Ep 277 — Delving into the Lymphatic System: “The Rebel MT” with Allison Denney

0:00:00.1 Speaker 1: Become a certified manual lymphatic drainage therapist with the Academy of Lymphatic Studies, ACOLS. ACOLS offers a variety of courses addressing edema and lymphedema management, the popular Manual Lymph Drainage certification, and complete Lymphedema Therapy certification courses can be taken completely in-person or in a hybrid format. With 150 annual course offerings all over the country students can find the right course for them. Visit acols.com to find a class near you. That's acols.com. 

0:00:44.7 S1: This episode is brought to you by Rebel Massage Deep Tissue Body Butter, crafted because oil is too slick and lotion absorbs too fast. These organic professional grade body work butters give you the grip you've been looking for. The best techniques in the world can get lost without the right product to support them. Try the Get A Grip version for a more specific focused work or the Total Meltdown version for that group with a little extra glide. Made by a massage therapist for massage therapists. Head over to rebelmassage.com to get your grip today. 

0:01:27.2 Speaker 2: The ABMP CE Summit on lymph is Tuesday, October 25th. During this free online event, you'll take an in-depth look at the anatomy, function and pathologies of the lymphatic system, as well as an introduction to the Manual Lymphatic Drainage modality and MLD techniques for the neck and face. This online event, including three hours of CE, is free for everyone in the profession. Learn more and register at abmp.com/summit. 

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0:02:03.5 S2: How important is it to learn Manual Lymphatic Drainage? Is it something we should know before learning how to work with injuries or chronic pain conditions, or even before graduating from message school? Is it a class that should be mandatory for body workers across the country? I mean, if I had a say in it, yes, absolutely, it should. But it is something that if we understand what it is and how it works, curating our work to help those clients with lymphatic system disorders might not be so overwhelming. Lymphatic drainage is not something most massage therapists understand upon entering the field as a new body worker. I mean, we learn right off the bat that massage increases blood flow, and maybe we figure out later that it doesn't really increase the flow of blood, but more precisely that it helps to free up blood vessels that might be hindered by stuck tissues. Does it do the same for lymph? Can the work we do influence the lymphatic system in the same way that it can have an impact on the circulatory system? And what even is lymph anyway? I'm so glad I asked. 

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0:03:12.9 S2: Picture this, You're in New York City and you decide to go visit the Met because art is always a good idea. So you find a map of the subway system, find the route you need to take and go down the stairs into the underground and complex weave of tracks that take people where they want to go. Once you're there, you marvel at all the folks getting on and off the train, circulating around the city, going from one place to the next, and then most likely back home again. It's a pretty cool thing. What you might not notice as much are the Metropolitan Transportation Authority workers milling around and cleaning up the mess that is made, because well, humans are human. Scrubbing floors and picking up trash, the workers of the MTA are the mostly unnoticed support system that helps keep the subway on its tracks, I mean, not literally. That's more of an engineer's job, but there is no doubt that if this crew of workers didn't exist, the trains of New York City's underground would eventually get so dirty and disgusting that they would be unrideable. 

0:04:15.1 S2: The whole system then would begin to deteriorate, eventually leaving all of New York City incapacitated and notably for the sake of this episode, sick. This is how I would like you to think about our circulatory and lymphatic systems. The trains of the subway system representing the vessels that wind around your body, bringing blood to where it needs to go, and the incredible workers of the MTA representing the lymphatic system, cleaning up the messes made by the other parts of the whole and silently keeping that which makes us unwell at bay. Obviously, this is not a direct comparison, there are a lot of things happening in the lymphatic system, not accurately personified by those who pick up trash under the streets of New York City, but it's the unsung hero part that I think is most important here. 

0:05:01.0 S2: Today, I will take us through what the lymphatic system is, how it works, and why understanding it is important to the work we do. But keep this in mind, this essential component to our immunity may not be the most popular system of human anatomy, but its ability to do what it does is endlessly working in the shadows to keep all the other parts of us going, and the whole of who we are happy and healthy. Let's start with the fact that the lymphatic system has some basic components that are important to note. It's got about 600 to 700 lymph nodes, the bumps along each of the lymph vessels all over the body, and that I used to think we only had about six or seven just under the jaw, and it's got lymph, the fluid and the stuff in the fluid that travels through these vessels, and that can be called all sorts of other stuff, but once it enters a lymph capillary it is then officially and ingeniously called lymph. 

0:05:58.7 S2: How it works though is a little more involved and where it gets more interesting. First and foremost, the path of lymph is unique. Unlike blood which circulates around the body and is pumped by the heart to do the circulating, lymph moves in a stubborn but practical one way direction, from distal to proximal. It travels from where it is picked up in the body, I will elaborate on this in a moment, to one of two terminuses or ducts located just underneath each clavicle where it gets returned to the circulatory system. This is important to note as a massage therapist, because if we are able to help these fluids along, remembering their end goal is key. So Lymph returns to whence it came, so to speak. 

0:06:42.2 S2: Twenty liters of blood is pushed through the arterial capillary beds of your blood vessels every day, but only 17 liters are picked back up through your veins, which leaves, and I am now mathematician here, three liters that are unaccounted for. Think of this as the trash and waste often left behind at the subway station. What was once a sandwich now becomes a wrapper dismissed as unworthy. And so what was once blood plasma is now interstitial fluid, floating in the spaces between the blood and lymph capillaries waiting to be picked up by a noble clean-up crew. Osmotic pressure and other such chemistry terms guides this unruly fluid to be picked up by the lymphatic system where it travels from the capillaries to the trunks and ultimately to the aforementioned terminuses. But as we wouldn't just return trash back into the subway, we wanna pick through it, clean it up and recycle it, so to speak. This is where the lymph nodes come in. 

