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Lymphatic Drainage Therapy

Lymphatic Drainage Therapy

Lymphatic Drainage Therapy (LDT) is a gentle hands on treatment that maps your lymph flow and encourages improvements where there is congestion.

 

Varous styles of lymphatic drainage massage have been developed since the mid 1800’s, starting with osteopath A.T. Still.  Bruno Chikly, MD and osteopath (France), teaches Lymphatic Drainage Therapy (LDT) practitioners to map exactly the “specific rhythm, pressure, quality and direction of the lymph flow”.  There is an emphasis on deep lymph pathways first, and then superficial.  The intent is to add an extra level of precision, and to work with rather than on the body to support recalibration of lymph pathways.

 

How does my Lymphatic System keep me healthy?

1.  Lymph helps blood remove wastes from cells, and to maintain tissue fluid balance

Lymphatic vessels are the third part of  your circulatory system, next to arteries and veins.  Like blood vessels, they transport fluid – though only in one direction, from your cells back to your heart.

The blood circuit

  • Large vessels leave the heart (“arteries”) and divide into smaller and smaller vessels until they are so tiny that the vessel wall is only one cell thick (“capillaries”).
  • Nutrients and oxygen can move easily out into extracellular fluid and into cells where are taken up and used.  By-products of cell metabolism can also return easily into blood capillaries.
  • Capillaries converge into larger and larger blood vessels (“veins”) to return blood to the heart. 
  • Your heart as a pump/vortex keeps blood moving & maintains blood pressure.  

The Lymph one way backup

Blood needs a back up drainage system.  This is because ~95% of what needs to leave the cells and tissues is taken up directly into the blood. The other ~5% is taken up by the open ended one way lymph vessel system — a bit like a microscopic vacuum. 

Lymph capillaries tend to take up more of large proteins, bacteria, viruses & junk than blood capillaries.  Lymph fluid is otherwise a lot like blood with almost no red blood cells (RBC).

Lymph vessels also merge into larger and larger vessels and return towards the heart, though not quite all the way.  Just behind the inner ⅓ of your collar bones, they make a T-junction with large veins just before they meet your heart.  

2. Lymph is a major player in your immune system

Aside from having almost no RBC, another important difference between blood and lymph is that lymph contains many more lymphocytes than blood. 

Lymphocytes are the white blood cells (WBC) that give you “acquired immunity”.  They either destroy pathogens (disease causing organisms — bacteria, viruses etc) directly, or tag them for destruction by other immune cells.

Lymph nodes also contain many lymphocytes and other immune cells. Your body has between 400 and 700 lymph nodes, distributed in line at strategic places along your lymph vessels. 

As lymph travels through these nodes, lymphocytes and other immune cells do their thing – tagging, destroying and dismantling “invading pathogens”.  This way, by the time lymph re-mixes  with your blood, pathogens are reduced or eliminated.

There are large collections of lymph nodes around your neck and throat, deep in your chest and abdomen, and in your armpits and groin.

What keeps my lymph moving?

It is a big fat juicy myth that your lymphatic system has no propulsion system of its own, and that it relies entirely on your muscle activity to squeeze it along.

Lymph flow does benefit from your movement, but the compression action of your muscles are only part of what keeps your lymph flowing. 

  • Like veins, medium and larger vessels have valves to prevent reverse lymph flow. 
  • Lymph vessels also have a muscular layer.  As lymph fills an individual segment between valves, the muscular wall contracts — squeezing that lymph towards your heart.  This muscular pump is called a “lymphangion” or “lymph heart”.  The combined effect of all the lymphangions is a co-ordinated and rhythmic flow of lymph towards your heart.
  • Activity and exercise stimulates lymphangion activity generally
  • Lymphatic Drainage Therapy targets specific areas where your lymphatic system is not flowing well.

How can I look after my Lymphatic System?

In a general sense, all of the usual ways would keep yourself physically well and healthy will benefit your Lymphatic System:

  • Be Active — activity stimulates blood and lymph flow, directly and indirectly.  
  • Eat Well — lean towards fresh, local, seasonal, organic/spray free.  
  • Be Well Hydrated — in general, 1L water per 30kg body weight is ideal.
  • Be Well Rested — sleep is a time for regeneration.

