resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
November, 2013, Vol. 13, Issue 11
Lymphatic Pump Techniques Improve Immune Function
By Massage Therapy Foundation Contributor
Contributed by Derek R. Austin, MS, CMT, Jolie Haun, PhD, EdS, LMT, and M.K. Brennan, MS, RN, LMBT
Do you know that lymphatic pump techniques (LPT) can enhance your massage practice? Immune response is central to maintaining health.However, health can be compromised when there is any delay in the immune response to a pathogen. Lymphatic flow is a key component in facilitating the immune response. Techniques that focus on lymphatic flow are effective adjunctive therapy in acute infection, as well as immune support.
Exercise, passive movement and manipulative techniques have been shown to increase lymph flow. Osteopaths have historically used osteopathic lymphatic pump techniques (LPT) to improve lymphatic circulation, reduce edema and combat infectious disease. However, until recently, there was no scientific evidence that LPT enhances function of the lymphatic and immune systems.
Lymphatic pump techniques may be familiar to readers, as these techniques are commonly used to treat edema. This month's Massage Therapy Foundation research column summarizes two recent reviews on the lymphatic and immune effects of lymphatic pump treatment. The first article, by Lisa Hodge and Fred Downey, "Lymphatic Pump Treatment Enhances the Lymphatic and Immune Systems," was published in the journal Experimental Biology and Medicine in October 2011. The second article, by Lisa Hodge, "Osteopathic Lymphatic Pump Techniques to Enhance Immunity and Treat Pneumonia," was published in the International Journal of Osteopathic Medicine in March 2012.
Lymphatic pump techniques, also known as lymphatic pump treatments, affect the lymphatic system and are a staple of osteopathic manipulative medicine. Leukocytes traveling in the blood and lymphatic system perform an important role in the body known as "immune surveillance," searching for foreign bodies that will trigger an immune response. Thus, it is important that the flow of lymph not be restricted, as it is in lymphedema. Skeletal muscle contraction, intestinal peristalsis and respiration are already known to increase lymphatic pressure and flow. Additionally, LPT may enhance lymphatic and venous drainage, improving immune surveillance during times of infection.
Despite slowly mounting research evidence, the question remains: Is LPT helpful for infection? Small sample sizes limit the validity of pilot studies that suggest LPT can enhance innate immunity in patients with acute infection and healthy individuals. Though we often refer to human studies to give guidance on effective treatments, laboratory-based animal studies (often referred to as "basic" or "bench" research) also inform the mechanisms and efficacy of modalities such as LPT. Animal studies have demonstrated that abdominal and thoracic pumping increase thoracic duct flow in dogs and rats.
These animal studies point toward lymphatic pump treatments enhancing the uptake of lymph into the lymphatic system, thus increasing the immune function of this system. Previous research on anesthetized dogs by Hodge and her collaborators has shown that four minutes of abdominal lymphatic pump treatment may increase the flow of immune cells from both the innate and adaptive immune systems. That research showed LPT can mobilize white blood cells and other immune cells from GI tissue into lymph. Other research on dogs has found similar results whereby LPT to the abdomen mobilizes immune cells from the mesentery, though the effect sizes and clinical relevance are less well-established.
The lymphatic flux, or molecules per minute of lymph collected, of additional inflammatory mediators such as interleukins and cytokines, are also enhanced by LPT when measured during four minutes of LPT, when compared to the time immediately pre-LPT and 10 minutes post-LPT. Also, LPT improves thoracic duct leukocyte flux without increasing mean arterial pressure, at least under the condition of anesthesia.
More recent research in Hodge's laboratory has focused on a rat model employing LPT to the abdomen at a rate of one compression per second for four minutes. As in dogs, LPT in rats temporarily increases lymph flow and concentrations of immune cells, suggesting that LPT boosts immune surveillance. LPT releases mature, activated lymphocytes, including IgA+ and IgG+ B cells into both thoracic and mesenteric lymph. However, this canine and rodent research has only looked at abdominal LPT due to technical difficulties with performing thoracic LPT in the controlled experimental setting, so the effects of thoracic LPT in these animal models is still unknown.
However, thoracic LPT has been shown in a few studies to enhance antibody response in humans. Hodge points out the need for further experimentation to clarify the differences between abdominal and thoracic LPT.
