resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
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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