To get more specific

  • Seek out a Lymphatic Drainage Therapy practitioner
  • Learn some self lymphatic drainage techniques.  Here is my first self lymphatic drainage handout for General Lymphatic System activation.  I’ll update the blog links as Deep and Superfical LD PDF’s are added.  Sign up for the newsletter if you’d like to be notified.

How can Lymphatic Drainage Therapy help me?

In practice, I use LDT as one part of a holistic approach to treatment.  I use it where I can feel that lymphatic flow is reduced or altered. 

Circumstances where I find myself using LDT in treatment include helping people who have old injuries, chronic stiffness, scars (past surgery, skin and muscle grafts or injury), past inflammation, poor posture or posture and movement compensations. 

Potential uses and benefits are broad, which makes sense when you consider that the lymphatic system serves basiclaly the entire body.  If you have any questions about how LDT might benefit you, be in touch.  

References

(1) SW Chikly pp4-12

 

 

Your collar bone as key

Your collar bone as key

Your collar bone, like any other part of your body, should move well. If it doesn’t, it’s function will be affected either locally or further away.

Notice:
That the inner end of your collar bone (“clavicle”) attaches to upper end of your breastbone.  This is the only place your arm attaches to your torso. If your collar bone does not move well it can affect how any part of your shoulder or arm works.

Notice that there is a gap between the collar bone and the first rib. This gap allows blood vessels, lymph vessels and nerves to travel through.  If this lacks space then any of these structures can be compressed . That compression will lead you to move in a way to avoid irritating them. As a consequence, you can cause strain to your neck, shoulder, elbow wrist or hand.

Interesting patterns I’ve been seeing in the clinic

At the right collar bone, lymph flow is returning towards the heart from the upper liver and right lung, head, neck and arm. So here there can be an interplay between lymph congestion in those places and the right neck, shoulder or arm.

Similarly at the left collar bone, lymph flow is returning towards the heart from the left head-neck-arm-lung-abdomen-both legs, and so here there can be an interplay between lymph congestion in those places and the left neck, shoulder or arm.

For a Contented Clavicle

  • You should be able to float your shoulders upwards, forwards, backwards, and downwards.

Some simple stretches

Start all these stretches by interlacing your fingers.

  • Reach forward, pressing your palms way from you.
  • Reach upwards, pressing your palms away from you.
  • Interlace your fingers behind you, or grasp the back of one hand with the other behind your back.
    First, roll your shoulders up and open.
    Then,  straighten your arms +/- lift your hands off your back, keeping your shoulders rolled open.

Basic Posture tip

First, allow your upper body to be light and to float above your hips/lower body.
Then float your shoulders up and open.

Enjoy the stretches.

Connective Tissue Matrix

Connective Tissue Matrix

Connective Tissue (CT) is continuous throughout the entire body, connecting all of its various components and layers together.  It is viscoelastic, with fluid,  elastic and collagen components.

Tendons, ligaments, fascia, bone, and the membranes lining the body’s three interior compartments are made of Connective Tissue.

  • Tendons connect Muscle to Bone.
  • Ligaments connect Bone to Bone.
  • Meninges are the membranes that line the skull and spinal column, wrapping the brain and spinal cord.
  • Peritoneum is the membrane that lines the abdominal cavity, wrapping the abdominal organs.
  • Pleura is the membrane lining the rib cage, wrapping around the lungs.
  • Pericardium is the membrane enveloping the heart, and allowing it to move between the lungs.

Tendons, ligaments and fascia support and define the body’s movement from the outside in, so to speak.  By comparison, the meninges, peritoneum, and pleura/pericardium support and define the body’s  movement from the inside out.

That the body is a closed system meshed together by connective tissue means that a limitation of movement in one area will affect movement in another.  Musculoskeletal problems can have an important visceral and/or cranial connective tissue component.  A basic principle of treatment is to work with all layers of connective tissue that relate to the presenting problem.

CONNECTIVE TISSUE FUNCTIONS

Connective Tissue is involved in a variety of functions:

  • Support
  • Transport
  • Storage
  • Immune Defence and
  • Temperature regulation

CONNECTIVE TISSUE TYPES

Connective tissue takes many different forms. It can be either Connective Tissue Proper or Specialised Connective Tissue. Connective Tissue Proper can be loose or dense, varying in structural organisation.