Hodge, Downey and a group of collaborators used a rat model of pneumonia to study whether LPT improves lymphatic clearance of pneumococcal bacteria. In this study, 20 rats received four minutes of daily anesthetized LPT, another 20 rats received daily anesthesia and a sham treatment of light touch, and another 20 rats served as controls. Eight days after infection, the researchers found that the amount of S. pneumoniae bacteria in the lungs was significantly reduced in both treatment groups compared to control. Compared to the sham treatment, LPT led to an even higher amount of bacteria clearance.
The treated rats also exhibited fewer immune cells in the lungs, indicating their infections were improved compared to the controls. While this article focuses on the effects of LPT, it is interesting that light touch also had a significant effect compared to control. Light touch is often used as a "sham treatment" comparison group compared to a form of massage or bodywork. If light touch has a therapeutic effect, then it may not serve as a good control or comparison group.
In humans, LPT is used as an adjunct therapy to improve cleansing of the bronchi and trachea, increase sputum production and shorten the duration of cough in patients with lower respiratory disease, such as pneumonia.
The most significant recent research into LPT in humans is the Multi-Center Osteopathic Study in the Elderly (MOPSE). This randomized, double-blind, controlled trial compared light-touch, osteopathic manipulative therapy (OMT) and traditional care. The study involved 406 hospitalized elderly patients with pneumonia who were followed for outcomes including length of hospital stay, antibiotic use and respiratory failure or death.
As may be expected with many forms of bodywork, OMT led to a significantly higher report of increased musculoskeletal pain, compared to light touch and traditional care. While the MOPSE intention-to-treat analysis, which includes those randomized to receive OMT who may or may not have actually received it, did not show any significant differences between groups, the results were different for those who actually received OMT.
In that statistical breakdown, referred to as a per-protocol analysis, patients who received OMT plus conventional care had decreased length of hospital stay, duration of IV antibiotics and frequency of respiratory failure or death compared to the conventional care group alone.
Future research may illuminate other interesting benefits of LPT. Another rodent study by Hodge and various collaborators showed LPT partially prevented the development of pulmonary tumors in rats implanted with tumor cells. The amount of solid tumors was reduced by 30% and the number of immune cells, including B-cells, T-cells, NK cells and macrophages in the lungs, increased. Additionally, historical data from the H1N1 flu pandemic of 1917-1918 shows treatment under the care of an osteopathic physician significantly decreased mortality, especially in patients who had influenza complicated by pneumonia. Osteopathic manipulative medicine of this era already included lymphatic pump treatments that have only been studied rigorously in the 21st century.
The way by which LPT enhances immune system function and patient outcomes appears to be through at least two major mechanisms. LPT improves immunological memory, which may aid in the clearance of pathogens and prevent chronic infection. LPT also increases pulmonary trafficking of gastrointestinal immune cells, possibly providing immune protection in the lungs. Despite these benefits of LPT, other studies have had less-positive results. One study showed LPT does not increase serum interferon levels in healthy individuals, though interferon is not normally elevated in healthy people. A clinical trial also showed mild, but significant worsening of lung function in patients with COPD following LPT. Subjectively, however, the patients reported feeling better after LPT. And while LPT has been shown in some studies to enhance the immune-system response to vaccination, it did not increase antibody titers against influenza in a recent human study.
The development of antibiotic-resistant bacteria, including MRSA and resistant forms of pneumonia, has led to a serious search for non-antibiotic methods of treating infectious disease. While the research evidence is generally preliminary, laboratory and clinical studies are beginning to show that LPT has a significant immune-boosting effect. It is still unknown what quantitative effect LPT has, especially in humans, and particularly for diseases other than pneumonia. Furthermore, some studies confound LPT with other manipulative medicine techniques that may not be in the scope of practice of massage therapists.
Overall, with research showing significant results when LPT is applied for a duration of only four minutes, it may be an easy technique to incorporate into a massage session with proper training. Of course, some clients may not want their abdomens vigorously pumped. However, the health benefits may convince them otherwise.
These data provide important implications for the application of LPT in clinical practice, particularly when immune effects are a desired outcome. Furthermore, these findings provide a solid scientific basis, including both basic and applied research, to support the use of LPT when making treatment recommendations to clients and patients. These published findings support the field of massage therapy and bodywork in the clinical setting as professionals and research scientists continue to establish the scientific merit of modalities such as LPT.
One of the two reviews discussed in this article is available for free in PubMed Central. To learn more about the effects of modalities such as LPT, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.
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