Lymphatic Treatments Flashcards
d. Perform the Dome Diaphragm (Redoming the diaphragm) lymphatic treatment for zone one (thoracic)
-States how it will increase lymph flow: relax the diaphragm so it can produce greater pressure gradients to promote lymph drainage back to venous circulation‐ improves diaphragm excursion/frees up diaphragmatic motion & thus improves ability to move lymph back centrally
-Position: Pt Supine with doc standing at side of table facing cephalad
-Doc’s hands in the infracostal region, with fingertips/thumbs below thoracic cage (xiphoid)
-Have patient take a deep breath and press down (posteriorly) on exhalation
-Resists motion on inhalation.
-Repeat 3‐4 times & on last time, turn palmar aspect of thumbs cephalad,
-Slide thumbs slightly under the ribcage during exhalation and apply cephalad force to dome
the diaphragm
e. Perform the Rib Raise – Seated lymphatic treatment for zone one (thoracic)
-Patient seated with doctor standing in front of patient
-Doctor states the purpose is to stimulate sympathetic chain ganglia and/or improve lymph
flow in area 1
-Doctor has patient cross arms & lean forward placing elbows on his/her shoulder.
-Doctor reaches around the patient and contacts the lower rib angles bilaterally.
-Doctor induces a force pulling anterolateral (toward the doctor) then releasing the force.
-This is repeated rhythmically as the doctor moves his/her hands cephalad to cover the
entire rib cage.
f. Perform the Rib Raise – Supine lymphatic treatment for zone one (thoracic)
- States how it helps lymph flow: stimulates sympathetic chain ganglia initially followed by decrease stimulation, improved lymph flow by improving cage excursion with resulting increase pressure gradients
-Patient supine with doc stand facing table on side to Treat
-Start treatment bottom to top (unless specific abnormal area to Tx).
-Contacts ipsilateral rib angles with finger tips
-Applies anterior force with upper extremity and traction by rocking backward on heels in a
rhythmical manner
-Performs bilaterally for 1 minute
g. Perform the Tapotement lymphatic treatment for zone one (thoracic)
-Patient prone with doc at side of table
-Provides a hacking force to thoracic cage( karate chop) hacking with ulnar side of hands
rhythmically
-Switches to cupping/clopping (cup hands) while hands are in the c shape or like a “cup” and
provides rhythmical force to thoracic cage
-Switches to slapping force rhythmically applied to thoracic cage (use palmar surface of
hands)
-States the forces help to break loose consolidated material for improved drainage and
expulsion from lungs
h. Perform the Thoracic Pump lymphatic treatment for zone one (thoracic)
-States how it moves lymph fluid: affect pressure gradients, indicated for clearing thoracic duct region, especially for COPD, URI, LRI, swollen upper extremities, enhance immune function
-States Repetitive component to technique
-Patient is supine with doc at head of table
-Place thenar eminence of each hand over the respective pectoral muscle infraclavicular
region on ribs 2‐4 (offer women a pillow).
-Apply rhythmic pumping at a rate of 110‐120 x/min.
-Fast enough when in rhythm with rebound & strong enough when feet move
-States Vacuum component to technique
-Patient is supine with doc at head of table
-Place thenar eminence of each hand over the respective pectoral muscle infraclavicular
region on ribs 2‐4 (offer women a pillow).
-As patient exhales apply a force downward and maintain the end point (compressive force)
at end exhalation.
-Continues this for 4‐5 respiratory cycles.
-During 1/3 of the way through the last inhalation briskly remove force from hands to allow
rapid inhalation.
i. Perform the Abdominal pump lymphatic treatment for zone two (abdomen)
-States how this helps to move lymph fluid: indirectly affects pressure gradients, indirectly massage thoracic duct at its origin in cisterna chyli
-Patient is supine with doc standing at side of table.
-Doc places palms on abdomen with fingers pointing towards the patient head and thumbs
side by side.
-Provides a gentle pumping force (anterior to posterior) in a rhythmic manner at 20‐30 times
per minute
-Provides procedure for 1 minute
j. Perform the Sacral rocking lymphatic treatment for zone two (abdomen)
-States purpose: relax muscles at lumbosacral junction
-Position: patient prone.
-Doc at side of table
-Places heel of cephalad hand on the sacral base with fingers pointing towards the coccyx.
-Caudad hand on top of cephalad hand with fingers pointing toward the head.
-Exerts a gentle pressure downwards.
-Alternating rocking force applied in the sagittal plane motion with force on the sacral base
during exhalation and the force on the apex of the sacrum during inhalation.
k. Perform the Effleurage lymphatic treatment for zone three (UE)
-States purpose: aid in movement of lymph fluid toward central core of body (direct pressure technique to move lymph)
-Position: Pt supine.
-Doc at side of table on affected side.
-Raises the pts arm up to allow gravity to assist drainage.
-Technique: Doc’s other hand induces a stroking force directed distal to proximal on the
affected arm. (stroke distal to proximal)
l. Perform the Petrissage lymphatic treatment for zone three (UE)
-States purpose: aid in movement of lymph fluid toward central core of body (direct pressure technique to move lymph)
-Position: Pt supine.
-Doc at side of table on affected side.
-Raises the pts arm up to allow gravity to assist drainage.
-Technique: Doc induces a kneading/twisting force directed distal to proximal on the affected
arm utilizing both hands
m. Perform the Effleurage lymphatic treatment for zone four (LE)
-States purpose: aid in movement of lymph fluid toward central core of body (direct pressure technique to move lymph)
-Position: Pt supine.
-Doc at side of table on affected side.
-Raises the pts low extremity up to allow gravity to assist drainage.