Tendons, ligaments and fascia are made of Connective Tissue Proper.  Ligaments and tendons are dense, with very high collagen-low elastin/fluid components.  Fascia is variable but in general is more fluid and elastic.  Fascia forms the wrapping around/between individual structures, and the membranes that line each body compartment.

All Connective Tissue Proper has a support function – defining, guiding and delineating the body’s movement.  Different forms have different functions:  Ligaments and tendons are strong to support weight bearing. Whereas meninges, peritoneum and pleura/pericardium each secrete a little serous fluid, which permits sliding of internal organs against each other, at the same time as supporting them in their place.

Specialised Connective Tissues includes the liver, bone, cartilage, fat, blood, and lymphatic fluids.

MOVEMENT DYSFUNCTION

Restricted movement in one part of an interconnected system will change axes of movements, thereby resulting in compensations both locally and at a distance. However, the body has a great capacity to adapt and compensate, and dysfunctions can be mild or inconsequential. If the body ‘runs out of room’ to adapt and to compensate for lost mobility, dysfunctions become problematic, and perhaps injuries arrive or persist.

A basic principle of treatment is to restore mobility so that the body can regain adaptability.  Another basic principle is that to improve the mobility of any part of the body will help to improve its function.

RELATIONSHIPS

The more I learn about anatomy, and the relationships that exist within the body, the more interesting it becomes. Let’s consider:

  • The connective tissue sling that anchors the small intestine to the back wall of the body effectively connects to the front of the lower back vertebrae.
  • Tissue that connects the liver and stomach to the diaphragm is continuous with fascia lining the central area of the chest to the front area of the neck, connecting with the front of the thoracic & cervical (neck) spine and to the base of the skull.
  • Connective tissue covering the top of the lung anchors to the 6th and 7th cervical (neck) and 1st Thoracic vertebrae, to the 1st Rib, and also to the meninges.
  • The oesophagus passes just in front of the thoracic spine, sitting against T4,5
  • The kidneys tuck up under the lower attachment of the diaphragm, sliding down and up along the upper psoas muscle with each breath.

And there’s more…

  • The diaphragm tendon anchors to the front of not only T12, but also L1, 2, 3 and 4. It has fibres that support part of the duodenum.
  • The pleura attaches itself to the inside surface of each rib.
  • The cecum (first part of the large intestine) and the sigmoid colon (last part of the large intestine) lie in front of the greater pelvis adjacent to the sacroiliac joints (SIJ).  Appendix scars if adhered have the potential to reduce the mobility of the cecum.
  • Ligaments that support the heart connect it in front to the breastbone, and in back to the thoracic spine.
  • The heart attaches to the central tendon of the diaphragm, providing stability so that the diaphragm can flare the lower ribs during inhalation.
  • Continuation of the fascia connecting the bladder to the pelvis can be traced via the obturator (hip rotator cuff muscles) to the hip joint, and via the tailbone-hamstrings-peroneal muscles to the central arch of the foot (navicular bone)

RESTORING NORMAL MOVEMENT TO THE CONNECTIVE TISSUE MATRIX

Visceral Manipulation aims to improve the freedom of movement of internal organs, how they move in relationship to each other, and to the muscles and skeleton to which they connect

Neural Manipulation aims to improve the freedom of movement of the nerves along their trajectories where they should slide and glide.  It also aims to improve the subtle mobility of skull sutures, Sacro-iliac joints (SIJ), and the spine. Craniosacral Therapy also touches on these same structures, using a slightly different approach.

Vascular Manipulation aims to improve the elastic environment of arteries

Manual Articular Approach considers joints as an integrated unit and aims to improve mobility of their connective tissue elements (capsule, ligaments, tendons), arteries and nerves that supply them, and the sites where information receptors are concentrated (e.g. golgi tendon organs at muscle-tendon junctions)

Lymphatic Drainage Therapy aims to improve the ease of flow of lymph through the lymphatic system

Breath, breathing and the diaphragm demystified

Breath, breathing and the diaphragm demystified

A big ask, I know, but what is simple has been made complicated, and what is unified has been dismantled and disjointed.  When it comes to breath, breathing & the diaphragm, I have noticed for many people that this is indeed the case.

