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Massage Today
January, 2016, Vol. 16, Issue 01

Congestion is What Steals Our Quality of Life

By Dale G. Alexander, LMT, MA, PhD

All of us have experienced the sponginess of edema in a client's ankle or foot. All of us have felt the extra weight of a client's cranium who comes in with sinus troubles or chronic headache patterns.

All of us have noticed the difference between the heaviness of one extremity vs. the other. These are "hands on" examples of congestion.

This article begins to describes how, in 35 years of clinical practice, I have come to understand and experience my clients' varying states of "congestion" and why I believe that addressing it is such a key concern in assisting clients with chronic somatic dysfunction to regain their functional capacity and vitality for life. The focus here will include my anatomical interpretations of congestion which occurs below the diaphragm and to some degree within the thorax.

In an previous article, I identified that a conceptual triad of compression, congestion, and dis-coordination of the nervous system provides us with simple specific language to describe the intention and beneficial outcomes of therapeutic massage and bodywork.1 I now see that being able understand and describe the far ranging effects of congestion and how it occurs furthers this ability and conveys your competence as a practitioner.

Describing the "Sacs and Tubes Theory of Stress" is a useful construct to set the stage for prospective clients. Our human physiological response to stress can be described as a process in which the internal "sacs around our major organs cringe, while the tubes which comprise our visceral organs and the tubes between them shorten, narrow, and sometimes even twist."2

congestion - Copyright – Stock Photo / Register Mark Imagine the human body as a whole experiencing significant stress: cringing, shortening, narrowing toward the center and even sometimes twisting, thus producing enormous contraction of the external somatic tissues, pushing juxtaposed bones to the limits of their normal range within their joint capsules and potentiating the protective response that our soft tissues are dedicated to - protecting our joints. Internally, this cringing, shortening, narrowing and twisting adds resistance to the delivery and return of the blood supply. Together, these internal and external effects of stress are the causative factors of congestion and the predominant reasons that clients seek us out.

My definition of congestion is the slowed, sluggish, or stopped movement of blood toward its normal outflows. Places of congestion in our bodies are where I believe toxins accumulate. Places where their pressures build. Congestion is the source of much of our somatic pain as inflammatory cycles are spawned as vessels become distended. And, congestion is definitely a primary co-conspirator in the perpetuation of chronic somatic difficulties.

To better comprehend how congestion occurs, let's build a simple model of our vast and complex vascular system. The heart is responsible for pumping our blood, filled with oxygen, nutrients, and hormones, across an enormous journey of 60,000 miles. Wow! That estimated distance alone, over two times around the equator, from leaving the heart to returning to the heart/lung complex is truly astounding!3

Previously, I have proposed that the autonomic nervous system has three cards to play to assist this arterial flow when impeded: make the heart work harder, narrow the vessels of the arterial and venous system, or simply divert blood flow, thereby increasing it to certain areas while decreasing it to others.4 Is this allocation of resources truly equal, or is there an innate hierarchy that the body follows in which some tissues get more increased blood flow and other tissues less?

I propose that when we reduce the degree to which the body is congested, we are assisting the body to more effectively reallocate its most precious healing resource: blood. Working with this proposition has stimulated the understanding and experience of my newest clinical axiom, "for a part of the body to heal, the system as a whole must function more efficiently." This translates into assisting the flow of both the arterial and the venous and lymphatic return systems.

So, how do we as massage therapists, go about relieving congestion and increasing systemic function? By reducing resistances to heart and the lungs expansion. Throughout my career, enhancing the capacity and efficiency of cardiac output has been my Number One priority in each session with every client. This is at the center of how we may assist our clients to reduce congestion and regain and maintain their quality of life.

I believe that increasing and enhancing the flow of raw blood products back to the heart/lung complex is also a necessary component of how cardiac output efficiency is maintained. It is an equally compelling priority of physiology. It is my perception that one cannot really separate these two priorities. In common sense there needs to be the timely volume of returned/used blood and lymph available in order for newly generated blood to be pumped out.

