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.