I have noticed that many people and paradigms who instruct breathing emphasise a particular perspective while missing the something of its central essence.  The ‘student’ will often switch from one dysfunctional pattern of breathing to a different one, and as often as not revert to the familiar “old habit” because the new one is unsustainable, unfamiliar and unhelpful.

I find myself often bringing people’s attention to their breath, to begin to understand what they understand about their breath.  

Common misconceptions include:

  1. Diaphragm breathing is belly breathing
  2. Diaphragm breathing is breathing into the sides of you rib cage
  3. Belly breathing is good, chest breathing is bad
  4. The chest should not expand
  5. Diaphragm breathing will fill the pelvis first, then abdomen then chest – in that order
  6. Deep breathing is good, shallow breathing is bad.

All of these ideas when examined are correct in some way, all are well meaning, but on their own are dysfunctional.  Except for the idea that the chest should not expand – which is just plain wrong.

I notice that people’s awareness of where their diaphragm is in their body, what it does, and how it works varies a lot. This is not really surprising, given that it is rather interior, and that as our ultimate endurance muscle the sensation of its contraction is super subtle (in general, power muscles have an obvious sensation eg biceps or rectus abdominus, whereas endurance muscles have a quiet, subtle, almost negligible sensation eg Transversus Abdominus or subscapularis).  

Nevertheless, I believe it is the birthright of everyone of us who breathes to be able to experience normal diaphragm function, and a free and uninhibited ability to breathe.

I’ve been reading recently a collection of interviews with the Breathworker Dan Brule.  His work encompasses a range of disciplines, drawing on his many teachers, and combining with his own perspective and experience.

Dan highlights 3 concepts common to all perspectives on Breathwork, with which I concur:

  1. Becoming more aware of your breathing … simply noticing it
  2. Using the breath to relax and to release the breathing mechanism, and
  3. Breath Control.

Of value to notice here is the sequence:  Before you can develop breath control, your breathing mechanism needs to be free … Before you can free your breathing mechanism, you need to cultivate an awareness of your breath …

Interestingly, the misconceptions I listed earlier all revolve around Breath Control.

What is assumed, consciously or not, is that the prerequisites of Breath Awareness and a relaxed Breathing Mechanism already exist.  The importance of this cannot be underestimated.  

So we’ll return to Breath Control, later,  and start at the start.

1. Breath Awareness:  I challenge you to to start with this.  It is at once the simplest and the most challenging. Simply notice without analysing, without making any deliberate changes, without judging, without evaluating – only noticing.  The practice of noticing your breath (I use the word practice rather deliberately) will reveal much – sensations, constraints, relationships of your breath to physiological mental and emotional states, and to energy levels.

This simple practice alone of noticing can be rather valuable.  As you simply notice, bringing your conscious awareness to your unconscious breath patterns, this in itself will generate changes in your breath – which you simply notice … “going with the flow”.  You might notice it speed up, slow down, become smaller, become larger, soften, energise, quieten, enliven.  Then you can start to play with this … ‘riding the wave’.

Practicing Breath Awareness:  Dan Brule suggests 10 minutes breathing practice morning and evening (2 x 10min) plus 2 minutes 10 times a day (10 x 2min), which I rather like.  This is a great general principle: 

Regular extended practice + frequent small reminders  = sustainable changes.  

Remember to simply notice your breath, allowing your breath to take its own course.

2. Freeing the Breath Mechanism:  Now this is where I spend a little time with people, so that they can understand the breath mechanism enough to experience what it means to breathe freely; and put to rest existing misconceptions and poor habits. Dan Brule in his interviews simply speaks about taking a deep breath, and letting it go – the emphasis being on the letting go – without controlling the pace of the exhale, neither slowing it down nor squeezing it out.

The other aspect I’d like to explore here is to do with having a relaxed inhale – with neither effort nor constraint.  But first a little about the anatomy of breathing.