0:07:37.4 S2: Occasionally along the path, lymph hits a node, a slightly enlarged portion of the vessel, where the real action happens. Lymph nodes act as a sort of centrifugal spin cycle sorting out the good from the bad. And with the added bonus of in-house specialized cells known as lymphocytes, which act like contamination snipers for the occasion when a rogue infection or disease gets in. So if your lymph nodes are swollen, it may be uncomfortable, but it's a good sign that the good guys are finding the good fight under your skin. There's a twist though, remember that blood has its own particular pump to help keep things circulating? Lymph is not so lucky. Lymph vessels are made up of smooth muscle tissue, which if you'll recall enacts a series of wave-like contractions called peristalsis to help move what's on the inside through. 

0:08:28.1 S2: This is most notable with the digestion of food as it passes through your digestive system. But food typically has the added help of gravity, whereas lymph does not. There are the intermittent valves slamming shut as to prevent back flow, and you might already understand that if the valves aren't working, this is when we start to see some swollen ankles, but lymph needs a little more help than that. This is where we come in, well, and muscles. This is also where muscles come in. Because lymph vessels do that cool thing where they travel in between tight spaces, they are nudged up against lots of different muscles all over the body, and as we move through the world, those muscles contract and relax, giving the vessels a little assistance in getting that fluid up to its respective terminus. But muscles don't always perform in the way that we want them to. They get weak or they get injured or stuck or tense, or any of the numerous things that can happen to muscles, lymph then doesn't experience optimal flow. 

0:09:27.6 S2: This is really where we come in. So if we understand that interstitial fluid gets picked up distally into the lymph vessels and travels through a series of segments and clean-up points before it gets to its destination under the clavicle at the terminus, and that these segments and clean-up points can get stuck or blocked or overloaded as anatomical parts tend to do, our job is to clear the way so the fluid can move more fluidly. The crux of the work lies in this fundamental truth, if you push stuff into an area that is already stuffed with stuff, that stuff isn't going anywhere, so making sure the terminus is clean and clear first is huge, then following the same logic, moving just a little down the path, clear that out, push it toward the terminus, then clear out the terminus again. And then moving a little further along, repeat the same steps. So you're kind of starting at the end, inching your way in, coming back to the end, inching your way farther in, coming back to the end and so forth. 

0:10:31.7 S2: How we do this is also important, as you must already know. Lymphatic drainage is usually done with lighter pressure and a series of manual pumps into strategically placed points and in decisively specific directions. Understanding which lymph vessels travel to what terminus is not so straightforward either. Looking at the anterior surface of the body, imagine a clock set at about 8 o'clock so that the hour hand reaches down into the right ribs and the minute hand divides the face in half. All lymph vessels in the upper right portion, if you were that person, between 8 o'clock and 12 o'clock, so the right arm, the right half of the torso and the right half of the head and neck drains into the right lymphatic duct and then into the internal jugular vein, and all the lymph in the rest of the body, drains into the thoracic duct and then into the subclavian vein. In other words, don't try to push lymph from the right leg into the right lymphatic duct. It's not gonna get there. 

0:11:29.7 S2: There is a little or a lot more to it, but for those who want to get a feel for the work, try this. With your client lying supine on the table, position your client's arms so that they're slightly internally rotated and elbows slightly bent. Place both hands with the soft palm just below each clavicle, fingers pointed inward toward the sternum. Gently press into the tissue with a rhythmic pumping motion 10 times, then move your hand placement laterally so that each hand is cupping the anterior deltoid and your fingers are gently compressing into the axillary area. 

0:12:03.8 S2: Side note, use a tissue or the sheet here, if you don't want deodorant on your hands. You have just cleared both terminuses and are ready to move outward. Focusing on the right arm, walk around to the right side of the table, grab the wrist, lift the arm and give it a little shake to ensure that they are letting go. From there walk to the head of the table again, bring the arm upward so that it is resting either on your knee or a bolster near their ear. This should bring the medial aspect of the arm up towards the ceiling, giving you greater access to where the lymph vessels tend to hide out. With soft finger pads, start your work close to the axillary area, pressing down gently and ever so slightly toward the armpit, repeat this rhythmically five to seven times, then move distally about an intro to and repeat that process. Softly sink in and guide the lymph towards the armpit with your work. Continue these steps until you get to the elbow. 

0:13:00.2 S2: Once you've covered that area, follow through with some light sweeping strokes from the elbow to the armpit. Lift the client's arm up, sweep again from the wrist to the shoulder and then bring the client's arm back down to a neutral position on the table. Return to the terminus and the initial compressions there. Have your client take a deep breath and maybe you can do the same. This is a very simple version of what is a beautifully intricate modality that I encourage you to learn more about. Lymph and the system it belongs to does more for our health and well-being than most of us realize. Giving our attention to the heroes in the shadows is like giving the Metropolitan Transportation Authority workers a big raise. It makes us feel good, it makes them feel good, and it keeps everything on track. 

0:13:49.0 S1: Members are loving ABMP Five-minute Muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP Five-minute Muscles delivers muscle-specific palpation and technique videos plus origins insertions and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology created in conjunction with Ruth Werner, puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members log in at abmp.com and look for the links in the Featured Benefits section of your Member home page. Not a member, learn about these exciting member benefits at abmp.com/more.