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Revision as of 23:31, 1 October 2013
The lymphatic pump is a method of manipulation used by physicians who practice manual medicine (primarily osteopathic physicians and chiropractors) to increase the rate of lymph flow in order to help fight infection.
The lymphatic pump can also refer to the flow of lymph from peripheral tissue to central lymph ducts, preventing backflow. The flow of lymph from extracellular fluid (ECF) to peripheral lymph capillaries is mediated by overlapping endothelial cells which slide aside when facing higher interstitial pressure, and contracting when the lymphatic pressure is higher. The flow of lymph from the peripheral, via vasa lymphatica and lymph nodes and then to trunci, finally ending up in ductus thoracicus or ductus lymphaticus dx, is at least partially mediated by contracting muscle fibers.
Unlike the cardiovascular system, the lymphatic system is not closed and has no central pump. Lymph transport, therefore, is slow and sporadic. Despite low pressure, lymph movement occurs due to peristalsis (propulsion of the lymph due to alternate contraction and relaxation of smooth muscle), valves, and compression during contraction of adjacent skeletal muscle and arterial pulsation.[1]
History
The term lymphatic pump was originally used by Earl Miller, DO to describe what is currently known as the thoracic pump technique.[2] Currently, thoracic pump is a term used to refer to a range of techniques that act to move lymphatic fluid through the lymph system.
Techniques
Techniques to achieve this include the thoracic pump and abdominal pump. These methods increase the flow of lymph through the thoracic duct. It is believed that increased lymph flow is beneficial, as the lymphatic system is part of the immune system. Other techniques include Miller Pump (rhythmic, rapid, compression of the superior-anterior wall of the thorax), pedal pump, and diaphragmatic redoming. A modified version of Miller Pump can be used to treat atelectasis (loss of lung volume) by inducing sudden, rapid inflation of the lung. Indications for thoracic lymphatic pump include productive cough, upper respiratory tract infection, and extended bed confinement. Contraindications include osteopenia/osteoporosis, and injury (including surgical) to the thorax.
Clinical significance
AIDS Lymphatic treatments continue to be an important component of osteopathic manipulative medicine. Miller developed the lymphatic pump in 1926, stating that it is "an exaggeration of the movements of respiration."[3] The lymphatic pump technique is used to treat patients with edema and infections because increasing lymphatic flow improves the filtering and removal of fluid, inflammatory mediators, and waste products from interstitial space.
During the influenza pandemic of 1917, Smith reported that osteopathic manipulative treatment (OMT) decreased the mortality rate from 5% to 0.25% among 100,000 patients.[4][5]
Relative contraindications
While no firmly established absolute contraindications exist for lymphatic techniques, the following cases are examples of relative contraindications: bone fractures, bacterial infections with fever, abscesses, and cancer.[6]
References
- ^ Shayan, Ramin; Achen, Marc G.; Stacker, Steven A. (2006). "Lymphatic vessels in cancer metastasis: bridging the gaps". Carcinogenesis. 27 (9): 1729–38. doi:10.1093/carcin/bgl031. PMID 16597644.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ "Glossary of Osteopathic Terminology" (PDF). American Association of Colleges of Osteopathic Medicine. April 2009. p. 28. Retrieved 4 November 2012.
- ^ Miller, CE (1926). "The lymphatic pump, its application to acute infections". Journal of the American Osteopathic Association. 25: 443–445.
{{cite journal}}:|access-date=requires|url=(help) - ^ Knott, E. Marty (2005). "Increased lymphatic flow in the thoracic duct during manipulative intervention". The Journal of the American Osteopathic Association. 105 (10): 447–56. PMID 16314677. Retrieved 18 November 2012.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Smith, RK (2000). "One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment. 1919". The Journal of the American Osteopathic Association. 100 (5): 320–3. PMID 10850019. Retrieved 18 November 2012.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Savarese, Robert G.; Copabianco, John D.; Cox, James J. (2009). OMT review. p. 126. ISBN 978-0967009018.
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