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The Role of Manual Lymphatic Drainage in Fibromyalgia
Several things, from exercise to hot weather, can cause swollen hands. The first lymph sacs to appear are the paired jugular lymph sacs at the junction of the internal jugular and subclavian veins. Respiratory structures in the head and neck, Sagittal section of the left side of the head and neck showing the location of respiratory structures Part 1. Retrieved 26 October Boosting the Immune System anti-oxidants Regeneration of damaged tissues organic nutrients Destruction of cancer without destroying the body Psychological Healing An integrated comprehensive approach is the patient's best insurance policy for beating cancer. Abdominal aorta and its principal branches, Anterior view of superior mesenteric artery and its branches.

Lymphatic circulation

Anatomy Drill and Practice

It consists of connective tissue formed of reticular fibers , with various types of leukocytes , white blood cells , mostly lymphocytes enmeshed in it, through which the lymph passes. Lymphoid tissue can either be structurally well organized as lymph nodes or may consist of loosely organized lymphoid follicles known as the mucosa-associated lymphoid tissue. The central nervous system also has lymphatic vessels, as discovered by the University of Virginia Researchers.

The search for T-cell gateways into and out of the meninges uncovered functional meningeal lymphatic vessels lining the dural sinuses , anatomically integrated into the membrane surrounding the brain.

The lymphatic vessels , also called lymph vessels, conduct lymph between different parts of the body. They include the tubular vessels of the lymph capillaries , and the larger collecting vessels—the right lymphatic duct and the thoracic duct the left lymphatic duct.

The lymph capillaries are mainly responsible for the absorption of interstitial fluid from the tissues, while lymph vessels propel the absorbed fluid forward into the larger collecting ducts, where it ultimately returns to the bloodstream via one of the subclavian veins. These vessels are also called the lymphatic channels or simply lymphatics.

The lymphatics are responsible for maintaining the balance of the body fluids. Its network of capillaries and collecting lymphatic vessels work to efficiently drain and transport extravasated fluid, along with proteins and antigens, back to the circulatory system. Numerous intraluminal valves in the vessels ensure a unidirectional flow of lymph without reflux.

The collecting lymphatics, however, act to propel the lymph by the combined actions of the intraluminal valves and lymphatic muscle cells. Lymphatic tissues begin to develop by the end of the fifth week of embryonic development. The first lymph sacs to appear are the paired jugular lymph sacs at the junction of the internal jugular and subclavian veins.

Each jugular lymph sac retains at least one connection with its jugular vein, the left one developing into the superior portion of the thoracic duct. The next lymph sac to appear is the unpaired retroperitoneal lymph sac at the root of the mesentery of the intestine. It develops from the primitive vena cava and mesonephric veins. Capillary plexuses and lymphatic vessels spread from the retroperitoneal lymph sac to the abdominal viscera and diaphragm. The sac establishes connections with the cisterna chyli but loses its connections with neighbouring veins.

The last of the lymph sacs, the paired posterior lymph sacs, develop from the iliac veins. The posterior lymph sacs produce capillary plexuses and lymphatic vessels of the abdominal wall, pelvic region, and lower limbs. The posterior lymph sacs join the cisterna chyli and lose their connections with adjacent veins. With the exception of the anterior part of the sac from which the cisterna chyli develops, all lymph sacs become invaded by mesenchymal cells and are converted into groups of lymph nodes.

The spleen develops from mesenchymal cells between layers of the dorsal mesentery of the stomach. The lymphatic system has multiple interrelated functions: Lymph vessels called lacteals are at the beginning of the gastrointestinal tract , predominantly in the small intestine.

While most other nutrients absorbed by the small intestine are passed on to the portal venous system to drain via the portal vein into the liver for processing, fats lipids are passed on to the lymphatic system to be transported to the blood circulation via the thoracic duct.

There are exceptions, for example medium-chain triglycerides are fatty acid esters of glycerol that passively diffuse from the GI tract to the portal system.

