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Friday, 02 March 2012 14:14

Lymphatic Drainage

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The human body consists of two-thirds of fluid, thus we are able to drain about 40 to 50 liters of body water, regulating the homeostatic disturbances of metabolism, in connective tissues as well as in bursae and joins (synovial).

New Lymph Means New Life
The lymphatic system has for a long time, until now, been a step-child of the medical profession. In our century the ancient humoral therapy is finding its place in modern healing practices, especially since the method of lymph drainage was demonstrated in Paris in 1936 as a new kind of massage.

Administered by specialists, lymph drainage is a natural, rational cleaning of focal infections, especially in nasal, tonsillar and dental affections. Until now lymph has been condemned, mostly as a dangerous distributor, but now scientists think in a new way, regarding lymph as the saving regenerating factor.
Lymph drainage is a new method of massage, working upon lymph vessels and glands, in order to stimulate elimination of watery stagnation of the tissues (oedemas) and to improve a quicker flow of body fluids. Lymph drainage is an all-around, effective method of regeneration, especially in connection with breathing and relaxation exercises, dieting and appropriate medical treatment.

Manual Lymphatic Drainage
It was a long journey, beginning in 1932 when Vodder, a Danish scientist, not only discovered Manual Lymph Drainage (MLD) intuitively, but also endeavored to elucidate the technique theoretically on the basis of the somewhat obscure literature on the lymph system, which was still founded essentially on macroscopic studies.
In order to describe MLD today and reveal its underlying mechanisms of action, we draw reference to Vodder's description of his method: The nature of the stimulation gives rise to a corresponding effect, with pressure, contact area, frequency and rapidity of the manipulations, stretching of the skin, et cetera having a variable effect.
In this respect then, MLD is a technique based on certain guidelines, but one that depends primarily on the finger control of the therapist, who strives to exert a fluid displacing effect on both drainage systems, the venous and lymphatic, instead of a hyperemizing effect.
Body fluids can be displaced both intra-vascularly and extra-vascularly; that is to say in the vessels and in loose connective tissue. In the vessels is performed either mechanically by centripetal strokes, or by stimulation of the vascular muscles. In loose, interstitial connective tissue only mechanical displacement is possible.
It should be recognized that owing to the function of the lymph system a certain suction effect arises, analogous to the effect of a vacuum-type water pump, which extends into the connective tissue. Proteins and protein-bound water are thus transported into the bloodstream via the lymph system. Because urinary outflow is increased in healthy subjects following MLD, it is surmised that it releases some water bound to mucopolysaccharides of amorphous (i.e. nonfibrillous) ground substance.
The stimulating action of MLD on the lymphatic muscles was demonstrated by Mislin in 1972. Mislin also described how the unique manipulations of MLD stimulate the lymphatic musculature: Physiologic vasomotor lymph drainage results from the autonomic pulsations of the lymphatic sections or series of lymphatic sections. It is likely that MLD has a decisive influence on this drainage system. The process consists of rhythmically alternating phases of dilation and contraction in a successive series of metachronous activated lymph sections.
This gives rise to a peristaltic wave along the lymphatic vessel. Thus, the dilation contraction frequency of the lymphatic sections are synchronized and the resulting pulsations are peristaltically metachronousy. Myogenous and nervous control of vascular activities by synergistic receptors in the vessel walls ensure the coordinated transport of lymph. The main physiologic stimulation is pressure and temperature. Intravascular stretching across, but also along, the vessels increases the pulse rate of the lymphatic sections; smooth muscle cells (e.g. those in the vessel walls) exhibit electrical and mechanical reactions upon passive stretching. Vascular muscles having autonomous (i.e. pacemaker) properties require well-dosed stretching dependent on the momentary intravascular volume in order to ensure regulation of their rhythmical repolarization that is adapted to the prevailing situation. For all these reasons MLD, which exerts a (in some respects, inadequate) physiologic tensile stimulation, stimulates the vasomotor lymph drainage system.
