Physiotherapy of Lymphatic System Disorders

The lymphatic system is constituted by the system of lymphatic vessels with lymph-nodes, the lien, the thymus, and tonsillae.

Blood, interstitial fluid, lymph, and cerebrospinal fluid are collectively referred to as bodily fluids.

1.   DRAINAGE FUNCTION OF THE LYMPHATIC SYSTEM

Intercellular space (interstitium) is washed by interstitial fluid, 90% of which is absorbed by the blood circulation system and 10% turns into lymph. Lymph is drained off the bodily tissues via lymphatic vessels - first it enters into capillaries and flows on via lymph collectors with valves into lymph trunks (lymphatic ducts) which finally lead into the blood steam, namely vena cava inferior and vena cava superior. This is how bodily tissues are drained off.

Human body contains up to 10-15 liters of interstitial fluid. 2-3 liters of lymph are drained off on a daily basis.

2.    IMMUNITY FUNCTION OF THE LYMPHATIC SYSTEM

Filtering of substances that are contained in the lymph is performed by lymph nodes, constituted by clusters of lymphocytes. Human body contains approximately 450 lymph nodes, with highest concentration of them located at the front part of the neck, in axilla (armpits), in the groin, in mediastinum, but also laid at deeper levels such as along the large arteries (aorta), in areas where important organs are anchored, around the small intestine, etc.

Lymphocytes (B and T) play an important part in immunity reactions of the organism. B-lymphocytes participate in production of antibodies, and T-lymphocytes take part in cell-mediated immunity reactions.

There is no immunity reaction without lymphocytes.

3.    TRANSPORT FUNCTION OF THE LYMPHATIC SYSTEM

Lymphatic circulation occurs due to contractions of lymph collector walls - supported by contractions of skeletal muscles upon locomotion, by breathing whereby - upon in-breath -intrathoracic decompression occurs which sucks the lymph into the breast, more precisely to the thoracal lymphatic duct; furthermore by pulsation of surrounding arteries and arteriolae, and by the pressure in blood capillaries which influences the speed of interstitial fluid formation and interstitial fluid pressure.

Partial or complete failure of the lymphatic system leads to ELEPHANTIASIS = LYMPHOEDEMA.

• Primary lymphoedema is a consequence of innate damage (non-formation) of lymph vessels - hypoplasia (reduced caliber - cross-section or number of lymph vessels) or hyperplasia (overflow of lymph vessels, causing accumulation of lymph volume)
• Secondary lymphoedema is a consequence of obliteration (congestion) of blood vessels. It may be caused by:

a) inflammatory reaction - viruses, bacteria, parasites, fungi, insect bite,...
b) traumatic lymphangiopathy - trauma (injury) transecting the lymphatic vessels or creating a barrier
c) malignant or benign processes - blocking or destruction of lymphatic vessels
d) iatrogenous causes - effected by the physician - such as removal of nodes for preventative reasons