Lymphatic Drain/Stimulation

In this therapy we focus on getting the lympatic system to circulate and drain properly.

Terms to know:
Mosby’s Medical and Nursing Dictionary describes the lymphatic system as: a vast, complex network of capillaries, thin vessels, valves, ducts, nodes, and organs that helps to protect and maintain the internal fluid environment of the entire body by producing, filtering, and conveying lymph and by producing various blood cells. The lymphatic network also transports fats, proteins, and other substances to the blood system and restores 60 percent of the fluid that filters out of the blood capillaries into interstitial spaces during normal metabolism. The peripheral parts of the lymphatic complex do not directly communicate with the venous system into which the lymph flows, but the endothelium of the veins at the junction of the blood and the lymphatic networks is continuous with the endothelium of the lymphatic vessels. Small semi lunar valves throughout the lymphatic network help to control the flow of lymph and, at the junction with the venous system, prevent venous blood from flowing into the lymphatic vessels. The lymph collected from throughout the body drains into the blood through two ducts situated in the neck. Various body dynamics, as respiratory pressure changes, muscular contractions, and movements of organs surrounding lymphatic vessels combine to pump the lymph through the lymphatic system. The thoracic duct that rises into the left side of the neck is the major vessel of the lymphatic system and conveys lymph from the whole body, except for the right quadrant, which is served by the right lymphatic duct. Lymphatics have a beaded appearance because of sinuses associated with the many valves in the vessels. They resemble veins but have more valves, thinner walls and contain lymph nodes. The lymphatics are so thin and transparent that the lymph they contain can be seen moving through these delicate tubules in a living body. Special techniques are required, however to examine the lymphatic system closely. The lymphatic capillaries, which are the beginning of the system, abound in the dermis of the skin, forming a continuous network over the entire body, except for the cornea. The system also includes specialized lymphatic organs, as the tonsils, the thymus, and the spleen. The lymphatics of the intestine contain a special substance, especially during the digestion of fatty foods. Lymph flows into the general circulation through the thoracic duct at a rate of about 125 ml per hour during routine exertion. The rate may jump to as high as 1,800 m per hour during vigorous exercise.

Lymph-Lymph is a straw colored fluid that is derived from and is very similar to the tissue fluid or interstitial fluid of the body part from which it flows. Lymph bathes all cells, acting as a medium of exchange, trading nutritive materials to the cells and receiving in return the waste products of metabolism. Most of this filtering fluid is re-absorbed into the capillaries. About 10% enters the lymphatic capillaries returning it to the blood via the lymphatic system.

Lacteals- Lymphatic capillaries located in the villa of the small intestines. The walls of the Lacteals are constructed of endothelial cells that overlap the edges yet are not securely attached. This creates flap-like valves that allow fluid from the tissue spaces to enter the capillaries.

Lymphatics- Consist of a vast network of tubes transporting lymph. 

Lymphatic Pump- The action of external forces on the lymphatic system.

Thoracic duct (left lymphatic duct)- The common trunk of all the lymphatic vessels in the body, except those on the right side of the head, the neck, and the thorax, the right upper limb, the right lung, the right side of the heart, and the diaphragmatic surface of the liver. In the adult, it is 38 to 45 cm long and 3 to 5mm in diameter. It begins high in the abdomen at the cisterna chili, ventral to the second lumbar vertebra, enter the thorax though the aortic hiatus of the posterior mediastinum, between the aorta and the azygous vein. In the neck, it arches over the clavicle and opens into the junction of the left internal jugular and the left subclavian veins. The thoracic duct contains various valves, including two at this orifice that prevent venous blood from flowing into the lymphatic system.

Lymph Node- One of the many, small oval structures that filter the lymph, fight infection, and in which there are formed lymphocytes, monocytes, and plasma cells. The lymph nodes are of different sizes, some as small as pinheads, others as large as lima beans. Each node is enclosed in a capsule, is composed of a lighter colored cortical portion and a darker medullary portion. They consist of closely packed lymphocytes, reticular connective tissue laced by trabeculae, and three kinds of sinuses, sub capsular, cortical, and medullary. Lymph flows into the node through afferent lymphatic vessels that open into the sub capsular sinuses. Efferent lymphatic vessels arise from the medullary sinuses of the node and emerge through a small peripheral hilum that also receives blood vessels. The sinuses and meshes of reticular fibers retard the flow of lymph to which lymphocytes are added from germinal centers within the node that multiply those cells by mitosis. Most lymph notes are clustered in areas, as the mouth, the neck, the lower arm, the axilla, and the groin. The lymphatic network and nodes of the breast are especially crucial in the diagnosis and treatment of breast cancer in women. Cancer cells from a “primary” breast tumor often spread through the lymphatic system to other parts of the body.
Lymphedema-
A primary or secondary disorder characterized by the accumulation of lymph in soft tissue and swelling, caused by inflammation, obstruction, or removal of lymph channels. Congenital lymphedema (Milroy’s disease) is a hereditary disorder characterized by chronic lymphatic obstruction. Lymphedema praecox occurs in adolescence, chiefly in females, and causes puffiness and swelling of the lower limbs, apparently because of hyperplastic development of lymph vessels. Secondary lymphedema may follow surgical removal of lymph channels in mastectomy, obstruction of lymph drainage caused by malignant tumors, or the infestation of lymph vessels with adult filarial parasites. Lymphedema of the lower extremities begins with mild swelling of the foot, gradually extends to the entire limb, and aggravated by prolonged standing, pregnancy, obesity, warm weather, and the menstrual period. There is no cure for the disorder, but lymph drainage from the extremity can be improved if the patient sleeps with the foot of the bed elevated four to eight inches, wears elastic stocking, and takes moderate exercise regularly. Light massage in the direction of the lymph flow and thiazide diuretics may be prescribed. Constricting clothing and salty or spicy foods that increase thirst are contraindicated. Surgery may be performed to remove hypertrophied lymph channels and disfiguring tissue.