVATION ASSESSMENT Assignment & Presentation 30% Quiz 20% Total 50% Test 50% Total Score 100%  OM309 : OMT – LYMPHATIC ACTIVATION Lesson Topic Hours LESSON PLAN 1 Overview 0.25 2 What Does The Lymphatic System Do? 0.25 3 How Does The Lymphatic System Work? 1.5 4 Anatomy 2.5 5 Indications 0.5 6 Contraindications 0.5 7 Diagnostic Principles 0.5 8 Treatment Principles 0.5 9 Technique or Treatment 0.5 10 Quiz 1 11 Assignment 1 12 Presentation 1 Total Hours 10  OM309 : OMT – LYMPHATIC ACTIVATION OMT – LYMPHATIC ACTIVATION OM309 : OMT – LYMPHATIC ACTIVATION WHAT IS LYMPHATIC SYSTEM ?  OM309 : OMT – LYMPHATIC ACTIVATION WHAT IS LYMPHATIC SYSTEM ? OVERVIEW A network of tissues, organs, and veins called the Lymphatic System cooperates to return a colorless, watery fluid called Lymph to your circulatory system, or bloodstream. Your Lymphatic System, an essential component of your immune system, eliminates outdated or aberrant cells that your body no longer needs and keeps you safe from infection. Keeping your body's fluid levels appropriate and absorbing lipids and fat - soluble vitamins so they may enter your bloodstream are other lymphatic system duties.  OM309 : OMT – LYMPHATIC ACTIVATION WHAT IS LYMPHATIC SYSTEM ? OVERVIEW OM309 : OMT – LYMPHATIC ACTIVATION WHAT DOES THE LYMPHATIC SYSTEM DO ?  OM309 : OMT – LYMPHATIC ACTIVATION WHAT DOES THE LYMPHATIC SYSTEM DO ? FUNCTION The Lymphatic System serves a variety of purposes. Its Primary duties consist of : Retrieving extra fluid from bodily tissues and putting it back into your bloodstream. This helps your body maintain appropriate fluid levels. This fluid is also filtered by your lymphatic system to remove waste materials and aberrant cells. A disruption in the processing of fluids can lead to Lymphedema, which is a type of localized swelling.  OM309 : OMT – LYMPHATIC ACTIVATION WHAT DOES THE LYMPHATIC SYSTEM DO ? FUNCTION Improving the body's fat absorption. The majority of nutrients are able to enter your body through microscopic holes in your capillary walls, where your body may absorb and utilize them. However, some lipids and other compounds are too big to go this route. These chemicals are present in the fluid your lymphatic system gathers from your intestines and returns to your circulation.  OM309 : OMT – LYMPHATIC ACTIVATION WHAT DOES THE LYMPHATIC SYSTEM DO ? FUNCTION Defending your body from outside threats. A component of your immune system is the lymphatic system. It creates and releases other immune cells as well as lymphocytes, a subset of white blood cells. These cells search for and eliminate any intruders that may infiltrate your body, including bacteria, viruses, parasites and fungus.  OM309 : OMT – LYMPHATIC ACTIVATION HOW DOES THE LYMPHATIC SYSTEM WORK ?  OM309 : OMT – LYMPHATIC ACTIVATION HOW DOES THE LYMPHATIC SYSTEM WORK ? The liquid portion of your blood, known as plasma, exits your body through microscopic pores in the thin walls of your capillaries approximately 20 times per day. Think of a sponge that is leaking water. What happens to this liquid? It supplies each capillary's surrounding tissues with nutrients and oxygen. Like a child who finishes their meal but leaves behind a mound of sticky napkins, the tissues ravenously absorb all the nutrients while excreting waste.  OM309 : OMT – LYMPHATIC ACTIVATION HOW DOES THE LYMPHATIC SYSTEM WORK ? The Plasma doesn't care to tidy up after itself; it gathers trash and flows back through the pores in your capillary walls to enter your bloodstream. In this method, roughly 17 liters of plasma return to your circulation daily. 3 liters remain to be found in the tissues of your body because the original 20 liters that drained out of your capillary walls are still there.  OM309 : OMT – LYMPHATIC ACTIVATION HOW DOES THE LYMPHATIC SYSTEM WORK ? Your Lymphatic System intervenes in this situation. This leftover fluid is collected from your tissues by tiny Lymphatic Capillaries. Throughout its journey, the fluid acquired a new name: Lymph has replaced plasma as its previous moniker. The lymph is moved by your lymphatic capillaries into lymphatic vessels, which are bigger tubes.  