If I asked you to describe the lymphatic system – what it is, how it functions, how it serves the human body and enables us to survive – would you be able to answer?
Prior to studying osteopathy, I might have offered a very vague response, but I really did not have a clue and had not heard much about it before.
It is not something you can feel like muscles, joints or bones, let alone something you can see.
So how can a system so infinite be so crucial to our functioning? And how can osteopathic techniques influence it to promote healing?
Once I had a clear understanding of the lymphatic system’s significance, I made it an integral part of my osteopathic treatment and patient management approach. If you are like I was and not sure about this system of the body, I’d love to make it clearer for you all – I want you to be able to answer the question with a more educated response than I could have offered prior to becoming an osteopath!
What is it and why is it so important?
The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other by-products of cellular breakdown. The primary function of the lymphatic system is to transport lymph, a fluid containing infection-fighting white blood cells, throughout the body. Lymphatic capillaries (very thin lymphatic vessels, only slightly larger than blood capillaries) transport the lymph through spaces between cells throughout the body – except the central nervous system and non-vascular tissues. The organs (lymph nodes) filter the lymph fluid and also house white blood cells – which can activate the immune response if particular products are detected within the lymph fluid (Zimmermann, 2018).
Lymph fluid is formed as a final product, once plasma has completed its transit from body cells to deliver nutrients and remove debris and waste. Plasma is the clear, liquid portion of blood that remains after red blood cells, white blood cells, platelets and other cellular components are removed. It is about 55 per cent of the blood volume – containing water, salts, enzymes, antibodies and other proteins. Plasma-remains enter the venous circulation via venules (a small vein that collects blood from the capillary level), continuing as venous blood where it is eventually processed to lymph fluid. Inflammatory cells and excess fluid found in oedema are processed in this way by the body (Zimmermann, 2018).
There are more than two hundred lymph nodes in the human body. They have both deep (around the heart and lungs within the thorax) and superficial (around the neck, groin and armpit) locations. Lymph nodes can be located roughly between the head and knee areas of the body.
Did you know the largest organ in the lymphatic system is the spleen? The spleen is located beneath the left lowest ribs at the front of the thorax (rib cage), behind the stomach, above the left kidney. It essentially functions as a filter of the blood, having a dense network of arteries that pass through it. It somewhat controls the number of red blood cells circulating in the blood stream and aids in fighting infection (Wallace et al., 2003; Zimmermann, 2018).
In the event that the spleen (and lymph nodes) detects potentially dangerous bacteria, viruses or other microorganisms in the blood, it kickstarts production of white blood cells (lymphocytes) to destroy them. Antibodies are produced to eliminate the pathogen and prevent their spread. Blunt trauma and other trauma to the abdomen (high-speed car accidents are a common culprit) can result in severe splenic injury. Humans can live without a spleen, although people who have lost their spleen to disease or injury are more prone to infections (Zimmermann, 2018).
The tonsils are considered the first line of defence of the immune system. They detect viruses and bacteria as they enter the body via the nose or mouth. They are large clusters of lymphatic cells residing at the back of the pharynx. In some immunocompromised individuals they become recurrently inflamed and are removed.
Removing of the tonsils is one of the most common surgical procedures performed, despite the number of surgeries reducing considerably since the 1950s. Frequent throat infections tend to occur in those having had a tonsillectomy, however this tends to be the lesser evil of recurrent tonsillitis.
The final organ of the lymphatic system - the thymus – is located in the chest just above the heart. Immature cells are stored here. These will eventually become T-cells – responsible for eliminating cancerous cells within the body (Wallace et al, 2003; Zimmermann, 2018).
