OMM: Lymphatic Zink Patterns

by Sheldon C. Yao, DO

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    00:00 So when we discussed lymphatics, we need to consider Dr. Zink patterns and spinal junctions.

    00:09 So, Dr. Gordon Zink was a professor at Des Moines in the 1970s. He published a paper titled “The Common Compensatory Pattern” and he was the first to really write and describe how we diagnose the body and how fascial patterns could potentially affect the lymphatics. So, Zink emphasized that fascial restrictions could actually limit venous and lymphatic return. He stressed the importance of the different abdominal pumps and the diaphragms and how it helped to maintain lymphatic homeostasis. Actually, in 1980s, all his initial written concepts were proven when we were able to look at increase venous return with Doppler studies. So, Dr. Zink observed his patients and found that some of his patients had this recurrent pattern of somatic dysfunction.

    01:01 These somatic dysfunctions impeded proper fascial motion and so these different regions that he diagnosed were the different transition zones in the spine and then according to Dr. Zink these fascial patterns are a response to postural compensation. So, our body is constantly fighting gravity. Gravity exerts this force throughout our body and we are trying to stay upright. So based on the force, our body develops a postural equilibrium and so these fascial strings are created due to these compensations from these postural changes. So, the transition zones in our spine are the regions where our occiput reach the cervical spine, cervical to the thoracic, thoracic to the lumbar, lumbar to the sacrum and so Zink found that these transition zones are vitally important because the spine have these curvatures and that are the areas where the spine changes from a lordosis to a kyphosis. The spine is not a straight stick because when it is curved it allows to absorb forces and take on different stresses and so those areas tend to be the weak points associated with trauma and also fighting the forces of gravity. And so at these transition zones, Zink found that there were significant somatic dysfunctions and fascial strains.

    02:27 At each of these zones, there is also an association with the transverse diaphragm of the body. So at the OA, this is the craniocervical junction and is associated with the tentorium cerebeli. At the cervicothoracic junction, you have association with the thoracic inlet. At the thoracolumbar junction, you have association with the respiratory diaphragm or the abdominal diaphragm. And in the lumbosacral junction, you have associations with the pelvic diaphragm.

    02:57 So, there are osseous attachments or connections from these junctions to each of these diaphragms and as we discussed in the past, these diaphragms are really important. As horizontal structures, it could potentially limit and decrease any sort of lymphatics and circulatory flow which is traveling more vertically throughout the body. So, Zink classify these patterns as ideal, meaning that there is equal glide in both ways, there is no side bending rotation. This ideal fascial pattern is someone who will be totally symmetric and does not have any sort of preference, which pretty much is very unlikely. Zink also found that some of his patients were compensated, meaning that his patterns going from head to toe at the different junctions tended to alternate.

    03:52 So when you have an alternating pattern, that would allow for more ability of the patient to adapt to somatic dysfunctions. And then patients that he found that had patterns that did not alternate, he classified as uncompensated patterns. So, Zink made this observation based on diagnosis of his patients and he found that in general when his patients had a compensated pattern they were relatively more healthy. Those with uncompensated patterns tended to have a harder time having more pain, having more difficulty recovering and so he found that in his patients that had a compensated pattern there was more common one. So he labeled it the common compensatory pattern. So, the common compensatory pattern was approximately about in 80% of his healthy patients he found that at the different junctions the OA was rotated left, the cervicothoracic was rotated right, thoracolumbar rotated left and lumbosacral junction rotated right. So it is a left, right, left, right going from head to toe and so that is the common compensatory pattern.

    05:09 At about 20% of his healthy patients, these patients were compensatory, meaning the patterns alternated but it started off more with the OA rotated right, cervicothoracic rotated left, thoracolumbar rotated right and lumbosacral junction rotated left. So more of a right, left, right, left alternating pattern and this he labeled the uncommon compensatory pattern. Again, an uncompensated pattern is any pattern that does not have an alternating pattern and he found that these patients tended to be less healthy, took more time to recover, had more chronic pain and issues. So the clinical significance of the Zink patterns is that he found that when his patients had a compensatory pattern, they were able to tolerate stresses, had less somatic dysfunction and were able to recover from illnesses quicker. He reasoned that having a counter balance rotation, patients were thus more adaptive and responded more favorably to stresses. The transition zones in the spine absorb the majority of forces during trauma and so these regions if they had acute dysfunction could also affect the diaphragms in those regions.

    06:24 So let's take a closer look at the different junctions and its importance clinically. So in the craniocervical junction, we have a lot of proprioceptors, in fact 30% of our body’s proprioceptors are in the upper cervical region. This is important because the craniocervical junction is important for figuring out how to keep your head level to the horizon. So if I had spinal dysfunctions or curvature that made me lean one way or the other, there are small adjustments that occur at the base of the skull to keep my eyes level with the environment. So these proprioceptors help to detect your positioning and also help to keep your eyes level. This junction is also associated with the tentorium cerebelli and the cranial nerves that exit the skull. So any sort of restriction in this area could potentially impede and restrict those nerves. The cervicothoracic junction is vitally important to lymphatic drainage. Remember this is the region for terminal lymph drainage. Your thoracic duct and your right lymphatic duct empty into the subclavian veins in this region. If you have restrictions here, you could also impinge on the brachial plexus which comes out, exits and innervates your arms. It could also affect the GI and the abdominal system because of the course of the vagus nerve and the phrenic nerves. The thoracolumbar junction is a really important region, this is the area where your abdominal diaphragm attaches to posteriorly. If you have restrictions in the thoracolumbar junction, that could negatively affect the excursion of the abdominal diaphragm and so if we have any sort of decrease in diaphragmatic excursion that is going to decrease the pressure changes that occur with respiration and thus decrease lymphatic and venous return. Remember also the cisterna chyli lies just anterior to the diaphragm, so any sort of restriction there could also restrict the ability of the diaphragm to assist the cisterna chyli with helping to pump it and move lymphatics along. The lumbosacral junction is associated with the pelvic diaphragm. If we have restrictions at the lumbosacral junction, that could potentially prevent the pelvic diaphragm from moving properly, so if the pelvic diaphragm is not descending properly then the abdominal diaphragm cannot descend. So remember this is one large container and so if the floor of the container is not moving this can prevent the rest of the container from moving, so that could impede lymphatic drainage. Also restrictions in the area could affect the sacral nerves and the parasympathetic coming up innervating the colon and the pelvic organs. So, here is another look at that pelvic diaphragm.

    09:17 You could see here how it supports the viscera and it also helps to control many of the different sphincters important for the GI and GU system. So, when we are trying to augment circulatory lymphatics in GI presentations, we have to remember that at first we want to remove any of these restrictions especially at those spinal junctions, especially at the thoracic inlet because that's the area of terminal drainage. We want to try to improve thoracic cage mobility, diaphragmatic motion and then utilize proper lifts and abdominal pumps to help with lymphatic flow if indicated.

    About the Lecture

    The lecture OMM: Lymphatic Zink Patterns by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by System.

    Author of lecture OMM: Lymphatic Zink Patterns

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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