OM309 : OMT – LYMPHATIC ACTIVATION HOW DOES THE LYMPHATIC SYSTEM WORK ? The Lymph is kept flowing by these vessels until it eventually reaches one of the two main ducts in your upper chest. These are similar to on - ramps on the highway and are known as your thoracic duct and right lymphatic duct. They combine to form your Subclavian Veins, which are large veins into which lymph is emptied. Your lymph can then once more circulate throughout your body once it has returned to your bloodstream. OM309 : OMT – LYMPHATIC ACTIVATION ANATOMY  OM309 : OMT – LYMPHATIC ACTIVATION ANATOMY OF LYMPHATIC SYSTEM A subsystem of the circulatory system that consists of a complex network of vessels, tissues and organs. Helps to maintain fluid balance in the body by collecting excess fluid and particulate matter from tissues and depositing them in the bloodstream. It also helps defend the body against infection by supplying disease-fighting cells called lymphocytes.  OM309 : OMT – LYMPHATIC ACTIVATION ANATOMY OF LYMPHATIC SYSTEM As blood circulates through the body, blood plasma leaks into tissues through the thin walls of the capillaries. The portion of blood plasma that escapes is called interstitial or extracellular fluid and it contains oxygen, glucose, amino acids and other nutrients needed by tissue cells. Although most of this fluid seeps immediately back into the bloodstream, a percentage of it, along with the particulate matter, is left behind.  OM309 : OMT – LYMPHATIC ACTIVATION ANATOMY OF LYMPHATIC SYSTEM The lymphatic system removes this fluid and these materials from tissues, returning them via the lymphatic vessels to the bloodstream and thus prevents a fluid imbalance that would result in the organism’s death. Only a few regions, including the epidermis of the skin, the mucous membranes, the bone marrow and the central nervous system, are free of lymphatic capillaries, whereas regions such as the lungs, gut, genitourinary system, and dermis of the skin are densely packed with these vessels.  OM309 : OMT – LYMPHATIC ACTIVATION CIRCULATION OF LYMPH The fluid and proteins within the tissues begin their journey back to the bloodstream by passing into tiny lymphatic capillaries. Once within the lymphatic system, the extracellular fluid, which is now called lymph, drains into larger vessels called the lymphatic vessels. These vessels converge to form one of two large vessels called lymphatic trunks, which are connected to veins at the base of the neck.  OM309 : OMT – LYMPHATIC ACTIVATION CIRCULATION OF LYMPH One of these trunks, the right lymphatic duct, drains the upper right portion of the body, returning lymph to the bloodstream via the right subclavian vein. The other trunk, the thoracic duct, drains the rest of the body into the left subclavian vein. Lymph is transported along the system of vessels by muscle contractions and valves prevent lymph from flowing backward. The lymphatic vessels are punctuated at intervals by small masses of lymph tissue called lymph nodes, that remove foreign materials such as infectious microorganisms from the lymph filtering through them. OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION LYMPHATIC VESSELS 1) Lymph Capillaries Have one way mini-valves allowing excess fluid to enter but not leave Picks up bacteria and viruses as well as proteins, electrolytes and fluid Absent in bones, bone marrow, teeth, CNS  OM309 : OMT – LYMPHATIC ACTIVATION LYMPHATIC VESSELS 2) Lymphatic Collecting Vessels Similar to blood vessels (3 layers), but thin & delicate Superficial ones in skin travel with superficial veins. Deep ones ( in trunk and digestive viscera) travel with deep arteries. Drain into superficial and deep lymph nodes.  OM309 : OMT – LYMPHATIC ACTIVATION 3) Lymphatic Trunks Paired except intestinal Lumbar & Intestinal - drain into cisterna chyli Intestinal - Receives fatty lymph (chyle) absorbed through lacteals of intestines Broncho-mediastinal Subclavian Jugular OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION 4) Lymphatic Ducts Thoracic duct (always present) - (drain into left subclavian and jugular vein) 20% also have a right lymphatic duct - (drain into right subclavian and jugular vein) OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION LYMPHOID ORGANS Lymph nodes Spleen Thymus Tonsils Small intestine Appendix (lymphoid nodules)  OM309 : OMT – LYMPHATIC ACTIVATION LYMPH NODES ARE FOUND IN GROUPS Superficial groups : -Cervical -Axillary -Inguinal Deep groups : -Tracheobronchial -Aortic -Iliac  OM309 : OMT – LYMPHATIC ACTIVATION Lymph Nodes Structure Bean shaped masses of lymphoid tissue( Conn. Tissue & lymphocytes) Covered by Capsule, gives off trabeculae. In between trabeculae, Cortical and Medullary sinuses. Sinuses contain lymph. follicles (nodules) Follicles are masses of B-Lymphocytes (functions???) OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION Nodules also called follicles! They are spherical masses of mostly B-lymphocytes. 