-Technique: Doc’s other hand induces a stroking force directed distal to proximal on the
affected lower extremity. (stroke distal to proximal)
o. Perform the Iliotibial Band Effleurage lymphatic treatment for zone four (LE)
-States purpose: Reduce lymphatic congestion to aid other treatments to the IT band (MFR/ST)
-Position: Pt is lateral recumbent with the affected side up and the foot placed in the popliteal fossa
-Doc stands and faces patient
-The docs cephalad hand contacts the pts greater trochanter for stabilization.
-With the caudad hand, makes a c‐shape with the webbing between thumb and fingers,
contacts the pts IT band.
-Initially starting 1⁄2 between the greater trochanter & knee & strokes distal to proximal with
gentle pressure.
-After freedom (less congestion is felt) progress to starting just superior to the knee and
continue stroking in a distal to proximal fashion.
-Can be done for 1‐2 minutes.
p. Perform the Pedal Pump lymphatic treatment for zone four (LE)
-States purpose: Passively move fluid centrally by creating an oscillatory pump.
-Position: Patient is supine with doctor facing patient’s feet.
-Doctor contacts plantar portion of feet over distal metatarsals bilaterally with his/her palms
and dorsiflexes feet.
-Applies a repetitive, cephalad force to hyperdorsiflex the feet and send an oscillatory fluid
wave through the body at rate of ~100x/minute.
-Fast enough when in rhythm with rebound & strong enough when nose moves.
q. Perform the Cervical stroking lymphatic treatment for zone five (head & neck)
- States purpose: stretch muscle groups surrounding cervical vertebrae and move lymph fluid in process
- Position: patient supine with doc at head of table
- Place hands along paravertebral muscle and sternocleidomastoid muscle.
- Slowly stroke the muscles in a caudad direction (from head to thoracic inlet).
- Performs on one side at a time but performs bilaterally
r. Perform the Anterior Cervical traction lymphatic treatment for zone five (head & neck)
- Locate the anterior and posterior border of the inferior portion of the sternocleidomastoid (SCM) muscle. Place your thumb along the anterior margin, the second through fifth digits along the posterior margin.
- Beginning in the lower portion of the SCM and anterior cervical fascia, gently lift anteriorly and laterally until you note relaxation.
- Move superiorly to the middle portion, and repeat again on the superior portion. This procedure may be repeated up to three times.
s. Perform the Pre‐ and Post‐auricular lymphatic treatment for five (head & neck)
-States purpose: direct pressure technique to move lymph fluid in the head and neck region
-Position: patient seated, doc standing in front or behind patient
-Places index finger anterior to ear and middle finger posterior to ear.
-Applies a clockwise & a counterclockwise motion to the auricular lymph nodes rhythmically
for 1 minute
t. Perform the Mandibular Drainage: Galbreath Technique lymphatic treatment for zone five (head & neck)
-States purpose: direct pressure technique to move lymph fluid in the head and neck.
-States indications: Eustachian tube dysfunction, lymphatic congestion in ENT or
submandibular region
-Patient is supine & rotate the head and neck to face doctor
-Doc standing at side of table opposite affected side
places cephalad hand over ipsilateral ear to stabilize the head and neck.
-Places caudad fingers at angle of mandible with the thenar eminence on ramus.
-Apply a slow, repetitive downward traction on the mandible from angle toward the mentum
(may describe a Face Raking process)
u. Perform the Submandibular lymphatic treatment for zone five (head & neck)
-States purpose: direct pressure technique to move lymph fluid in the head and neck region
-Position: patient supine with doc at head of table
-Provides a raking motion under the mandible from angle of mandible towards the
chin/mentum.
v. Perform the Anterior tracheal / Deep cervical lymphatic treatment for zone five (head & neck)
- States purpose: direct pressure technique to move lymph fluid in the peri‐tracheal node region.
- Position: patient supine or seated. Doc at head of table
- Contacts the trachea between index and thumb.
- Applies force to move trachea from side to side
- Works up and down the trachea between larynx and sternal notch
w. Perform the Suprahyoid and Infrahyoid lymphatic treatment for zone five (head & neck)
- States purpose: direct pressure technique to move lymph in area 5 (Head and Neck).
- Position: patient supine with Doc stand at side of table
- Grasps the hyoid bone between index and thumb.
- Gently provides a force to move hyoid bone from side to side for no more than 1 minute
b. Perform the Thoracic Inlet (myofascial release) lymphatic treatment for zone one (thoracic)
- Patient supine, Doc at head of table
- Contacts the SC joint, angle of rib 1, thumbs on T-1 transverse process bilaterally
- Applies caudad and rotation force to the left and right to evaluate for restrictive barrier and ease of motion barrier
- Applies a caudad and rotation force into the restrictive barrier
- Describes waiting for the tissue creep or release
- Reassesses motion of fascia
c. Perform the Pectoral Traction lymphatic treatment for zone one (thoracic)
- States how increases lymph movement: increasing negative pressure in thorax
- Position: Pt Supine, Doc at head of table
- Grasps inferior border pectoralis major (ant axilla)
- Elbows extended
- Applies cephalad traction bilaterally.
- Force applied when pt inhales and resist movement on exhalation
n. Perform the Petrissage lymphatic treatment for zone four (LE)
- States purpose: aid in movement of lymph fluid toward central core of body (direct pressure technique to move lymph)
- Position: Pt supine, Doc at side of table on affected side.
- Raises the pts lower extremity up to allow gravity to assist drainage.
- Technique: Doc induces a kneading/twisting force directed distal to proximal on the affected lower extremity utilizing both hands
