00:00
Pectoralis Traction:
It’s important to address
any sort of hypertonicity of the
pectoralis muscles
especially for lymphatic
flow.
00:08
When the pectoralis muscles
are spasmed,
you will bring the shoulders
more anterior
and that could
compress on
the lymph nodes
in the region.
00:16
What we want to do is
we want to get
our fingers, kind of
curl it around
the anterior axillary fold
and make sure
you have good purchase
on the muscle.
00:24
Then when you have a
good grasp on
the musculature, you’re going to
gently lean back.
00:28
That’s going to provide a traction
on those muscles.
00:32
You’re going to hold this until
you feel a release.
00:34
Once you feel a release, you’re
going to slowly release
the traction and come back,
and then
reassess to see if
you decreased
the muscle spasm in the
pectoralis muscles.
00:45
Upper Extremity
Lymphatic Treatment:
With the upper extremity, what
we want to do
is try to promote lymph
drainage
from the arm back
to the body.
00:53
Patients have carpal
tunnel.
00:55
They have that increased
upper extremity
edema from lymph
edema.
00:59
This is something that we could
utilize to treat and help
decrease the edema in the
hand and the arm.
01:05
First, we make sure that the
thoracic inlet is open.
01:08
It’s important to
make sure
the pectoralis muscle
is released
and any other musculoskeletal
restrictions
in the arm has
been treated.
01:15
Afterwards, we’re going to
grab the hand
and we’re going to create a
little bit of a fluid flow.
01:20
So we’re going to start here
at the wrist
and just create a little
bit of what
my teachers used to
call a wobble.
01:26
So we’re just trying
to increase
the lymphatic flow by
raising the arm.
01:31
That helps to utilize
gravity to help
with the lymphatic
drainage.
01:35
After you start to feel
a little bit more
of a decreased
congestion,
you could go ahead
and start
to wobble more by
the elbow.
01:42
So you kind of progressively
move
from the wrist to
the elbow,
and then target more
the shoulder.
01:49
This is more of an upper
extremity wobble
to help with lymphatic
flow from
the extremities to return
back to the center.
01:56
Afterwards, you could check for
hopefully decreased edema
and decreased congestion around
the thoracic inlet.
02:03
Lower Extremity Wobble Technique:
This technique
is a lower extremity lymphatic
drainage technique.
02:09
Again, you want to
make sure that
there’s no contraindications to
performing the technique.
02:13
If we wanted to apply this
more unilaterally,
you could utilize this
technique
to try to work one
side at a time.
02:22
What we're going to do is
we’re going to lift up
the extremity that we
want to treat,
support it with our hands here,
and we’re going to
use gravity to help with drainage
of the lower extremity.
02:32
We’re going to start by creating
a little bit of oscillation
by the ankle with our
hand on the foot.
02:41
We could do this for
a bit of time,
maybe 30 seconds
to a minute
until you start to feel a little bit
of less tissue resistance.
02:49
Then we’re going to start to create
a wobble by the knee.
02:54
And so again, this is to
help improve
lymphatic flow from the
lower extremity
and try to promote and augment
lymph flow.
03:01
Once you’re done, you could bring
the leg back slowly
and recheck to see if there’s
decreased edema
to see if the technique
was successful.
03:09
2nd Intercostal
Space Siphoning:
So this technique is utilized to try to
promote lymphatic flow.
03:16
So the thoracic duct and the
right lymphatic duct
drain into the subclavian
which is approximately
in the region of the
2nd intercostal space.
03:24
What we’re trying to do
with the technique
is to create a siphoning
effect to draw
more lymph back into the
thoracic cavity.
03:30
To perform the technique,
we’re going to have
one hand which is the
sensing hand,
find that second
intercostal space.
03:36
The other hand is the
action hand
that’s going to go on
top and create
a little bit of oscillatory force
aiming down
into that region of the
subclavian vein.
