Lymphatics

Question 1

How do you evaluate central myofascial pathways?

Answer 1

look for compensated vs uncompensated patterns
compensated = L/R/L/R, etc
uncompensated patterns can further contribute to lymphatic congestion

Question 2

What are the 4 junctions should you evaluate before doing lymph treatments?

Answer 2

Cranial-cervical
Cervical-Thoracic
Thoraco-lumbar
Lumbo-Pelvic

Question 3

How do you evaluate the cervical-thoracic junction?

Answer 3

observe symmetry of the inlet
examine supraclavicular and infraclavicular areas for TART
place palms on scapula and fingers rest w/ pads infraclavicularly to introduce rotation to the right and left

Question 4

How do you evaluate the thoracolumbar junction?

Answer 4

Observe symmetry of the rib cage
palpate lower-most ribs w/ entire hand and examine for tenderness, texture abnormality, and asymmetry
place palms on lateral aspects of lower ribs to introduce rotation to left and right

Question 5

How do you evaluate the lumbopelvic junction?

Answer 5

palpate the ASIS and iliac crests
place pads of hands on posterolateral aspects of innominates to induce rotation to the right and left
TART

Question 6

What are the 3 fluid pumps?

Answer 6

thoracic inlet
thoracic diaphragm
pelvic diaphragm

Question 7

What is the zink test?

Answer 7

warmth provocative test

warmer areas may be a site of SD

Question 8

What are the 5 principles of diagnosis?

Answer 8

evaluate for indications/risk-benefit ratio
evaluate central myofascial pathways
evaluate fluid pumps
evaluate for spinal involvement
evaluate peripheral/regional pathways

Question 9

What do you feel for when palpating lymph nodes? (6)

Answer 9

size
shape
consistency
tenderness
mobility
overlying skin

Question 10

What are the regional collection sites (6)?

Answer 10

supraclavicular space
epigastric region
posterior axillary fold
inguinal region
popliteal space
achilles region

Question 11

What are the 4 principles of lymph treatment?

Answer 11

1. open pathways to remove restriction to flow
2. maximize diaphragmatic functions
3. increase pressure differentials or transmit motion
4. mobilize targeted tissue fluids

Question 12

Thoracic inlet MFR

Answer 12

pt supine w/ physician at head of table
hands palms down over shoulders, at cervicothoracic jxn
thumbs over posterior first rib, fingers at SC joint
Assess for motion, apply MFR principles

Question 13

Doming the diaphragm

Answer 13

pt supine w/ hips and knees flexed
thumbs inferior to xiphoid process w/ thumbs pointing cephalad
instruct pt to take a deep breath and exhale
on exhalation, press thumbs posteriorly and superiorly
push further on exhalation, resist on inhalation
repeat 3-5 times

Question 14

Ischiorectal fossa release: Doming the pelvic diaphragm

Answer 14

pt prone, physician at side of table facing cephalad
thumbs medial to ischial tuberosities bilaterally
apply cephalad and lateral force
increase force during exhalation, maintain on inhalation

Question 15

Pectoral traction

Answer 15

pt supine w/ hips and knees flexed, physician at head of table
grasp inferior to pt’s clavicles at anterior axillary fold
apply cephalad traction bilaterally
pull when pt inhales and resist on exhale
repeat 5-7 times

Question 16

Rib raising (supine)

Answer 16

Pt supine, physician sitting on side to treat
grasp ipsilateral posterior/inferior rib angles by flexing fingers
starting w T12, apply anterolateral traction by rocking backward/leaning elbows into the table; continue up ribs

Question 17

Rib raising (seated)

Answer 17

Pt seated w/ arms crossed, physician faces pt and pt leans forward toward dr
dr grasps bilateral posterior rib angles
starting w/ T12, pull superiorly and toward Dr. continue up ribs

Question 18

Thoracic pump: repetitive/oscillatory

Answer 18

pt supine w/ hips and knees flexed
place thenar eminence of each hand inferior to clavicles (offer woman a pillow or place their hands under yours)
have pt take a deep breath and exhale fully
at the end of exhalation, apply rhythmic posterior inferior pumping
120x/min for several minutes

Question 19

Thoracic Pump: (vacuum/atelectasis modification)

Answer 19

Pt supine w/ hips and knees flexed
thenar eminence inferior to clavicles and hands on chest
have pt take a deep breath and exhale fully
as pt exhales, apply compressive force downward and resist during inhalation. continue for 4-5 breaths
at beginning of last inhalation, briskly remove hands to allow for rapid, deep inhalation

Question 20

Abdominal pump

Answer 20

Pt supine, physician at pt’s side
place palms on abdomen w/ fingers toward pt’s head, thumbs side by side
pump posteriorly in a rhythmic manner 20-30 times a min

Question 21

Sacral rocking

Answer 21

Pt prone
place heal of cephalad hand on sacral base w fingers pointing toward coccyx, other hand on top pointing cephalad
exert gentle pressure downwards to gap SI joint
inhalation = sacral apex anterior (extension)
exhalation = sacral base anterior (flexion)

Question 22

Pedal pump

Answer 22

pt supine, physician at head of table
contact plantar portion of feet
dorsiflex pt’s feet
on and off rhythmic cephalad force 120x/min for 1-2 min

Question 23

Tapotement

Answer 23

pt prone, physician at pt's side
apply rhythmic forces to thoracic region
hacking = karate chop
cupping/clopping = cup hands into slight C shape
slapping = use palmar surface of hands

Question 24

Effleurage and Petrissage

Answer 24

pt supine, physician on side to treat
raise pt’s arm or leg to treat
effleurage: stroke distally to proximally
petrissage: kneading/twisting distally to proximally

Question 25

IT band effleurage

Answer 25

Pt lateral recumbent w/ affected side up
cephalad hand on pt’s greater trochanter for stability
w/ caudal hand, make a C shape and contact pt’s IT band
start halfway btw hip and knee –> stroke distally to proximally
after some congestion frees, start just superior to knee and continue stroking
1-2 min

Question 26

Anterior cervical arches release

Answer 26

pt supine
place fingers lateral to trachea, other hand stabilize beneath hand or on forehead
move anterior neck structures from side to side, working up and down anterior neck
continue for 30 seconds - 2 min

Question 27

Cervical stroking

Answer 27

Pt supine, Dr at head of table
place hands along cervical paravertebral muscles
slowly stroke the region in a cephalad to caudal direction

Question 28

Cervical chain drainage

Answer 28

Pt supine, dr at head of table
w caudal hand, palmar aspect of fingers over sternocleidomastoid near angle to mandible
use cephalad hand to stabilize
gently roll along muscle in milking fashion, working caudally
treat one side at a time

Question 29

Submandibular drainage

Answer 29

Pt supine, physician at head
fingertips below inferior rim of mandible
direct fingers superiorly and evaluate for ease/restriction of motion
apply principles of MFR

Question 30

Mandibular drainage (galbreath technique)

Answer 30

pt supine, rotate head towards doc. doc standing opposite side to treat
fingers of caudal hand along post ramus of mandible and hypothenar eminence along body of mandible
stabilize head w/ cephalad hand
slow, repetitive downward and midline traction on mandible
30 sec - 2 min, repeat on other side

Question 31

Auricular drainage

Answer 31

pt supine, doc at opposite side to treat
spock hand w fingers in front and behind ear
cephalad hand stabilizes head
apply clockwise and counterclockwise motion
30 sec - 2 min