1. Scattered Lymphatic nodules. (in submucosa of GIT). 2. Aggregated lymphatic nodules. (“Peyer's Patches”)  OM309 : OMT – LYMPHATIC ACTIVATION THYMUS Secrete hormones (thymopoietin, thymulin and thymosin) for the development of T-lymphocytes Thymus is the organ where T-cells become mature and differentiate. The gland is mainly located within the thoracic superior mediastinum, posterior to the manubrium of the sternum. However, in some individuals, it can extend superiorly into the neck (reaching the thyroid gland) and inferiorly into the anterior mediastinum (lying in front of the fibrous pericardium). OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION The thymus gland has an asymmetrical flat shape, with a lobular structure. The lobules are comprised of a series of follicles, which have a medullary and cortical component : Cortical portion – Located peripherally within each follicle. It is largely composed of lymphocytes, supported epithelial reticular cells. Medullary portion – Located centrally within each follicle. It contains fewer lymphocytes than the cortex, and an increased number of epithelial cells. Hassall’s corpuscles are also present – these are concentric arrangements of epithelial reticular cells. Their function is unclear OM309 : OMT – LYMPHATIC ACTIVATION Hassall’s corpuscle  OM309 : OMT – LYMPHATIC ACTIVATION Blood Supply and Vein Drainage The arterial supply to the thymus gland is via the anterior intercostal arteries and small branches from the internal thoracic arteries. Venous blood drains into the left brachiocephalic and internal thoracic veins.  OM309 : OMT – LYMPHATIC ACTIVATION SPLEEN The spleen is an organ located in the upper left abdomen and is roughly the size of a clenched fist. In the adult, the spleen functions mainly as a blood filter, removing old red blood cells. It also plays a role in both cell-mediated and humoral immune responses. OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION The spleen in located in the upper left quadrant / left hypochondriac region of the abdomen, under cover of the diaphragm and the ribcage – and therefore cannot normally be palpated on clinical examination (except when enlarged). It is an intraperitoneal organ, entirely surrounded by peritoneum (except at the splenic hilum).  OM309 : OMT – LYMPHATIC ACTIVATION Structure Slightly oval shape - covered by a weak capsule that protects the organ whilst allowing it to expand in size. The outer surface of the spleen can be anatomically divided into two : Diaphragmatic surface – in contact with diaphragm and ribcage. Visceral surface – in contact with the other abdominal viscera.  OM309 : OMT – LYMPHATIC ACTIVATION Blood Supply and Veins Drainage Arterial supply from the splenic artery. As the artery reaches the spleen, it branches into five vessels – each supplying a different part of the organ. Venous drainage occurs through the splenic vein. It combines with the superior mesenteric vein to form the hepatic portal vein.  OM309 : OMT – LYMPHATIC ACTIVATION TONSILS (WALDEYER’S RING) The tonsils are collections of lymphatic tissue located within the pharynx. They collectively form a ringed arrangement, known as Waldeyer’s Ring : Pharyngeal tonsil Tubal tonsils (x2) Palatine tonsils (x2) Lingual tonsil  OM309 : OMT – LYMPHATIC ACTIVATION The tonsils are classified as mucosa-associated lymphoid tissue (MALT), and therefore contain T cells, B cells and macrophages. They have an important role in fighting infection – the first line of defence against pathogens entering through the nasopharynx or oropharynx. OM309 : OMT – LYMPHATIC ACTIVATION OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION LINGUAL TONSILS The lingual tonsil refers to numerous lymphoid nodules located within the submucosa of the posterior third of the tongue. This tonsil is responsible for the irregular appearance of the posterior tongue surface. and forms the inferior part of Waldeyer’s ring.  OM309 : OMT – LYMPHATIC ACTIVATION Blood Supply and Veins Drainage Arterial supply to the lingual tonsil largely via the lingual artery, with contributions from the tonsillar branch of the facial artery and the ascending pharyngeal artery. The dorsal lingual branch of the lingual vein performs the venous drainage. OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION Pharyngeal Tonsil The pharyngeal tonsil refers to a collection of lymphoid tissue within the mucosa of the roof of the nasopharynx. When enlarged, the pharyngeal tonsil is also known as the adenoids. It is located in the midline of the nasopharynx and forms the superior aspect of Waldeyer’s Ring.  