Rib cage – thoracic spine, ribs, cartilages and breastbone in 3 parts

2 (a) The Breath Mechanism:  includes includes the rib cage in its entirety – thoracic spine, ribs, cartilages and breastbone in 3 parts (around 120 articulations all up, depending how you count them)  – plus the diaphragm and lungs.  Left to its own device, free from any restriction inhibition or dampening, the diaphragm expands the entire rib cage, which in turn inflates the lungs contained therein.

Diaphragm outline – front, side and back views

2 (b) Your Diaphragm: is a thin muscle layer shaped like a dome, parachute, of jelly fish, if you like.  The central top area of the diaphragm is tendon – pliable but inelastic.  The outer area is muscle, its fibres curving over and downwards to its lower edge.   The images above show its location from the front, side and back.

To orient yourself to your own diaphragm:

  • First, find find the lowest tip of your breastbone, and then with finger pads of both hands trace the lower edge of your rib cage down and out and around the cartilage edge, continuing around your side and back tracing the lowest floating rib to where it meets your backbone.  You have now traced the lower “hem” of your diaphragm where it attaches inside the lower circumference of your rib cage.
  • Then, close your left hand and place it in the centre of your breastbone, this is the position of your heart – which rests atop the centre of your diaphragm.  So at the undersurface of your heart-hand is the central tendon of your diaphragm internally.  From here the muscle fibres of the diaphragm curve over and down internally to meet the lower edge of your rib cage.

So what does your diaphragm do, and how??

  • Recall that the diaphragm alone left to its own devices will expand the entire rib cage – all 120 articulations.  It does this through a combination of two actions:
    • the upper fibres of the muscular part of the diaphragm pull on the central tendon – drawing it down and elongating your heart & throat structures.  At the same time…
    • the lower fibres of the muscular part of the diaphragm pull on the lower edge of the rib cage, which lifts and expands its entire perimeter (which you just traced)
  • The expansion that the diaphragm creates, then, is:
    • An even expansion of the chest and belly
    • An expansion side to side and front to back
    • A lengthening of the thoracic spine, and, if there are no restrictions in the neck or back, a lengthening of the entire spine from head to tail
    • In other words, and expansion of the entire torso
  • … Air expands the lungs, and breath expand the entire torso
Diaphragm relationships – front & side view + in context entire torso

To orient yourself to your own Diaphragm breath:

  • Begin by allowing your awareness to settle into your breath, and for your breath to settle into its own rhythm.
    • allow a little time for this
  • Bring your awareness to the shape of your rib cage, abdomen and backbone. In turn, bring your awareness to the entire interior space within.
    • allow a sense that this entire interior space is spacious, and “at ease”
  • Now if you allow your breath to relax out, and you wait just a little, your breath will start to find its own way in.
    • Allow your breath to trickle in, without adding any sense of exterior “muscular effort”.
      • To increase volume, simply allow more time (rather than effort).
      • For a little more volume try this exercise. As your breath trickles in and meets the first sense of elastic resistance, pause. Suspend your breath for a moment before you allow your breath to again relax out.
      • To explore more volume again, as your breath trickles in and meets the first sense of elastic resistance, pause. Suspend your breath here for a few moments. Wait until your breath is able to find a bit more space which it might occupy. Let your breath in further.
        • all the while, avoiding adding any exterior ‘muscular effort’.
    • Play with each of these different stages. Return to a resting breath as you wish. Simply simply noticing your breath and allowing it to find its own rhythm.
      • notice any changes in your breath.
    • repeat.

You can practice this any time you are awake Practicing whilst lying down simplifies things, at least to begin with.

Other helpful hints:

  • Bring your awareness to your breastbone, collar bones and the whole front of your chest wall. Allow it to feel ‘soft’ and ‘at ease’.
  • While lying down, bring your awareness to the contact between your body and the surface you are lying on. Allow it to rest there.

Notice the words – awareness, wait, suspend, trickle, relax, and allow.  Allowing the breath is a key sensation here – rather than any words like do, push pull, make.  The idea is to foster the ability of your body to relax around the expansion of your breath, and also to allow your breath to find otherwise hidden or forgotten places.

Start now, practice consistently, notice change

In my next post/s about breath, breathing & the diaphragm, I’ll continue with more strategies for relaxing your breath mechanism, highlight other nuances of a complete diaphragm breath, and explore different ways to play with breath control.  

But for now start at the start.  enjoy!!