03:46
And so, as you create
this force down,
you’re trying to create
a siphoning effect
to increase emptying of the
distal portion of the two
and that should potentially help
with drawing more
fluids and increasing return
back into the circulation.
04:04
And so, you could perform this
technique on both sides.
04:07
It’s gentle and it’s safe and
it’ll help with drawing
more lymphatic fluid back
into circulation
Thoracic Inlet Release:
It's important to address
any somatic dysfunctions around
the thoracic inlet to make sure
that we treat any muscle
hypertonicities, restrictions here.
04:23
Remember, the thoracic
inlet is also
the region for terminal
lymphatic drainage.
04:28
We’re going to contact the
posterior aspects
of the first ribs with
our thumbs.
04:32
We’re going to place our fingers
around the clavicles
and my pinkie kind of reaches
around to the shoulders.
04:38
We’re going to find the
freedom of motions
in the thoracic inlet.
So we’re going to check
side-bending by pushing down
towards the feet
and see which way
the thoracic inlet
likes to side-bend
towards.
04:50
Here, it likes to side-bend
to the left.
04:51
I’m going to hold that and
stop the freedom.
04:54
Now, I’m going to
check rotation.
04:56
Here, the thoracic inlet likes
to rotate to the right.
05:00
Then, we're going to check a little bit
of flexion and extension.
05:04
Here, the thoracic inlet likes
to go into extension.
05:07
So I’m holding all
three freedoms
and I want to apply a little bit
of a lateral traction
by the first rib, opening
up the inlet
and trying to decrease some of the
muscle tension here.
05:18
So you’re going to match the tension
underneath your fingers.
05:20
You’re going to hold it until
you start to feel
the tissue start to soften
a little bit more.
05:25
Once you feel that
tissue release,
you could bring the hands back and
then reassess to see
if there’s improved mobility in motion
in the thoracic inlet.
05:35
Supine Rib Raising:
With supine rib raising,
what we want to do is to try to
improve rib mobility,
remove restrictions around
the rib cage,
allow for better excursion
which will then
help with circulatory
lymphatic flow.
05:50
So what we want to do is
we want to get
our fingertips medial to
the rib head.
05:54
We’re going to slide our
fingers underneath
and then we’re going to lift superiorly
to engage the rib heads
and then we’re going to slowly
traction laterally.
06:05
So there’s going to be a lift
where you
fulcrum across your forearms
against the table,
and then lateral
traction.
06:11
We’re going to get our
fingers in the right spot.
06:14
Usually, I’ll start two
medials
so I get on the thoracic
spinous processes.
06:21
Then I come out laterally and
I’ll feel the transverse,
and then you’ll feel a
little bit of a ridge
which are the
posterior rib angles.
06:28
That allows your finger pads to
kind of come medial to that.
06:33
I’m going to slowly push my elbows
down towards the floor,
which then creates an anterior
lift onto the ribs.
06:41
I want to wait for the soft
tissue to soften up
until I really feel like my finger pads
are contacting the rib.
06:51
Once I contact
the rib,
I’m going to apply a gentle
lateral traction.
06:56
You don’t want to pull back as
hard as you can.
06:58
You just want to pull back
until you meet
the tension underneath
the ribs.
07:03
You’re going to feel
like a softening,
like things loosening
up.
07:06
Actually, if you pull a little
bit too hard,
you’ll feel increased
tension.
07:09
We’re going to hold the
traction here
until we feel a release. After you
feel a release,
you’re going to bring
your hands out.
07:19
Then you could go ahead and
reassess rib excursion,
rib motion to see if the
technique was successful.
07:26
Doming the Abdominal
Diaphragm:
Our abdominal diaphragm is
responsible for
respiration and helping with circulatory
lymphatic pumps.
07:34
When the diaphragm is spasmed,
it actually will be flattened.
07:37
What we’re trying to do with
doming the diaphragm
is to restore its
natural shape.
