The lymphatic system can easily be overlooked, but it has a drastic impact on the immune system. This mesh of tissues and organs exports toxins, waste, and unnecessary materials via lymph fluid out of the body. Osteopathic manipulative treatment (OMT) is used to treat somatic dysfunctions. OMT focuses on enhancing the neuromuscular connection, improving biomechanical balance, decrease pain, and increase range of motion.[1]
Some osteopathic techniques are similar to those implemented by chiropractors, physical therapist, and massage therapists, and other methods are solely used by osteopathic physicians. However, one main difference is that these physicians are trained to apply their knowledge of these techniques in combination with their extensive knowledge of physiology. This allows the osteopathic physician to tailor their treatment to each patient.[2] This will enable OMT to be applied to more than just spinal alignment to treat a vast amount of physiologic conditions.[2] Many techniques comprise OMT, which can treat a multitude of ailments, including the lymphatic system. Problems within this system lead to the accumulation of lymph, decreased immune responses, fat build-up, tissue swelling, and connective tissue accumulation.[3]
The spleen, lymph nodes, thymus, lymph channels, adenoids, tonsils, and thymus make up the lymphatic system.
These organs share connections via small lymph channels similar to capillaries, which mimic the circulatory system. Lymph vessels form a one-way system to transport fluid and leukocytes that have extravasated from blood vessels.[3] The vessels are lined with smooth muscles to propel the fluid through the body.[4] This system eventually drains back into the blood at either the left subclavian vein or the right subclavian vein. The right extremity, right hemi-cranium, most of the lungs, and the heart drain via the right lymphatic duct then into the right subclavian vein at the junction with the right internal jugular vein. The rest of the body, including the left upper lobe of the lung, drains via the thoracic duct.[5] Both of these lymphatic ducts go through Sibson’s fascia of the thoracic inlet at the level of the seven cervical vertebrae. However, the thoracic duct, which drains the majority of the body, traverses this fascial layer twice before returning to the circulatory system.
A significant number of illnesses and medical conditions can be treated or improved with lymphatic OMT. The following list includes many, but not all.
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:
Relative contraindications for some techniques:
Consent is necessary before any procedure, including OMT. The patient must understand the risks, benefits, and alternative options to be able to provide informed consent.
Patients appreciate the provider warming his or her hands before the treatment begins.
OMT is relatively safe, and lymphatic treatments are some of the safest. Some transient effects may include headache, tiredness, and fatigue.[2] Adverse effects may be avoided if the patient drinks plenty of fluids.
Due to the vast amount of illnesses and injuries treated by OMT, it can have substantial clinical significance. During the so-called Spanish flu of 1918, there was a 33% mortality rate for patients who received care. However, patients who also received treatment with OMT had a mortality rate of 10%. The techniques used improved lymphatic flow, immune defense, and respiratory function.[6] In 2010, a randomized controlled trial of over 400 elderly patients with pneumonia found that OMT as an adjunctive treatment to the standard of care lowered costs, decreased hospital length of stay, duration of intravenous antibiotics, and incidence of respiratory failure or death.[6]
For the last 130 years, osteopathic physicians have been practicing medicine.[2] Although the understanding of osteopathic medicine has dramatically increased, it is still poorly understood by healthcare workers and patients. It is vital for members of a team, including nursing providers and staff, to understand OMT and what it can provide to patients. This way, the patients know what options are available and may receive increased relief for their ailments in addition to allopathic medicine. Outcomes and patient satisfaction will improve. OMT is also very safe, and if some issues are treatable with OMT alone, it will also increase patient safety.
[1] | Bodine WA, Osteopathic Manipulative Treatment: A Primary Care Approach. American family physician. 2019 Feb 15; [PubMed PMID: 30763051] |
[2] | Earley BE,Luce H, An introduction to clinical research in osteopathic medicine. Primary care. 2010 Mar; [PubMed PMID: 20188997] |
[3] | Alitalo K, The lymphatic vasculature in disease. Nature medicine. 2011 Nov 7; [PubMed PMID: 22064427] |
[4] | Mikhael M,Khan YS, Anatomy, Abdomen and Pelvis, Lymphatic Drainage 2020 Jan; [PubMed PMID: 32491652] |
[5] | Null M,Agarwal M, Anatomy, Lymphatic System 2020 Jan; [PubMed PMID: 30020619] |
[6] | Yao S,Hassani J,Gagne M,George G,Gilliar W, Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. Journal of visualized experiments : JoVE. 2014 May 6; [PubMed PMID: 24836893] |
[7] | Chin J,Francis M,Lavalliere JM,Lomiguen CM, Osteopathic Physical Exam Findings in Chronic Hepatitis C: A Case Study. Cureus. 2019 Jan 22; [PubMed PMID: 30937237] |