Lymphatics

Question 1

Thoracic inlet

Answer 1

• Removing barrier
• Fingers fix off 1st rib
• SB head towards hand, rhythmically compress when head is closest to hand
• Rot head away from hand- warn Pt it may be slightly uncomfortable as inc stretch
• Support head with stomach, aim for full range of rotation whilst fixing 1st rib

Question 2

Thoracic inlet via clavicle

Answer 2

• Ask Pt to place hands on chest
• Fix ribs 2-3 (relatively medial/close to sternum)
• Ask Pt to hold your side, grip arm between your arm and your side
• Rhythmically pull arm out laterally

Question 3

Diaphragm

Answer 3

• Assess movement from each side- move side to side
• Find xiphoid cartilage, move a couple of cm inferiorly, place thumbs here
• Ask Pt to breathe in deeply, and out, apply pressure down/lean in into diaphragm
• If restriction is found, hold
• Bend knees to relax rectus abdominals
• Variation
  o If Pt is too big/cant apply pressure through thumbs
  o Stand above head
  o Grip fingers underneath ribs
  o Be mindful of palms in relation to chest
  o Pull/grip underneath as Pt breathes out

Question 4

Ischial tuberosity/diaphragm- practitioner sitting

Answer 4

• Supine, bend knee, locate ischial tuberosity (medial)- explain where you are going, “ischial tuberosity is sitting bone, lmk if you feel uncomfortable”
• Rest leg against your shoulder
• Place hand over diaphragm (fingers point towards couch)
• Inhibition- should feel like they move together

Question 5

Pectoral traction

Answer 5

• Practitioner sitting
• Grip underneath pec major
• Lean back and pull
• Useful for people with shoulder protraction/problems
• Keep pulling until release is felt

Question 6

Thoracic pump

Answer 6

• Cross hands- more important to do so on a female, can have arms uncrossed
• Pump 2x1s- caution= osteoporosis
• Push down (CPR like movement)
• Promotes blood and lymph movement (redness on skin is blood flow)

Question 7

Abdominal pump

Answer 7

• Bend knees
• Applying pressure to thoracic duct
• Push in under ribs

Question 8

Side lying pump

Answer 8

• Place their arm on your shoulder
• Grab hold of liver with both hands + squeeze together
• Continue until release is felt

Question 9

Direct pressure to move lymph

Answer 9

• Telephone arm
• Effleurage- towards heart, light touch shouldn’t need cream
• Petrissage- towards heart, squeezing (similar to thigh twist, maintain contact)