07:41
We’re going to get our
thumbs underneath
the costal margin. We’re going
to gently let our thumb
sink in as the patient breathes
in and out.
07:48
We’re going to have the
patient take a breath in
and breathe out. We’re
following exhalation
and we’re noting any tension
underneath our thumbs.
07:56
Go ahead and
breathe in again.
07:57
We resist inhalation and follow
with exhalation.
08:00
So here, the left side is a
little more restricted.
08:02
So I’m matching the tension
on the left side here
further sinking my thumbs
underneath the costal margin,
trying to restore the dome
shape here.
08:11
Once I feel a little bit
of a release,
I could come back out
and recheck to see
if the diaphragm is
moving better.
08:19
You could also work along
the costal margins
and continue to free up
any region where
you might feel a little bit
more restriction,
not only near the xiphoid but all
the way down
to more the lower
costal margin.
08:32
Afterwards, recheck and
you could see
if the diaphragm is
moving better
having restored its
natural shape,
thus allowing it
to function better.
08:42
Popliteal Spread:
With the popliteal spread,
what we want to do is to
try to address
any sort of
fascial restrictions
in the posterior aspect
of the knee.
08:51
Remember, there is a
diaphragm there.
08:54
It’s not a true
diaphragm.
08:55
But it’s where the hamstring
tendons
and the gastroc tendons
overlap.
09:00
If there are increased
spasms
of those tendons and
those muscles,
it could kind of constrict
that area
preventing proper
lymphatic flow.
09:08
What we want to do
is to contact
the posterior aspect of
the knee here
and create a spread
to decrease
some of the tension
in the fascia
to allow for a proper
lymphatic flow.
09:17
We’re going to put our
first two fingers,
the pointer finger and
the middle finger,
on the hamstring tendons
and we’re going to try
to put our fourth and fifth
fingers on the gastroc.
09:28
And so, we’re going to put our
hands underneath,
and then what we’re going to
do is to gently
kind of spread our fingers apart
and also pull laterally.
09:35
So you’re spreading vertically
and horizontally.
09:39
Make sure you identify
the tendons.
09:42
Check the tension in the posterior aspect
of the popliteal fossa.
09:46
Get a good purchase on the hamstring
tendons and the gastroc.
09:50
Then again, a little bit of spreading
of my fingers
and then a little bit of
traction laterally.
09:55
You’re going to hold this until
you feel a release.
09:58
Once you feel a release, you
could come back
and reassess the tension in
the posterior aspect
of the knee to see if the
technique was successful.
10:07
Pelvic Diaphragm Release:
The pelvic diaphragm needs to be
moving well to allow for a proper
lymphatic drainage.
10:17
One of the things that we could
do is to try to treat
the pelvic diaphragm.
So we want to contact
the pelvic diaphragm gently
with our thumbs.
10:24
You need to thoroughly explain
the technique
to your patients. Make sure
you obtain consent
and they understand the
technique and its purpose.
10:33
You want to find your
landmarks.
10:35
You’re going to start by
first finding
the ischial tuberosities, so that’s
our sit bones,
the bones that
we sit on.
10:41
So I tell my patients usually,
I’m going to be
pushing on the bones
that we usually sit on
and coming a little bit medial
to it with my thumbs.
10:50
So I find the
ischial tuberosities.
10:52
I get my thumbs just medial to
the ischial tuberosities.
10:56
Then I’m going to place a little
bit of a superior force.
11:00
When I do so, I could
have the patient take
a nice, deep breath in. So breathe in
and breathe out.
11:05
You should feel the pelvic diaphragm
descend on inhalation
and on exhalation you’re going to follow
the pelvic diaphragm up.
11:13
You’re going to do this for
several cycles until you feel
the tension underneath
your thumbs decrease.
11:19
Once you feel the release, you
could go back and then
reassess the amount of tension
in the pelvic diaphragm.