OM309 : OMT – LYMPHATIC ACTIVATION Blood Supply and Veins Drainage The pharyngeal tonsil receives arterial supply from several vessels : Ascending palatine artery Ascending pharyngeal artery (external carotid) Pharyngeal branch of the maxillary artery Tonsillar branch of the facial artery Venous drainage is via numerous small veins which pierce the superior constrictor muscle to empty into the pharyngeal plexus. OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION Tubal Tonsils The tubal tonsils refer to lymphoid tissue around the opening of the Eustachian tube in the lateral wall of the nasopharynx. They form the lateral aspect of the Waldeyer’s ring. Arterial supply is chiefly via the ascending pharyngeal artery and venous drainage is to the pharyngeal plexus. OM309 : OMT – LYMPHATIC ACTIVATION  OM309 : OMT – LYMPHATIC ACTIVATION Palatine Tonsils The palatine tonsils are commonly referred to as “the tonsils” They are located within the tonsillar bed of the lateral oropharynx wall They form the lateral part of the Waldeyer’s ring.  OM309 : OMT – LYMPHATIC ACTIVATION Blood Supply and Veins Drainage The arterial supply to the tonsil is via the tonsillar branches of the facial artery, ascending pharyngeal artery, dorsal linguae branches and descending palatine artery. The venous drainage is via the external palatine vein (drains into the facial vein) and numerous smaller vessels which drain into the pharyngeal plexus. OM309 : OMT – LYMPHATIC ACTIVATION OM309 : OMT – LYMPHATIC ACTIVATION OM309 : OMT – LYMPHATIC ACTIVATION INDICATIONS  OM309 : OMT – LYMPHATIC ACTIVATION INDICATIONS Diseases or conditions exhibiting some degree of edema, tissue congestion, or lymphatic or venous stasis are among the indications for using OMT to affect the lymphatic system. Acute SDs, sprains/strains, pregnancy, infection, inflammation, and pathologies with significant lymphatic and/or venous congestion are some specific indications.  OM309 : OMT – LYMPHATIC ACTIVATION INDICATIONS A significant number of illnesses and medical conditions can be treated or improved with lymphatic OMT. The following list includes many, but not all. Upper respiratory infections Sinusitis Chronic obstructive pulmonary After a myocardial infarction disease (COPD) Congestive heart failure Asthma Pericarditis Atelectasis Myocarditis Pneumonia Mastitis Bronchitis Lymphedema Otitis Thoracic inlet syndrome Pharyngitis Constipation  OM309 : OMT – LYMPHATIC ACTIVATION INDICATIONS Gastrointestinal infections Tendonitis Crohn’s disease Joint swelling Colitis Joint infection Liver cirrhosis Chronic hepatitis Nephrotic syndromes Pancreatitis Uterine fibromas Uterine contractions Premenstrual syndrome Endometriosis Cystitis OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS  OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS Contraindications When using lymphatic techniques, clinical judgment must be exercised while keeping the patient's diagnosis, clinical status and ongoing medical therapy in mind. These variables affect which treatment technique, dosage, length and frequency are best. Absolute contraindications include anuria if the patient is not receiving dialysis because of the possible risk of pulmonary edema, necrotizing fasciitis (localized inflammation in the affected area) and uncooperative or unwilling patients.  OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS Acute asthma exacerbation due to increasing reflexive bronchospasm risk, unstable cardiac conditions, cancer (immune system activation vs. lymphatic spread), chronic obstructive pulmonary disease (COPD) due to increased residual volume post- treatment, and inability of congestive heart failure (CHF) patients to tolerate excessive preload are examples of relative contraindications. Although research in this area is ongoing, there are currently no risks connected to lymphatic treatment for cancer patients. The majority of authorities back prudent use in cancer patients.  OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS While exercise and orbital metastatic transfer (OMT) to increase lymphatic flow have not been shown to increase cancer risk, treatment over metastatic sites or involved lymph nodes is contraindicated. Research on lymphatic therapy in animal models has demonstrated some promise in treating pulmonary neoplasms and infectious diseases.  OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS Additional contraindications include the following : 1. Pregnancy (uterus/deep abdominal work) 2. Circulatory disorders (venous obstructions, embolism, hemorrhage) 3. Untreated coagulopathies or patients on anticoagulants (adjust the technique to be less vigorous) 4. Bacterial infections with a risk of dissemination 5. Chronic infections with a risk of reactivation (e.g. abscess, chronic osteomyelitis) 6. Diseased organ (i.e. treating thyroid in the presence of hyperthyroidism splenomegaly as in infectious mononucleosis)  OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS There are relative contraindications (pain) and absolute contraindications (no consent from the patient). However, with lymphatic techniques, these can be more difficult to discern. Absolute contraindications : Abscess Thrombotic events Localized infection Nearby surgical wounds Bacterial infection with high fever Lymphoma Bone fractures Leukemia Certain stages of carcinomas (some contradict this)  OM309 : OMT – LYMPHATIC ACTIVATION CONTRAINDICATIONS Relative contraindications for some techniques : Thoracic and pedal pumps Osteoporosis Deep vein thrombosis Recent abdominal surgery Splenic / liver pump Acute hepatitis Friable liver Traumatic injury to either organ Doming the diaphragm A full stomach OM309 : OMT – LYMPHATIC ACTIVATION DIAGNOSTIC PRINCIPLES  OM309 : OMT – LYMPHATIC ACTIVATION DIAGNOSTIC PRINCIPLES DIAGNOSTIC PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM A methodical approach is useful in identifying the existence of SD and any effects it may have on the lymphatic system. The following components of this strategy are present : History and Physical Examination A complete history and physical examination are crucial in this, as in any medical or surgical scenario. Any signs of swelling or puffiness, infection, inflammation, organ disease, shortness of breath, and tissue trauma should be closely monitored during the physical examination.  OM309 : OMT – LYMPHATIC ACTIVATION DIAGNOSTIC PRINCIPLES Terminal Lymphatic Drainage Sites When assessing whether regional tissue congestion is present, palpable tension, tenderness or ticklishness, or full, boggy tissue texture changes in the regional terminal lymphatic drainage sites are especially helpful (Figure 8). Palpating anatomical transition zones, central myofascial pathways detect the presence of fascial restrictions that could impede lymphatic flow.  OM309 : OMT – LYMPHATIC ACTIVATION DIAGNOSTIC PRINCIPLES Fluid pumps ascertain whether any of these muscular, fascial, and/or membranous regions have restricted physiologic motion. the supraclavicular fossa region (often referred to by DOs as the "thoracic inlet"), the thoracoabdominal diaphragm, the pelvic diaphragm, and the cranial dura membranes, particularly the tentorium cerebelli (which DOs consider to be a "cranial diaphragm").  OM309 : OMT – LYMPHATIC ACTIVATION DIAGNOSTIC PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM Figure 8: Terminal Lymphatic Drainage Sites  OM309 : OMT – LYMPHATIC ACTIVATION DIAGNOSTIC PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM Spinal Involvement Less optimal lymphatic flow may be a result of reduced biomechanical efficiency and increased tension in the corresponding muscular and connective tissue structures caused by SDs of the sacrum, rib cage, and spinal vertebrae. Peripheral Pathways Palpate additional regional and local tissues to assess the presence of congestion and excess fluid in the interstitial tissues after assessing terminal lymphatic drainage sites. This makes it easier to find any areas that could profit from local fluid techniques. OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES  OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM Clear treatment objectives are the foundation of an efficient and successful treatment plan for SD that impairs optimal lymphatic system function. These therapeutic objectives will direct the practitioner toward the best course of action for each patient, including the application of OMT to support optimal lymphatic system function. Treatment plans with well defined objectives should focus on minimizing impaired lymphatic fluid movement, improving the mechanical respiration process by lessening breathing effort and boosting the effectiveness of air and fluid flow regulated by this respiratory pump, and improving lymph and lymphocyte movement from peripheral, localized, and regional tissues that require decongestion.  OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM Theoretically, all OMT techniques can improve the functioning of the lymphatic system by altering the tone of the muscles, releasing myofascial restrictions, adjusting neural reflexes, maintaining a balanced autonomic tone, and having positive effects on breathing. The Five Models of Osteopathic Patient Care are a clinical reasoning process that OMT Practitioners use to establish a logical therapeutic osteopathic approach.  OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM Biomechanical, neurological, respiratory-circulatory, metabolic- nutritional and behavioral-biopsychosocial are the specific models. By employing this framework to direct the collection of data during the history, physical and structural examinations, the physician can create a strong basis for making therapeutic decisions. Table 1 explains some possible perspectives for these models in relation to the lymphatic system.  OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM Table 1: Five Models of Osteopathic Patient Care  OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM  OM309 : OMT – LYMPHATIC ACTIVATION TREATMENT PRINCIPLES FOR SD AFFECTING THE LYMPHATIC SYSTEM The use of a treatment protocol When using OMT to treat SDs that impact the lymphatic system, some DOs favor a more protocol-based approach. With the help of this technique, it is possible to determine the specific lymphatic system components that require restoration to optimal function and the appropriate sequence for their restoration. Generally speaking, the more central elements of the lymphatic system are treated first, followed by the more peripheral and regional elements. OM309 : OMT – LYMPHATIC ACTIVATION TECHNIQUE OR TREATMENT  OM309 : OMT – LYMPHATIC ACTIVATION TECHNIQUE OR TREATMENT Chapman’s Reflexes There are roughly 100 documented Chapman’s points. These are areas of gangliform contraction, which, when in certain areas are associated with specific organs that have dysfunctions. Treating these points will decrease sympathetic tone, increase myofascial motion and improve lymphatic return to the visceral dysfunction. Chapman’s points have been documented in chronic hepatitis patients found on physical exam. They can help physicians narrow their differential, validate a diagnosis, and increase treatment options.  OM309 : OMT – LYMPHATIC ACTIVATION TECHNIQUE OR TREATMENT Thoracic pump Increases mobilization of all lymphatic fluid movement and increases rib case mobility. Pedal pump Increases mobilization of all lymphatic fluid movement. This technique is very useful in pediatric patients. Thoracic inlet release Sibson’s fascia mentioned above is the fascial layer comprised of the connective tissues of the longus coli and scalene muscles. The right and left thoracic ducts travel through this fascia once and twice, respectively. Using techniques to release Sibson’s fascia will better allow all lymph to return to the circulatory system.  OM309 : OMT – LYMPHATIC ACTIVATION TECHNIQUE OR TREATMENT Rib raising Increases thoracic movement and lessens somatic dysfunctions of the area treated. Parathoracic sympathetic ganglia are also normalized during this treatment. This treatment is effective for pneumonia COPD, and asthma. Splenic / liver pump This procedure facilitates the flow of lymph to the liver and spleen. In the liver, this increases the ability of the Kupffer cells to interact with antigens and toxins in the lymph. The spleen’s ability to screen and remove damaged cells from the system is also enhanced.  OM309 : OMT – LYMPHATIC ACTIVATION TECHNIQUE OR TREATMENT Facial sinus pressure techniques Improves sinus congestion and otitis media Involves direct strokes applied to the sinuses, zygomatic bones, and the temporal mandibular joints bilaterally to enhance lymph movement towards the right and left lymphatic ducts. Galbreath technique Facilitates the opening of the eustachian tubes and allows the flow of lymph distally from the ears. Anterior cervical mobilization Side to side movement of the hyoid, thyroid, and cricoid cartilage, and the trachea increases drainage from the head, neck, and throat.  OM309 : OMT – LYMPHATIC ACTIVATION Extremity pump Wave-like motions are applied in a distal to proximal fashion to the arms and legs to improve lymph motion towards the axillae and groin, respectively. Doming the diaphragm Increases mobilization of lymphatic fluid from the lower extremities and increases diaphragm mobility. Useful for hiccups OM309 : OMT – LYMPHATIC ACTIVATION THANK YOU OM 309 OMT – LYMPHATIC ACTIVATION Diploma in Osteopathic Manual Manipulative Practice