Lymphatics Flashcards
5b. Thoracic Inlet myofacial release- Zone 1
: To release restrictions around the thoracic duct’s junction w/ the venous system
pt. supine, fingers on SC jt, angle of rib 1, thumbs on TP of T1 bilaterally
apply caudad + rotation (L/R) evaluating restrictive barrier and ease of motion
*** direct treatment= toward restrictive barrier apply force until feel tissue creep
*** indirect treatment= toward ease of motion, apply force until feel tissue relax
5c. Pectoral Traction- Zone 1
: INC negative pressure in thorax to pull lymph centrally
pt. supine, grasps inf border of pectoralis mj/ant axilla region bilaterally
with elbows extended, apply cephalad traction
force applied when pt. inhaling AND exhaling
5d. Doming the Diaphragm- Zone 1
: relax diaphragm to improve natural dome shape so greater P gradients produced to pull lymph fluid centrally, directly exert P on thoracic duct to push lymph superiorly
pt. supine, dr. facing cephalad, thumbs below rib cage/xiphoid bilaterally
as pt. exhales, apply posterior force, resists motion on inhales
3-4x, slide thumbs superiorly, under ribcage during last exhale, doming the diaphragm
5e. Rib Raise, seated- Zone 1
: normalize sympathetic tone at the sympathetic chain ganglia to improve lymph flow in zone 1, INC thoracic cage excursion => INC P gradients
pt. seated, facing dr., pt. crosses arms leaning elbows on dr. shooulders
reach around pt. and contact lower ribs angles bilaterally, apply anterolateral force rhythmically (move hands cephalad to conver entire ribcage)
5f. Rib Raise, supine- Zone 1
: normalize symphathetic zone at the sympathetic chain ganglia to improve lymph flow in zone 1, INC thoracic cage excursion => INC P gradients
pt. supine, doc on side to be treated
contact ipsi- rib angle with finger tips, apply anterior force by rocking backwards on heels, rhytmically
perform bilaterally
5g. Tapotement- Zone 1
: break loose consolidated material for improved drainage and expulsion from lungs
pts. prone
1) hacking force to thoracic cage via karate chops with ulnar side of hands rhythmically
2) cupping/clopping hand in C-shape provide rhythmical force to thoracic cage bilaterally
3) slapping force via plamar surface of hands to thoracic cage bilaterally
***perform bilaterally
5h. Thoracic pump- Zone 1
: affect P gradient, clear thoracic duct region, for COPD,swollen upper extremities, enhance immune function
- pt. supine, place thenar eminence of each hand over the respective pectoral muscles/infraclavicular region in ribs 2-4 bilaterally (if pt. female offer a pillow or request that she hold breasts)
- apply rhytmic pumping 2/sec = 110-120x/min, fast enough that feet move
- vacuum component: as pt. exhales apply downford force and maintain end pt. of exhalation, cont for 4-5x, 1/3 through last inhalation briskly remove force from hands allowing for rapid inhalation
5i. Abdominal Pump- Zone 2
: indirectly affects P gradients, indirectly massages throracic duct at cisterna chyli
- pt. supine, dr. at side facing cephalad placing palms on abdomen, fingers facing cephalad, thumbs touching
- procide gentle pumping force anterior-posterior in rhymical manner: 20-30X/min
5j. Sacral rocking- Zone 2
: relax muscles at lumbosacral jctn to improve lymph flow centrally
- pt. prone, heel of cephalad hand on sacral base w/ fingers facing caudad direction, caudad hand on top of cephalad hand w/ fingers facing cephalad direction
- exert anterior pressure, alternate rocking force in sagittal plane w/ force on sacral base during exhalation and force on apex of sacrum during inhalation
5k. Effleurage- Zone 3
: direct P technique to aid in movement of lymph fluid centrally
- pt. supine, dr. at side being treated
- pt. raises arm allowing gravity to assists drainage, dr. induces stroking force directed distal => proximal
- may require division of arm into multiple quadrants to assist drainage on all side
- perform bilaterally***
5l. Petrissage- Zone 3
: direct P technique to aid in movement of lymph fluid centrally
- pt. supine, dr. on side being treated
- pt. raises arm, dr. induced kneading/twisting force distal => proximal on affected arm utilizing both hands
- perform bilaterally***
5m. Effleurage- Zone 4
: direct P technique to aid in movement of lymph fluid centrally
- pt. supine, dr. on side being treated
- pt. raises leg onto dr.’s shoulder, dr. induces stroking force distal => proximal
- may need to divide leg into quadrants to drain all aspects of leg
- perform bilaterally***
5n. Petrissage- Zone 4
: direct P technique to aid in movement of lymph fluid centrally
- pt. supine, dr. on side being treated
- pt leg raised onto dr. shoulder, dr. induces kneading/twisting force in distal => proximal direction utilizing both hands
- perform bilaterally***
5o. Illiotibial Band Effleurage- Zone 4
: reduce lymphatic congestion to aid other tx to the IT band and to INC lymph flow centrally
- pt. lateral recumbent, affected side up flexed at knee, posterior lef extended underneath, dr. facing pt.
- cephalad hand stabilized greater trochanter, caudad hand C-shaped contacts IT band
- starting 1/2 way up thigh stroke distal => proximal w/ gentle stroking pressure
- after less congestion felt, start superior to knee and cont. stroking motion distal => proximal
- perform bilaterally***
5p. Pedal Pump- Zone 4
: passively move fluid centrally by creating oscillatory pump
- pt supine, dr. @ pts. feet
- contact plantar foot distal to metatarsals bilaterally w/ palms
- dorsiflex foot and apply rhythmical cephalad force to hyperdorsiflex foot and send oscillatory fluid wave through body @ rate 100-120X/min
- observe movement/force/rhythm of nose
