The lymphatic system is a significant system in terms of body defense and maintenance of health. If your lymphatic system stopped working, your body would become septic, and death would be likely within days. Keeping this system flowing properly is essential to health and vitality.
Lymphatic Massage Vs. Lymphatic Drainage
A distinction needs to be made between lymphatic massage and lymphatic drainage.
Lymphatic massage refers to general massage practice that aids lymph circulation. Light effleurage strokes that follow general lymph flow pattern can have a moderate effect on lymph fluid flow.
Wringing strokes to push lymph faster may be added. Additionally, I have seen techniques incorporating movement (rocking, jostling, shaking, shivering, vibration, percussion and bouncing a limb) added to aid lymph flow.
Lymphatic drainage techniques as originally presented by Estrid Vodder, ND, and her husband, Emil Vodder, PhD, will specifically be designed to directly impact lymphatic tissue and fluid. Emil and Estrid Vodder published findings in 1935 of their methods providing treatment relief for ailments pertaining to the lymphatic system. The Vodder Method was combined with techniques by Michael Foeldi, MD, and his wife, Ethel Foeldi, MD, to devise Complete Decongestive Therapy (CDT). This therapy includes the use of compression bandaging, wound repair and exercises that, along with the Vodder Method, will be used to aid many lymphedema patients, especially those in stage 2 and 3 lymphedema.
The lymphatic system’s primary function is to drain body fluids from interstitial tissue spaces and return these fluids into the bloodstream. “Interstitial” pertains to the tissue between blood vessels, including capillaries and cells. As cells excrete metabolic waste, lymphatic capillaries uptake the fluid commonly called lymph. If the body’s lymph does not get cleaned, our blood stream would become septic, resulting in death in a matter of one or two weeks.
Anatomical Structures
To properly understand the physiology of the lymphatic system, an overview of the anatomical structures is necessary. One important point to make initially is that the lymphatic system does not have a central pump akin to the cardiovascular system’s heart. Therefore, mechanisms of movement are needed to mobilize lymphatic fluid through the body.
Lymph is the fluid drained from interstitial spaces and contains an assortment of components. Primarily containing water, this fluid also contains metabolic waste, proteins, salts, bacteria and white blood cells. Famed Greek philosopher Hippocrates called lymph fluid “white blood” and wrote of its significance toward maintaining health and wellness along with the other humors of the body.
Lymphatic capillaries are intertwined among arterioles and venules within connective interstitial spaces within the body. These capillaries are simple squamous epithelial in structure (one layer of flat cells) allowing for osmosis and diffusion to occur. As interstitial pressure increases, the interstitial spaces open wider, thus enabling fluid to enter the lymphatic capillaries.
There are many factors that increase interstitial pressure, thereby enhancing the mobility of lymphatic fluid. Movement causing muscle contractions will squeeze lymphatic vessels to encourage improved mobility. Deep breathing techniques can also create the same impact, especially within the body’s torso regions. Manual therapies such as lymphatic drainage, lymphatic focused massage, dry brushing and general superficial effleurage can encourage and expedite lymphatic movement.
A series of lymphatic vessels convey lymph toward larger vessels and nodes, eventually leading cleansed lymph toward the subclavian vein and into the superior vena cava. The newly cleaned lymph returns to the bloodstream. In essence, most of your blood plasma is cleaned lymph fluid.
To be more specific, the smallest of lymphatic capillaries carry lymph toward larger collecting lymphatic vessels. Pericytes, cells that express alpha-smooth muscle actin, create a contractive pressure along the lymphatic vessel walls to further aid lymph movement.
Within lymphatic vessels are unique valves that are created by adhesions amongst the squamous cellular structure of the vessel walls. Stretching the walls of the vessels causes pericytes to stretch, thus facilitating the fluid movement along subsequent collecting ducts into lymph nodes.
Lymphatic Duties
Lymph nodes are organs in which lymph passes through to be cleansed. There is a wide range of lymph nodes within the body, estimated between 400 to 700.
Once lymph is within lymph nodes, entering via an afferent collecting vessel and exiting via an efferent collecting vessel, lymph fluid is cleansed via lymphocytic activity within the node. If an antigen is present within lymph fluid, dendritic cells in surrounding tissues enter the lymph node to seek and present the antigen to T-cells, thus initially an immune response to the antigen. The T-cells carry the antigen component through the body to combat this antigen anywhere it is found.
Failure of the lymphatic system to perform its primary task of interstitial tissue drainage results in a condition called lymphedema. As a patient progresses through lymphedema stages, the impacted region will witness a greater accumulation of lymph, leading to worsening skin, muscle, nerve and vessel damage. A therapist specially trained in complete decongestive therapy will likely be needed to aid a client with advanced lymphedema stages.