Extramural lymph drainage (i.e. the action of external mechanical factors on the lymphatic vessels) is founded on the fact that certain outside forces not only stimulate the vascular musculature in the manner described above but also exert a mechanical effect on the content of the lymphatic vessels. Foremost among these factors are the movements of the skeletal muscles, the pulsation of the arteries (analogous to functional coupling in the case of the veins), the peristalsis of the intestines, the movements of the diaphragm and other muscles of the respiratory system, and the variations in pressures that arise in the pectoral and abdominal cavities during respiration.
Extravascular lymph drainage involves lymph formation and extravascular circulation. The higher the content of protein in tissue, the less water can flow out of the tissue via the venous capillaries, because it is bound by protein. In assuming the function of returning protein from the tissue, the lymph system allows more water to drain from the venous capillaries.
The lymph capillaries commence as blind finger-like extremities in interstitial tissue. They lack the basement membrane found in blood capillaries and consist of a single, thin layer of partially overlapping endothelial cells connected radically at one end to stretch resistant collagen fibers of the connective tissue by extremely fine precollagenous (matrix) filaments. If the connective tissue swells as a result of an increased influx of water, the pressure within the interstitium increases. As a result, the collagen fibers distend, pulling the nonelastic anchor filaments of the lymph capillaries with them. The intercellular spaces in the lymph capillaries widen, so that there is an increased flow of water, macromolecule, large and small particles (sometimes including erythrocytes) into the capillary lumen.
As the lymph capillaries fill, the pressure in the interstitial tissue decreases due to the efflux of water, and the pressure in the lymph capillaries increases due to the influx of water. These pressure changes cause the endothelial cells, which act like flutter valves, to close the intercellular gaps, so that the lymph capillaries present as filled and closed channels. The anchor filaments have also returned to their initial position, since the water content and the pressure in the connective tissue have decreased. They would undergo a relative increase if proximal emptying of the lymph capillaries (e.g. as brought about by MLD) caused the intracapillary pressure to drop. The result of such a relative increase in interstitial tissue pressure is intercellular filtration into the lymph capillaries (a further active protein-transport mechanism as transcellular cytopempsis).
During MLD therapy unbound water in loose connective tissue also flows out of the interstitium at an increased rate via the venous capillaries. The result is, like that of a surgical stocking, decreased edema, provided that the fluid in question is low in protein content. Thus, MLD promotes, on the one hand, water drainage via venous capillaries and on the other hand, the removal of water and protein via the lymph system. Complications arise when the lymph system becomes incompetent, owing to the extirpation of lymph nodes or their fibrous obliteration by irradiation so that lymph drainage of whole regions is no longer ensured.
In such cases, MLD attempts to push the lymph against the normal drainage direction via the valveless lymph capillaries and the valved (but in contrast to the subsequent "transport vessels" still muscle free) "guiding vessel" as found in the superficial network of the skin lymphatics, rerouting it to regions still supplied with sufficient lymph vessels. Transport is against the normal direction of drainage, because the lymphatic vessel apparatus no longer functions due to the blockage or absence of regional lymph nodes. It is possible to transport the lymph in the skin lymph vessels deeper into the cutis or subcutis via so-called watersheds and interterritorial anastomoses. It should be kept in mind that the smallest lymphatic vessels of the skin, referred to above as "guiding vessels" and which already possess valves, can be influenced by MLD in such a way that the valves reverse position and the direction of lymph drainage can be controlled.
Milestones in the development of Manual Lymph Drainage:
The 1936 Beauty and Health Exhibition in Paris, on the occasion of which a newspaper wrote of a "revolution in skin therapy"

The establishment of the Society for Dr. Vodder's Manual Lymph drainage in 1967
Recognition of MLD by the national health insurance schemes in 1982
As a modality in aesthetics, it is our hope that, through proper training and guidance, lymphatic drainage will gain momentum as an effective, intensive, painless treatment.

Dr. Reinhard Bergel is the president and founder of H-e-a-t. Inc (Health-enhancement-accessories-training) Spa Kur Therapy Development. He is an advisor in Spa Kur facility development and conducts spa staff training. He has published numerous articles as well as the comprehensive SPA ENCYCLOPEDIA. Bergel is a founding member of the American Society of Lymphology and American Day Spa Association and has operated a health spa clinic and physical rehabilitation center for almost two decades. He has been practicing and teaching Lymphedema Management since 1986.

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