Lymph Pump Techniques

00:00 So there are different pump techniques that we could utilize. So remember the three steps in our sequence. One is to remove any restrictions treating those diaphragms, two is then optimizing the thoracic cage and treating any muscles that might be restricted running along those lymph channels and then the final step is to utilize these lymph techniques. And so these lymph pump techniques actually try to augment and promote lymph flow and so we could utilize pedal pump, thoracic pump, pectoralis traction techniques, liver and splenic pumps. Before using any pump, you have to make sure that you are aware of the contraindications to lymphatic pump techniques. Some absolute contraindications include osseous fracture. So if I had a fracture of my tibia I am not going to be performing a pedal pump. If I had a fracture of the rib cage I do not want to be performing the thoracic pumps. Patients with pneumothorax or acute disease, you do not want to be pumping on the chest and patients with risk of thrombotic events. Especially with the pedal pump, you do not want to throw the clot more distally. There are some relative contraindications to lymphatic pump techniques. One includes a bacterial infection with temperature over 102. So, in this case what you are trying to prevent is seeding that bacteria outside of where it is located and creating a septic environment. Again, this is a relative contraindication. Usually when I treat my patients with pump techniques when we were in the hospital we will make sure that the patient had antibiotics on board prior to doing the pump techniques, but you could utilize the first two steps and just open things up to optimize lymph flow without fear. Patients with a history of unstaged carcinoma. So if a patient has stage carcinoma that you know has spread, then there is really not so much of a risk but it is a relative contraindication of someone who was recently diagnosed unstage, not sure whether or not the tumor has spread. That said, these pump techniques, what I usually explain to patients, really is indicated to try to get lymphatics to move but it does not do more than if you were to just go out for a brisk jog. So my passive pumping of the feet and of the chest really will increase lymphatic flow just as much as if the patient were to go out for a jog and so really its indication and its use is for patients who are hospitalized, who are more bed bound, who is not getting out of bed, who is not using muscle contractions, who have a recent surgery and they are splinting, they are not taking deep breaths in. So, really, the history of carcinoma is more of a relative contraindication, the fear is that you are going to spread the tumor but when you look at the pump techniques itself, if the patient ambulates and moves, that is really going to pump their lymphatics just about the same. The patients who are posttraumatic, postsurgical you just have to be concerned about their incision site or the trauma itself whether or not these pumping techniques will cause more pain or injury and also in patients with potential fluid overload such as acute congestive heart failure, you do not want to perform a pump if it is going to overload their heart and cause more distress. One of the ways to assess for potential deep vein thrombosis is a special test called Homan sign. So for Homan sign what you are going to do is you are going to dorsiflex the foot and squeeze the calf and if the patient has pain then that is a positive sign for potential DVT. Ultimately, if you have a suspicion for DVT, do not do the pedal pump, get blood work, get an ultrasound first to double check to make sure that there is not a DVT present and then if it comes back negative then you could perform the pumping techniques. So, prior to performing pedal pumps, it is important to consider your patient population that may have increased risk factors for thrombosis. So, if your patient has any of these histories, it is something that you have to kind of consider and think about should you hold off on performing the pumps until you make sure that it was not present. So, things that increase risk for thrombosis include immobility, any sort of faulty blood clotting so abnormal clotting factors, patients on hormone-replacement therapy or oral contraceptives, any sort of prior damage to the lining of the veins. So patients with prior history of deep vein thrombosis is they are more at increased risk for clotting. Older patients have an increased risk, pregnancy also increases the risk, and obesity. So, the pump techniques itself, the thoracic pump is performed with the patient supine and the patients will place their hands on the upper rib cage. Patient is going to take a nice deep breath in and on exhalation the physician is going to augment exhalation by adding a little bit of compression or pump. You could also utilize an oscillatory or vibration at the end and then you continue this until there is a change in the actual tissues. For the pedal pump, the patient is going to stand at the feet of the supine or prone patient, you are going to start with dorsiflexing the patient’s feet and then again adding a little bit of oscillatory force to create again motion and movement, wave-like motion, and you are going to feel this oscillation until a little bit of the resistance is decreased.

06:23 So, in summary, when treating and utilizing the lymph model we want to first remove any sort of restrictions to lymph flow. So looking at the anatomy and understanding where these restrictions might be like treating the thoracic inlet, the diaphragm, the pelvic diaphragm, the popliteal spread or occipitomastoid suture, these are key areas where restrictions might be for a lymphatic flow. We also want to utilize techniques to promote lymphatic flow, optimize pulmonary respiration and balance autonomic tone, techniques such as rib raising, spinal articulatory techniques, suboccipital release, muscle energy to treat those hypertonic muscles.

07:05 Finally, lymphatic techniques to try to augment lymph flow including thoracic and pedal pumps, splenic pumps utilizing a siphoning technique to try to get the lymph moving. So, overall treatment of the lymphatics addresses the whole body and really you could utilize these techniques to address any sort of disease process that has any sort of inflammation and edema. It is a gentle and safe and effective technique to help promote the patient’s body in healing. So, going back to our case, we utilized lymphatic treatment techniques, oscillatory lymphatic techniques, pedal pump to our patient and after treatment initially there was little change noticed but what the patient noticed a month later was that there was definitely decreased edema in the legs bilaterally, actually noticed that her shoes fit better and then did not have any edema after a short plane trip. So, hopefully this case helps to illustrate how we applied osteopathic treatment into addressing the lymphatics and how you could utilize this model and treatment approach to help treat inflammation and edema in your patients.