A second, equally significant function of the lymphatic system is to extract dietary fat and lipid-soluble vitamins (A, D, E and K). Lacteal capillaries are a form of lymphatic capillaries that absorb these dietary components. These capillaries are separate from the circulatory capillaries within the intestinal villi, which absorb nutrients from food consumed.
These dietary components are taken to the liver for processing before returning to the bloodstream. The liver catalyzes the larger lipid molecules into smaller molecules for cellular uptake.
Assuming the liver is healthy, our body has an effective means toward processing fats from foods and the four essential fat-soluble vitamins. If a patient has liver and/or lymphatic system challenges, they will need to be especially careful with fat intake and monitor signs of vitamin A, D, E and K deficiencies. These include impaired immunity; deficiencies of the eyes, skin, sinuses, nose, liver or kidneys; bleeding disorders; and increased susceptibility to cancer.
A third function of the lymphatic system is the facilitation with the immune system. The lymphatic system can activate immune activity. One manner in which this occurs is that lymph carries antigen agents into lymph nodes that then activate white blood cell activity to combat the antigen. The white blood cells found in lymph are called lymphocytes. These are adept at combatting antigen agents that invade lymph fluid.
An antigen is anything that alarms the immune system. This includes but is not limited to pathogenic agents such as bacteria, fungi and viruses. Non-organisms such as pollen, dust and other allergens may also be antigens to the body.
Major lymphatic organs contribute toward the overall functioning of the lymphatic system’s duties:
• The spleen filters and stores blood and produces white blood cells that combat infectious diseases.
• The thymus gland is a site of white blood cell maturation.
• Bone marrow within softer, spongy bone tissue is the birthing place for white blood cells.
• Tonsils and adenoids trap pathogens that enter the oral and nasal cavities.
• Peyer’s patches line the walls of the small intestine to monitor pathogens within the alimentary tube.
• The appendix contains lymphatic tissue to further fight bacteria at the distal end of the small intestine.
Lymphatic System & Disease
In the case of oncology patients, monitoring the lymphatic system is key to ascertaining the prognosis of a patient. Observing the metastasis of cancer cells is key to combatting cancer if a patient’s case reaches stage IV. Tumor lymphangiogenesis can create a condition for cancer cells to further thrive and quickly spread through the lymphatic network. The chemical VEGF-C (Vascular Endothelial Growth Factor) overexpression can increase lymphatic flow and further metastasize cancer cells.
The two main cancers of the lymphatic system include Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma. Hodgkin’s lymphoma features the presence of Reed-Sternberg cells. This form of lymphoma is highly curable as there is a predictable metastasis pathway allowing doctors to know where to fend off cancer cells within the body.
Unfortunately, Non-Hodgkin’s lymphoma is unpredictable as cancer cells metastasize, making it much harder to anticipate where to combat these cells. The noncontiguous spread can invade tissues at random quickly.
Lymphatic system activity can also be examined for patients with chronic inflammatory conditions such as Crohn’s disease and ankylosing spondylitis, autoimmune conditions such as fibromyalgia and rheumatoid arthritis, and highly infectious diseases in both acute and chronic disease phases.
A Healthy Lymphatic System
Ensuring a healthy lymphatic system will do wonders to enhance the body’s cardiovascular, immune and digestive systems. Clients will have more energy, expedite healing, possess healthier skin, reduce areas of swelling and puffiness and prevent the impact of pathogenic factors within the body.
Helping our clients understand the importance of the lymphatic system will help many clients make healthy choices to encourage healthy physiology of this system. Encouraging our clients to move their bodies more often daily, take moments to breathe deeply and include more manual therapies to encourage lymph flow will help them maintain strong immune and lymphatic systems.
References
“History of Lymphatic Drainage”, Daly, Francis, PowerPoint presentation, 2017
Physiology, Lymphatic System, Ozdowski, L, Gupta, V, pubmed.ncbi.nlm.nih.gov/32491765, 2021
Anatomy of the Lymphatic and Immune Systems, Oregon State University, open.oregonstate.education/aandp/chapter/21-1, 2020
The Free Dictionary, The Gale Group, medical-dictionary.thefreedictionary.com/lymph, 2008
Lymphatic System, Staff, Cleveland Clinic, my.clevelandclinic.org/health/articles/21199-lymphatic-system, 2021
About the Author
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches classes on pathology and many other topics. He is a regular contributor to MASSAGE Magazine, and his articles include “Massage for Trauma: 3 Ways of Responding to an Emotional Release” and “This is How Proprioceptive Neuromuscular Facilitation Helps Muscular Function.”
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