The enriched lymph originating in the lymphatics of the small intestine is called chyle. The nutrients that are released into the circulatory system are processed by the liver , having passed through the systemic circulation. The lymphatic system plays a major role in the body's immune system, as the primary site for cells relating to adaptive immune system including T-cells and B-cells. Cells in the lymphatic system react to antigens presented or found by the cells directly or by other dendritic cells.

When an antigen is recognized, an immunological cascade begins involving the activation and recruitment of more and more cells, the production of antibodies and cytokines and the recruitment of other immunological cells such as macrophages.

The study of lymphatic drainage of various organs is important in the diagnosis, prognosis, and treatment of cancer. The lymphatic system, because of its closeness to many tissues of the body, is responsible for carrying cancerous cells between the various parts of the body in a process called metastasis. The intervening lymph nodes can trap the cancer cells. If they are not successful in destroying the cancer cells the nodes may become sites of secondary tumours.

Lymphadenopathy refers to one or more enlarged lymph nodes. Small groups or individually enlarged lymph nodes are generally reactive in response to infection or inflammation. This is called local lymphadenopathy. When many lymph nodes in different areas of the body are involved, this is called generalised lymphadenopathy. Generalised lymphadenopathy may be caused by infections such as infectious mononucleosis , tuberculosis and HIV , connective tissue diseases such as SLE and rheumatoid arthritis , and cancers , including both cancers of tissue within lymph nodes, discussed below, and metastasis of cancerous cells from other parts of the body, that have arrived via the lymphatic system.

Lymphedema is the swelling caused by the accumulation of lymph, which may occur if the lymphatic system is damaged or has malformations. It usually affects limbs, though the face, neck and abdomen may also be affected. In an extreme state, called elephantiasis , the edema progresses to the extent that the skin becomes thick with an appearance similar to the skin on elephant limbs.

Causes are unknown in most cases, but sometimes there is a previous history of severe infection, usually caused by a parasitic disease , such as lymphatic filariasis. Lymphangiomatosis is a disease involving multiple cysts or lesions formed from lymphatic vessels. Lymphedema can also occur after surgical removal of lymph nodes in the armpit causing the arm to swell due to poor lymphatic drainage or groin causing swelling of the leg.

Treatment is by manual lymphatic drainage. There is no evidence to suggest that the effects of manual lymphatic drainage are permanent. Cancer of the lymphatic system can be primary or secondary. Lymphoma refers to cancer that arises from lymphatic tissue. Lymphoid leukaemias and lymphomas are now considered to be tumours of the same type of cell lineage. They are called "leukaemia" when in the blood or marrow and "lymphoma" when in lymphatic tissue.

They are grouped together under the name "lymphoid malignancy". Lymphoma is generally considered as either Hodgkin lymphoma or non-Hodgkin lymphoma. Hodgkin lymphoma is characterised by a particular type of cell, called a Reed—Sternberg cell , visible under microscope. It is associated with past infection with the Epstein-Barr Virus , and generally causes a painless "rubbery" lymphadenopathy.

It is staged , using Ann Arbor staging. Chemotherapy generally involves the ABVD and may also involve radiotherapy. It is treated according to whether it is high-grade or low-grade , and carries a poorer prognosis than Hodgkin lymphoma. Lymphangiosarcoma is a malignant soft tissue tumour , whereas lymphangioma is a benign tumour occurring frequently in association with Turner syndrome. Lymphangioleiomyomatosis is a benign tumour of the smooth muscles of the lymphatics that occurs in the lungs.

Lymphoid leukaemia is another form of cancer where the host is devoid of different lymphatic cells. Hippocrates , in the 5th century BC, was one of the first people to mention the lymphatic system. In his work On Joints , he briefly mentioned the lymph nodes in one sentence. Rufus of Ephesus , a Roman physician, identified the axillary, inguinal and mesenteric lymph nodes as well as the thymus during the 1st to 2nd century AD. In the mid 16th century, Gabriele Falloppio discoverer of the fallopian tubes , described what is now known as the lacteals as "coursing over the intestines full of yellow matter.

