Osteopathic Lymph Treatment: Pelvis

by Sheldon C. Yao, DO

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    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.

    About the Lecture

    The lecture Osteopathic Lymph Treatment: Pelvis by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Pectoralis Traction
    • Upper Extremity Lymphatic Treatment
    • Lower Extremity Wobble Technique
    • 2nd Intercostal Space Siphoning
    • Thoracic Inlet Release
    • Supine Rib Raising
    • Doming Abdominal Diaphragm
    • Popliteal Spread
    • Pelvic Diaphragm Release

    Author of lecture Osteopathic Lymph Treatment: Pelvis

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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