This leads us to the logical, but unanswered question of what happens when raw blood products are lagging in the timeliness of their return? Does the body ramp up additional red cell production in the marrow of the ribs or does it tap the reserves within the spleen? Two simple and logical possibilities have occurred to me. Other possibilities, I pray, exist. I recently asked this question of an exceptionally gifted cardiologist and they encouraged me to seek the answer from a hematologist.

We have created endless theories of how supply and demand function in the external and financial worlds yet, this simple construct of fluid dynamics is missing in how it applies within our biology as viewed by current medical science. This lack of consideration to the importance of return blood flow to cardiac health leaves several critical questions unanswered: How may it influence our systemic health as we age or, how is it a probable stepping stone in progression toward the tipping point of where stress related dysfunctions becomes disease? This is what makes understanding the many dimensions of congestion of our bodily fluids so crucial to improving the systemic health of our clients.

Another interesting and important anatomical feature relating to fluid congestion: I find the fact that the heart and diaphragm are Siamese twins, meaning that they would literally have to be cut apart to be completely separate anatomical entities. It is not an accident that during the time of their embryological development they begin together at C2.

The primary pump of arterial blood, the heart, sits directly upon the primary pump of the venous and lymphatic fluids, the diaphragm. Is there a kinesthetic feedback mechanism between them? Might there be a way that their congenital organization serves us we have yet to discover?

The heart beats 100,000 time a day while the inferior movement of the diaphragm occurs 25,000 to 27,000 times a day. I sense an inherent rhythm between these numbers, approximately a 1:4 ratio, that is not an accident. What happens to one's systemic health when this ratio becomes skewed or is disrupted over time or, even for a short time? Might this be related to anxiety or panic attacks?

What we do know for certain is that the inferior and caudal movements of the diaphragm during respiratory inhalation is what creates the primary diffusion gradient that draws raw blood products back into the heart. It is my postulation that the diaphragm cannot, and does not, do the job all by itself. The body has multiple pumps and inherent relationships innately designed to assist the heart and the diaphragm in this very important return flow process.

An Osteopathic construct introduced to me by Dr. Richard MacDonald in 1988, postulates that the foot/ankle complex functions as the body's second heart.5 That the combined actions of dorsiflexion and plantar flexion initiated by the powerful gastrocnemius and soleus muscles with each and every step we take is what creates the seminal push that provides the momentum of flow upward against gravity, and in coordination with the intrinsic flipper valves within the veinous and lymph vessels, is the process which propels these fluids to at least reach the pelvic floor, or further proximally.

Does this underscore the importance of exercise, walking, Ti Chi or Yoga as health enhancing? I certainly believe so! The vascular system's efficiency is obviously dependent upon movement. And/or in the face of being unable to ambulate some additional means of manually or mechanically pumping these fluids is really important to substitute.

Now, what happens once these fluids reach the pelvic floor? Are we to imagine that the diaphragm's earlier described movements and the pressure gradient it stimulates are enough to draw these fluids further upward and to complete the journey back to the heart or are there other factors at work to assist their flow?

In 1986, Dr. Jean Pierre Barral, DO, galvanized my thinking about how the human body really works in this regard when he stated simply, "that, normal circulation is dependent upon the pressure within the thoracic cavity being ‘less' than that of either the abdominal pelvic cavity, or that of the cranial cavity."6 This leads us to many significant therapeutic implications regarding how this pressure differential becomes skewed and how we might restore this relationship. Yet, the first step is to recognize just how important this idea is to our work with clients. Fluids do freely move from an area of higher concentration to one of a lower concentration naturally when they are not restricted or blocked from doing so.

What I have discovered is that as one reduces the resistances to the heart and lungs expansion you get a "two for one effect" because these same intentions are achieved by whatever means of technique, reduces the pressure within the chest cavity consistently. And, one can kinesthetically verify this by feeling the pressure within the chest decrease as the tissues become softer and more distensible. A therapeutic response is indicated when the thorax depresses more easily when we compress it after treatment.

It has taken me decades to fully comprehend the implications of how frequent it is for raw blood products to build up within the abdomen and pelvis and how this relates to so many of the somatic complaints of our clients. Low back pain is just the tip of the iceberg, yet it is the most frequent complaint registered above all others and the reason for the most days of lost work in our society.7 I have never read in any scientific journal that congestion is a primary variable in its perpetuation; yet, deductive reasoning suggests that it is.