The lacteals were termed the fourth kind of vessels the other three being the artery, vein and nerve, which was then believed to be a type of vessel , and disproved Galen's assertion that chyle was carried by the veins. But, he still believed that the lacteals carried the chyle to the liver as taught by Galen.

He suspected that fluid to be chyle as its flow increased when abdominal pressure was applied. He traced this fluid to the thoracic duct, which he then followed to a chyle-filled sac he called the chyli receptaculum, which is now known as the cisternae chyli ; further investigations led him to find that lacteals' contents enter the venous system via the thoracic duct.

The idea that blood recirculates through the body rather than being produced anew by the liver and the heart was first accepted as a result of works of William Harvey —a work he published in In , Olaus Rudbeck — , a Swede, discovered certain transparent vessels in the liver that contained clear fluid and not white , and thus named them hepatico-aqueous vessels. He also learned that they emptied into the thoracic duct and that they had valves. He is also the one to have named them "lymphatic vessels.

Galen's ideas prevailed in medicine until the 17th century. It was thought that blood was produced by the liver from chyle contaminated with ailments by the intestine and stomach, to which various spirits were added by other organs, and that this blood was consumed by all the organs of the body. This theory required that the blood be consumed and produced many times over. Even in the 17th century, his ideas were defended by some physicians.

Alexander Monro , of the University of Edinburgh Medical School , was the first to describe the function of the lymphatic system in detail. Lithograph by Pierre Roche Vigneron. Lith de Gregoire et Deneux, ca. Lymph originates in the Classical Latin word lympha "water", [32] which is also the source of the English word limpid. The adjective used for the lymph-transporting system is lymphatic. The adjective used for the tissues where lymphocytes are formed is lymphoid. Lymphatic comes from the Latin word lymphaticus , meaning "connected to water.

From Wikipedia, the free encyclopedia. For the massage technique, see Manual lymphatic drainage. Castleman's disease Chylothorax Kawasaki disease Kikuchi disease Lipedema Lymphangitis Lymphatic filariasis Lymphocytic choriomeningitis Solitary lymphatic nodule.

Olaus Rudbeck in Biology portal Medicine portal. Primer to the immune response. Retrieved 12 November Gray's anatomy Thirty-fifth ed. Retrieved 26 October Dispensable but not irrelevant".

The New York Times. Archived from the original on Saunders Comprehensive Veterinary Dictionary 3rd ed. Retrieved — via The Free Dictionary by Farlex. Information, Surgery and Functions". Childrens Hospital of Pittsburgh - Chp. Lay summary — National Institutes of Health. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes.

The unique location of these vessels may have impeded their discovery to date, thereby contributing to the long-held concept of the absence of lymphatic vasculature in the central nervous system. The discovery of the central nervous system lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and sheds new light on the aetiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction.

Webster's New World Medical Dictionary. Bulletin of Mathematical Biology. Review of Medical Embryology. Retrieved Feb 25, Specific causes for fibromyalgia are unknown, but it is thought that a number of factors may be involved that could trigger fibromyalgia, which may include. This examination is based on criteria set by the American College of Rheumatology ACR for the diagnosis and classification of fibromyalgia 3.

Individuals affected by fibromyalgia may feel pain at other sites as well, however, those 18 standard possible sites on the body are the criteria used for classification. Due to the difficult nature of fibromyalgia, treatment requires a team approach including the patient, physicians familiar with the condition rheumatologists, internists , physical-, massage- and occupational therapists, and other health care professionals.

The main goal is the relief of pain and other symptoms associated with fibromyalgia and helping the affected individual to cope with the condition. Treatment may include physical therapy, stress-relief methods, including light massage and manual lymph drainage, and medication for pain and sleep management.

