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Osteopathic Lymph Treatment: Thoracic and Abdomen

by Sheldon C. Yao, DO

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    00:01 Thoracic lymph pump. What we want to do with the thoracic lymph pump is to encourage lymph flow throughout the thoracic cage, to help profuse the lungs and improve lymph flow to help with the immunity.

    00:13 The thoracic pump, what we’re going to do is we’re going to place our hands just underneath the clavicle. We’re going to create a little bit of an oscillatory force.

    00:22 This force will allow for increased lymphatic flow.

    00:25 You could continue this oscillation for about 30 seconds to a minute as tolerated by the patient. Afterwards, you can come back and recheck to see if that improves lymphatic flow. We could also utilize thoracic pump using respiratory assist. So, what the patient is going to do is they’re going to breathe deeply in and out. We’re going to try to encourage more negative pressure.

    00:49 We’re going to keep keeping the upper ribs in exhalation.

    00:52 We’re going to place the hands in the same position.

    00:54 Have the patient take a breath in and breathe out.

    00:57 When they breathe out, you’re going to keep those upper ribs in exhalation.

    01:00 Breathe in again and breathe out.

    01:04 Each time, you’re going to further hold the ribs in exhalation.

    01:07 One more time. Breathe in and breathe out.

    01:10 Then on the last breath, you’re going to suddenly let go.

    01:12 That causes a sudden change between the negative pressure and then the positive pressure rushing in. A lot of times, I will use that technique to try to improve respiratory excursion if they’re having a lot of chest congestion.

    01:27 If they need to kind of bring something up, they’ll help kind of drive things out of the lung.

    01:32 But you do have to warn the patient that they may start getting into a little bit of a coughing fit when that occurs.

    01:39 We could also utilize thoracic pump from a side approach.

    01:43 Here, what we’re going to do is we’re going to grab the arm, take the hand and put it underneath our arm to support it.

    01:52 So what we’re going to do is we’re going to traction the arm.

    01:56 Because of the shoulder’s attachment to the serratus, it’s going to pull those ribs into inhalation.

    02:03 So we could have the patient take a breath in and I lean back.

    02:06 When the patient breathes out, I’m going to bring the ribs into exhalation.

    02:10 I’m going to release that pull from the arms. Again, take a breath in.

    02:13 This helps to encourage the ribs going to inhalation and breathe out.

    02:17 That goes into exhalation. You could do this several cycles, breathing in and then breathing out, helping to encourage the ribs to move into inhalation and exhalation.

    02:29 You could also do it as a pump technique itself without respiratory cooperation, a little bit of a traction and compression up and down the lateral aspect of the ribs which then helps to articulate the ribs and get the ribs moving a little bit more.

    02:44 Afterwards, you can come back and recheck the rib excursion and see if the patient has improved mobility of the thoracic cage.

    02:52 Pedal Pump: We utilize the pedal pump to try to augment the lymphatic flow from the lower extremities.

    02:59 We want to try to apply a gentle oscillation to try to promote an inflow.

    03:04 Remember, prior to applying pedal pumps, you want to make sure that the diaphragms are opened up. You want to make sure there’s no contraindications to the pedal pumps such as DVT, or fracture, or any other potential malignancy that the patient may have, or high fevers where you could potentially spread infection.

    03:23 In order to perform the technique, what we want to do is to place our palms on the bottom of the feet here.

    03:30 Dorsiflex the ankles and do a little bit of a gentle oscillation back and forth.

    03:35 What you want to note is that the patient’s nose is kind of moving back and forth a little bit.

    03:41 Now, there’s a proper rate and rhythm for each patient.

    03:45 It could be a little bit slower. It could be a little bit quicker.

    03:49 You want to kind of pay attention to the amount of force that you’re utilizing and try to match the resistance in the tissues here.

    03:57 What you’ll find is that as you’re performing this, you’ll start to feel a decreased resistance. Then you know the technique is completed.

    04:07 Usually, rule of thumb, 30 seconds to 2 minutes might be the average time for performing the pump technique. Once you complete and you feel a little bit of a change, you can come back, reassess the extremities to see if there’s improved swelling, if there’s decreased tension in the tissue, to see if the technique was successful. The liver pump could be performed to try to promote increased blood circulation and to try to improve the function of the liver itself.

    04:39 We’re going to contact the lower ribs on the right side here and gently place our fingers over the region of the liver and then create a little bit of a gentle oscillatory pump.

    04:52 This is to try to encourage drainage, motion and movement of circulation surrounding the liver. After you do this pump for 30 seconds to a minute, you could come back and double check.

    05:05 Make sure prior to performing the technique, you ensure that there’s no contraindications. The patient doesn’t have enlarged liver or any other concerns that may be a contradiction for this technique.

    05:21 Splenic Pump: We utilize the splenic pump to try to boost immunity and to help demarginalize those immune cells and get them into circulation. For the splenic pump, we’ll get our hands underneath the lower rib cage and underneath the left costal margin and then provide a little bit of a gentle oscillatory force.

    05:42 This oscillation should be gentle. You should make sure that there’s no contraindications before performing this technique.

    05:49 You want to make sure the patient doesn’t have mono or any other potential causes for having a large spleen.

    05:55 So after performing the oscillation 30 seconds to a minute, you can come back and then reassess to make sure that the area feels a little bit less tense.


    About the Lecture

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

    • Thoracic Lymph Pump
    • Pedal Pump
    • Liver Pump
    • Splenic Pump

    Author of lecture Osteopathic Lymph Treatment: Thoracic and Abdomen

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO


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