Osteopathic Manipulative Treatment: Lymphatic Procedures

The lymphatic system can easily be overlooked but drastically impacts the immune system. This mesh of tissues and organs exports toxins, waste, and unnecessary materials out of the body via lymph fluid. Modern medical education today does not do full justice to the lymphatic system. This system removes fluids and protein from the extracellular space and interstitium to maintain proper osmotic balance. In acute inflammation, changes occur in the lymphatic system, so our body will try to maintain appropriate homeostasis. Osteopathic manipulative treatment (OMT) is used to treat somatic dysfunctions. OMT focuses on enhancing the neuromuscular connection, improving biomechanical balance, decreasing pain, and increasing the range of motion. In the historical context of osteopathy, Dr. Andrew Taylor Still placed a lot of importance on the lymphatic system during his development of the tenets of osteopathy. In the book  by Andrew Taylor Still, he mentions that "We suffer from two causes: want of supply and the burdens of dead deposits." Dr. Still understood the importance of the lymphatic system's role in clearing the "debris" that may cause disease. In modern medicine, we know more about the lymphatic vessels and how they may contribute to certain chronic conditions. Inflammation is a normal homeostatic response to injury or infection; it is the body's response to try to heal. During the process, significant amounts of different cytokines and other inflammatory mediators are released to signal the appropriate immune cells. Removing these markers through lymphatic drainage flow is essential to help resolve the inflammation.  Understanding the lymphatic formation and removal process from the interstitium is a crucial physiologic principle to treat osteopathically. Osteopaths believe that lymphatic drainage plays a significant role in rheumatoid arthritis; immune complexes are formed in the disease, which cause substantial inflammatory exudates. These exudates cause pain and destroy joint tissue, and it has been shown that there is increased lymph production and drainage from these patients. Some osteopathic techniques are similar to those implemented by chiropractors, physical therapists, and massage therapists, and other methods are solely used by osteopathic physicians. However, one main difference is that these physicians are trained to apply these techniques with their extensive knowledge of physiology and anatomy. This allows osteopathic physicians to tailor their treatment to each patient. This will enable OMT to be applied to more than just spinal alignment to treat many physiologic conditions.  Some techniques were designed to be used to help increase lymphatic flow. Some other techniques were not designed to be lymphatic, but they can be used in its treatment by understanding the complexity of the human anatomy. When treating lymphatic techniques, it is essential to be mindful of structures that may impinge the lymphatic vessels, such as fascia, muscles, ligaments, and other somatic dysfunctions. Many techniques comprise OMT, which can treat many 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.