More information on these various treatment approaches is available on various online resources 4, 5. Several studies on the effectiveness of manual lymph drainage MLD in the treatment of fibromyalgia indicate that MLD yields positive results in terms of pain relief, stiffness, sleep and general health status 6, 7, 8.

As readers of this blog know, massage and manual lymph drainage are two very different manual treatment modalities. It is unfortunate that the term massage is often wrongly used to describe MLD. The origin of the word massage is derived from the Greek massain to knead and is used to describe such techniques as effleurage, petrissage, vibration, etc.

Compared to traditional massage, the pressure applied with manual lymph drainage is much lower in intensity. The goal of these techniques is to manipulate the lymphatic structures located in the subcutaneous tissues.

In order to achieve the desired effect, the pressure should be sufficient enough to stretch the subcutaneous tissues against the fascia a structure separating the skin from the muscle layer located underneath, but not to manipulate the underlying muscle tissue. Do you need more information on other topics on lymphedema? Once selected, a new page will load with a number of articles related to the topic you chose. Click on any headline of the articles and the entire article will load up for you to read.

Join Lymphedema Guru , a Facebook page solely dedicated to inform about all things related to lymphedema — news, support groups, treatment centers, and much more.

I do have lymphedema in both my legs from the knees down. I was first diagnosed in Prior to that my legs were very painful to the touch. I never thought about fibromyalgia until I received your email. I never had a clue why my legs were so very sensitive to the touch. I was told by a lymphedema doctor that I may have a combination of lipodema and lymphedema. After reading your article, and also after years of treating patients with all kinds of conditions, I imagine that MLD is an underutilized treatment modality.

Does anyone do post op MLD with orthopedic, abdominal, back surgeries. As a Lymphedema Therapist, I would like to find more research based studies on these. Can you direct me to any sites that are valuable? Again a very very big thanks for this important article. There are quite a few lymphers who also have fibro. It is an interesting connection.

Fibro is considered an autoimmune condition and lymphedema seriously effect the cell mediated immune system of our bodies. Thank you Jo, This article hit close to home for me. I have been practicing Lymphedema therapy for only 5years, and I have never thought of the treatment being very possibly helpful to my sister suffering with Fibro and Chronic fatique syndrom for several years now. My question would be: Or is the pain from the fibromalgia pain siginals very localized?

Thank for your reply. In this case it is not necessary to apply techniques on the neck. MLD in the treatment for fibromyalgia is geared toward pain management gate-control theory.

Hi and thanks for the interesting article. I have to be put under general anesthesia in order to have a routine colonoscopy done. Also,I have read that the 11 out of 18 points being used for diagnosis assistance are now pretty obsolete, as people with FMS can have lots of pain in all sorts of places on their body. Have you heard anything about that?

I was a public school Special Education teacher for 25 years before these two syndromes knocked me slap out and I was having such a terrible time even trying to get out of bed to get ready for work. One rheumatologist thought that I might have Chronic Pain Syndrome, as the pain is everywhere. I do feel that retroviruses are going to eventually be found to be part of the FMS picture. When I have had to take an antibiotic, it seems to help my entire system feel a bit better for the time that I am taking the antibiotic.

Thank you so much for the information. Whenever I have tried to take Physical Therapy, it only made me feel worse and basically put me to bed for a week or so. But I do know that we are all different!

Getting pain medication here in South Carolina has been made much more difficult, by the illegal use by drug abusers. So now, I have to go in once a month to my dr. What you say about the different names is interesting, as well.

When my mother, now deceased, was a young adult, the dr. She had a lot of pain, but it was thought to be pain from Osteo-Arthritis. I would appreciate if you could send me references of places where I can get MLD treatment in the Washington DC metropolitan area Virginia Maryland as I have all the symptoms described as fibromyalgia and have been in terrible pain for many years.

Doctors never found an explanation. Have done physical therapy and acupuncture without any results. Thank you very much. My edema was also in my arms and face so I brushed all over. Great invigorating sensations for the minutes.

Muscular System Physiology