What are the most common areas where congestion occurs? Image the vascular tree descending below the diaphragm. Conceive of it as two rivers, one flowing inferiorly from the heart while the other flows superiorly back to the heart/lung complex. My experience has been that congestion builds in either or both of these rivers within the abdomen, pelvis, and within the thorax.

The naturally low pressure systems of the venous and lymphatic vessels are acutely vulnerable to their rate of flow being slowed by cringing of the peritoneal sac and by the shortening, narrowing, and twisting tendencies of the small and large bowel within the abdomen. The same tendency to restrict venous and lymphatic flow is caused by the shortening and narrowing of the esophagus and the cringing of the pericardium and pleural sacs in the thorax.

The internal arrangement of our organs is exceptionally compact. Any shift from normal positioning may encroach upon these vascular rivers, thus negatively affecting their rate of flow. Whether venous or arterial, we take it for granted that both sides flow without difficulty but, in fact, their respective flow is often impeded. My experience is that when we are able to restore the sliding and gliding between the sacs and tubes, thus re-establishing the normal spatial relationships within the abdomen, pelvis and thoracic cavity, the body as a whole begins to function more efficiently. Scar tissue and adhesions from a host of possible sources are probable co-conspirators here.

What my clients have taught me is that the body's most common plumbing problem occurs where the common bile duct enters into the small intestine through the Sphincter of Oddi. When the fluids of bile, pancreatic enzymes and juices do not reach the duodenum, then resistance to the flow of these fluids often provokes inflammation within the pancreas, gall bladder or liver.

All of these organs sit directly on top of the inferior vena cava and the collecting duct for the lymph, the Cisterni Chyli. Within the small intestine, if these fluids designed to help break down what we eat are insufficient in quantity, the small intestine's only recourse is to swell, thus using surface area as its last resort toward completing its task of absorption. The common result is the experience of gas and bloating so many of our clients report to us.8

Another location of frequent congestion is within the chest. The thoracic duct which carries the lymph further upward against gravity to its outflow into the left subclavian vein is often challenged as well. In a peculiar inelegance of design, this duct crosses from right to left across the front of the spine leaving itself that much more vulnerable to the cringing of the pericardium and the pleural sacs, as well as the shortening and narrowing of the esophagus.

When clients present with pain between their scapulae, it is the congestion of this duct that is often at the root of their problem. And allow me to hastily add that often a vertebra or rib head will often have subluxed as well. Ostensibly this subluxation is the first layer of what has provoked their pain; yet, beneath it is the congestion within the thoracic duct that is the real culprit. I suspect that persistent congestion here in such close proximity to the heart/lung complex may contribute to the progression of cardiovascular disease.

As soft tissue therapists, we are initially trained to feel tension in the superficial tissues. We are rarely educated as to how this reflects internal states of congestion. I respectfully propose that our initial orientation to how the body really works was simply incomplete. Consider that from this moment forward when you feel tension in tissues that it infers congestion, whether local or systemic, and it may also infer joint subluxation... another causative factor in stimulating congestion and another subject for future exploration in this column.


  1. A Look at Compression, Congestion and Dis-Coordination, Massage Today August, 2014 Vol.14, Issue 8.
  2. The Sacs & Tubes Theory of Stress, Massage Today January, 2014, Vol. 14, Issue 01.
  3. National Geographic Magazine, "Healing the Heart", February, 2007, Vol. 211, No.2.
  4. Freeing the Heart: The Role of the Autonomic Nervous System, Massage Today, January, 2013, Vol 13, Issue 01.
  5. Dr. Richard MacDonald, DO, Functional Anatomy Courses, The Upledger Institute, 1988-1989.
  6. Dr. Jean Pierre Barral, DO, Visceral Manipulation class notes 1987-1993.
  8. Part II: Chronic Problems Related To Gallbladder Dysfunction/Disease, Massage Today July 2007 Vol 07, Issue 07.

Click here for more information about Dale G. Alexander, LMT, MA, PhD.


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