Lymphatic Balancing

Lymphatic Balancing (LB) is a specifically designed curriculum that applies specialized manual lymphatic drainage techniques, originally designed to treat lymphedema, to the orthopedic patient. LB expands on the philosophical approach to lymphedema pioneered by Emil Vodder, PhD (Vodder Method), Bruno Chikly MD, DO (Lymph Drainage Therapy), and Albert Leduc PT, PhD (Leduc method) with the addition of traditional osteopathic lymphatic pumping techniques making it more applicable to orthopedic injuries. LB can be used to treat excess fluid (swelling), fluid stagnation or lymphedema in the cranium, spine, thorax, abdomen, viscera, pelvis, upper (shoulder, elbow, wrist, and hand) and lower extremities (hip, knee, ankle, and foot).

A properly functioning lymphatic system is critical for the body to maintain homeostasis and regenerate tissue. Specifically, the lymphatic system helps maintain normal blood volume and pressure, helps rid the body of cellular metabolic waste, and helps prevent excess accumulation of fluid in and around tissues. Additionally, the lymphatic system assists with tissue regeneration and supports the immune system by removing excess fluid, debris, toxins, and damaged cells from injured tissue.

An important principle of osteopathic treatment is Drainage Precedes Supply. This concept is based on the understanding that tissues need a healthy inflow of oxygenated and nutrient rich blood for cellular homeostasis and repair. However, for tissues to receive this healthy circulatory inflow, there must first be a properly functioning lymphatic outflow to drain the tissues. If lymph circulation stagnates due to injury or infection, tissues become congested and the ability of the tissue cells to receive healthy blood is compromised. This leads to an accumulation of cellular waste products in the tissues causing pain, tension, and edema. Since “drainage precedes supply,” a congested or impaired lymphatic system makes it difficult for injured tissues to filter out metabolic waste and receive nutrients and building blocks needed for repair. To prevent damage and promote healing, this accumulated waste and edema must be promptly removed.

LB is an effective manual therapy treatment to relieve congestion and remove accumulated waste and edema in the tissues to decrease pain, restore full pain-free movement, and allow for optimal tissue healing. The LB procedure involves both short and long lever manual pumping and drainage techniques to simulate gentle, specific wave-like movements that stimulate fluid motion and aid in the re-circulation of the venous and lymphatic flow. These subtle manual techniques not only activate lymph and interstitial fluid circulation, but also stimulate the immune system and help balance the autonomic nervous system.

LB is appropriate for the following patient populations: pediatrics, adolescents, young adults, adults, and geriatrics. LB is very effective for the following conditions:

• Edema (swelling)
• Lymphedema (primary & secondary)
• Tissue Injury and Impairments
• Burns
• Wounds
• Skin Impairments
• Orthopaedic Injuries and Dysfunctions
• Muscle Spasm/Hypertonicity
• Sports Injuries
• Post-Surgical Recovery
• Amputations
• Whiplash
• Acute and Chronic Pain
• Headaches
• TMJ
• Sinus and Tooth Pain Breathing Dysfunctions
• Dysphagia
• Stroke
• Head Injuries
• Organ Dysfunction
• Subacute and Chronic Inflammation
• Chronic Fatigue Syndrome
• Fibromyalgia
• Acute and Chronic Stress
• Insomnia
• Loss of Vitality
• Total Body Congestion and Toxicity
• General Wellness
• Esthetics

Lymphatic Balancing Curriculum

• Lymphatic Balancing Total Body (Total Body Approach): A total body lymphatic evaluation and treatment approach specifically designed for the orthopedic patient to modulate the autonomic nervous system, balance the transverse diaphragms, release lines of tension, and eliminate congestion in the lymphatic system.
• Lymphatic Balancing Upper Quadrant (Local Approach): A local treatment approach specifically designed for the orthopedic patient to release lines of tension and eliminate congestion in the lymphatic system of the cranium, face, cervical/thoracic spine, rib-cage, deep thorax, upper abdomen, and upper extremity.
• Lymphatic Balancing Lower Quadrant (Local Approach): A local treatment approach specifically designed for the orthopedic patient to release lines of tension and eliminate congestion in the lymphatic system of the lower abdomen, lumbar spine, pelvis, sacrum, lower extremity, deep lymphatic, and deep abdominal regions.

Each course involves a combination of lecture and lab that includes theory, demonstration, and hands-on practice. Course participants are given a highly illustrated study guide that includes lecture content, references, and detailed instructions for each of the evaluation and treatment techniques. Ample time is allotted for hands-on practice, as well as questions, discussion, and review. Course content includes instruction in the following:

Lymphatic Balancing Specific Techniques

• Long Lever Pump Techniques
• Short Lever Nodal Pump Techniques
• Long Lever Nodal Pump Techniques
• Effleurage
• Short Lever Pump Techniques
• Short Lever Drainage Techniques
• Local Pump Techniques
• Diaphragm Balancing Techniques**
• ANS Balancing Techniques**

Lymphatic Balancing Supportive Techniques

• Active Lymphatic Pump Exercises
• Compression Therapy/Lymphatic Taping
  (limited instruction in this curriculum)

Lymphatic Balancing Total Body Evaluation**

• Tension and Congestion Evaluation
• Transverse Diaphragm Evaluation
• Autonomic Nervous System Evaluation

** LBTB only

Lymphatic Balancing Course Objectives

At the completion of the Lymphatic Balancing curriculum, the participant will be able to:

• Demonstrate an understanding of the history, principles, and neuromuscular basis of Lymphatic Balancing (LB).
• Demonstrate an understanding of the anatomy and physiology of the lymphatic system.
• Describe the pathophysiology and pathogenesis of lymphedema.
• Understand common diagnostic procedures for swelling and lymphedema.
• Using ARTS, perform a Lymphatic Balancing Total Body Evaluation (LBEV) and a Specific Local Evaluation on the Upper and Lower Quadrant.
• Appropriately chart the results of the evaluation and formulate a properly sequenced treatment plan.
• Perform LB Specific and Supportive Techniques to help enhance the flow of body fluids.
• Understand the clinical importance of LB in relation to musculoskeletal dysfunction and how to integrate LB with other treatment modalities taught at the D’Ambrogio Institute.