Dysfunction and disease of the lymphatic system
The most common diseases of the lymphatic system are:
Lymphadenopathy – enlargement of the lymph nodes
Lymphoedema – swelling due to lymph node blockage
Lymphoma (various forms) – cancers involving the lymphatic system (Wallace et al., 2003)
Lymphadenopathy When pathogens are flagged in the lymph fluid, lymph nodes produce white blood cells in large numbers, causing swelling of the nodes. They can sometimes be felt in the neck, underarms and groin. Nodes that become large enough within the chest or abdominal cavity can impinge structures or encroach on organs in rare cases (Knott et al., 2005). Lymphadenopathy is usually caused by infection, inflammation or cancer. Enlargement of the lymph nodes can be localised to the area of infection – such as enlarged lymph nodes that can be felt in the neck from the common cold (viral infection). In some areas of the body the enlarged lymph nodes are palpable, while others are too deep to feel and can be seen with imaging (Schander et al., 2013; Wallace et al., 2003). Lymphoedema Surgery and/or radiation to remove affected lymph nodes can impede lymphatic flow returning to the heart, causing lymphoedema. This can be seen in women who have had surgery to remove breast cancer. Part of the operation to remove the breast cancer involves removing lymph nodes in the armpit (responsible for processing of fluid of the upper limb of that side). The more lymph nodes removed the higher the risk of chronic swelling and pain. Surgical procedures are improving consistently, requiring removal of fewer nodes to counteract this issue (Huff et al., 2010). Lymphoma This is a form of cancer that affects the lymph nodes; lymphocytes replicate uncontrollably. There are a number of different types, with well-known forms being Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma is the most common form. There can be several subtypes within categories of lymphoma, for example, follicular, diffuse large B-cell lymphoma and Burkitt’s lymphoma. There are even some unknown kinds that are yet to be named or understood (Zimmermann, 2018).
How can osteopathy help with diseases and dysfunction of the lymphatic system?
Although they cannot rid the body of lymphatic system dysfunction single-handedly, osteopathic techniques can provide relief during management and assist in a timely recovery in cases that are not chronic.
Lymphatic Pump Techniques
The osteopathic medical profession has designed a set of manipulative techniques called lymphatic pump techniques (LPT) to enhance the flow of lymph through the lymphatic system. Clinical research studies indicate that LPT can be effective in assisting dysfunctions namely affecting the thoracic cavity (pneumonia in multiple studies) and the peripheries (the limbs of the body) (Hodge, 2012; Huff et al., 2010; Schander et al., 2013; Wallace et al., 2003). Knott et al. conducted a study involving animal models and demonstrated increased lymphatic flow in the thoracic duct, using abdominal and thoracic pump techniques (Knott et al., 2005; Patterson, 2006). LPTs involve gentle, rhythmic compressions to encourage the normal mild pulsations of the venous system that returns fluid in the direction of the heart and greater lymphatic organs, such as the lymph nodes and spleen.
Effleurage
In addition to LPTs, osteopaths use effleurage to assist in the shift of subcutaneous oedema to return it to the lymphatic system. This involves gentle compressive massage that extends from the most distal point (furthest point) of a limb to its most proximal (close to the body) point. This encourages fluid movement toward the heart and larger organs of the lymphatic system to be processed rather than remaining in the limbs where is it otherwise causing discomfort.
Indirect visceral techniques
With careful, deep palpation (feeling with the hands and fingertips) of the abdomen, larger organs of the lymphatic system can be treated. Areas that feel restricted or congested can be released with a gentle pressure-point approach to remove any potential flow obstruction in these primary areas.
The lymphatic system is an integral component to provision of nutrients to the cells of the body and immune function. Equilibrium within the body cannot be properly regulated without it.Â
With knowledge in the areas of pathology and physiology, osteopaths can further assist by advising patients about appropriate lifestyle changes that can be advantageous to any dysfunction or disease of the lymphatic system they may be presenting with.
If you can relate to any of the above issues of the lymphatic system, please do not hesitate to contact your general practitioner for further advice and examination.
Take care of yourselves,
Lenore Dyson
References
Hodge, L. M.Osteopathic lymphatic pump techniques to enhance immunity and treat pneumonia, IJOM (2012) 3, 15(1): 13-21
Huff JB, Schander A, Downey HF, Hodge LM.Lymphatic pump treatment enhances the lymphatic release of lymphocytes, Lymphat Res Biol. 2010;8:183–7.
Knott EM, Tune JD, Stoll ST, Downey HF.Increased lymphatic flow in the thoracic duct during manipulative intervention, J Am Osteopath Assoc. 2005;105:447–56
Patterson, M. M,Mechanisms of Change: Animals Models in Osteopathic Medical Research,JAOA 106 (10) (2006) (593-596)
Schander A, Downey HF, Hodge LM.Lymphatic Pump Manipulation Mobilizes Inflammatory Mediators into Lymphatic Circulation, Journal of Experimental Biology and Medicine. (2013)
Wallace E, McPartland JM, Jones JM, III, Kuchera WA, Buser BR.Lymphatic system: lymphatic manipulative techniques, In: Ward RC, editor. Foundations for osteopathic medicine. 2nd ed Lippincott William & Wilkins; Philadelphia: 2003. pp. 1056–77
Zimmermann, K. A,Lymphatic System: Facts, Functions and Diseases.https://www.livescience.com/26983-lymphatic-system.html(Accessed 26/04/2020)