PT Classroom - Is Lymphatic Balancing the Missing Ingredient to Success in Your Practice? by Kerry D’Ambrogio, DOM, AP, PT, DO-MTP & Tracey Clark DO (MP), DCMOEB

Kerry D’Ambrogio is a physical therapist, osteopath and board-certified acupuncture physician. He is the president and director of the D’Ambrogio Institute and Therapeutic Systems, Inc., in Sarasota, Fla. He is the co-author of Positional Release Therapy (Mosby). D’Ambrogio is a graduate of the physical therapy program at the University of Toronto (Canada), the osteopathic program at the Canadian Academy of Osteopathy (Hamilton, Ont.), the John Wernham College of Classical Osteopathy (Maidstone, England), and the acupuncture program at the Academy of Chinese Healing Arts (Sarasota, Fla.).

Is Lymphatic Balancing the Missing Ingredient

to Success in Your Practice?

Many manual practitioners think of lymphatic drainage techniques as an area of specialty that may not factor into their practice and is only for patients with lymphedema. The belief that working with the lymphatic system will require taping techniques or complicated draping may have prevented practitioners from incorporating specific lymphatic work into their treatment. In fact, adding a principle based approach to lymphatic system support and balancing may be easier than thought and may be the answer to getting lasting results for some difficult cases that don’t seem to respond to current treatment protocols. The ability to incorporate lymphatic balancing into treatment will also promote healing from the inside out by helping to create an internal environment that is conducive to healing.

Within the hierarchy of healing, the principle that the movement of fluids is essential to the maintenance of health is one of the basic tenets of osteopathic medicine. Perhaps even more important is the concept that drainage must precede supply. This could be understood to be referencing the drainage of venous blood as a preparation for the delivery of arterial blood flow but we must not forget the incredibly important role that the lymphatic system plays in the purification of tissues, fluid balance, immunity and digestion. Dr. Andrew Taylor Still, the father of Osteopathy, emphasized that the treatment of the lymphatic system was vital for the treatment of disease and the maintenance of health and homeostasis. He stated “We strike at the source of life and death when we go to the lymphatics”.


The Lymphatic System
On a daily basis approximately 30 liters of fluid filters out of the capillaries with oxygen and nutrition into the interstitial spaces. Of that only 27 liters will return to circulation. The remaining 3 liters drains into the lymphatic system. The lymphatic system is made up of a network of thin tubes that run throughout the body called lymph vessels and oval-shaped organs called lymph nodes which collect and filter lymph. Before passing into the capillaries of the lymphatic system, the fluid cleans the extracellular spaces of particulate matter, exudates and bacteria. Lymph vessels collect and filter this fluid in lymph nodes before directing it toward blood vessels near the heart. It is here that lymph re-enters blood circulation. Returning lymph to the blood helps to maintain normal blood volume and pressure. It also prevents edema, the excess accumulation of fluid around tissues.

The proper functioning of the lymphatic system is critical to our body's ability to detoxify and regenerate tissues. The lymphatic system filters out toxins and foreign substances, recovers crucial substances that have escaped from the blood, and helps maintain a healthy immune system.

If the lymph circulation stagnates due to injury or infection, toxins accumulate, and cellular metabolism is significantly compromised. The result is an increase in acid and toxins within the tissues causing pain, tension, and edema. These substances, along with the edema, need to be removed quickly from the interstitial fluid, in order to promote proper tissue healing and restore proper pain-free movement.

History and Development of Lymphatic Balancing
The history of lymphatic drainage techniques dates back to the late 1800’s when the faculty at the first osteopathic college in Kirksville, Illinois began research on distribution within the vascular and lymphatic systems. Frederic Millard, DO, one of Still’s students, published Applied Anatomy of the Lymphatics in 1922, which led the way for further research and development of specific techniques aimed at treating the lymphatic system. J. Gordon Zink, DO, FAAO, inspired by the work of Millard, expanded the concepts to include the Respiratory-Circulatory model placing a special emphasis on the influence of fascial restrictions on the flow of venous and lymphatic return and the importance of creating pressure differentials in the cavities of the body to encourage the ease of flow.

Lymphatic Balancing was designed by Dr. Kerry D’Ambrogio to treat excess fluid or swelling, fluid stagnation or lymphedema in the cranium, spine, rib cage, visceral system, and the upper (shoulder, elbow, wrist and hand) and lower extremities (hip, knee, ankle and foot). Lymphatic Balancing expands on the work and teachings of Dr. Emil Vodder (Vodder Method), Bruno Chikly MD (Lymphatic Drainage Technique), Dr. Albert Leduc PT, PhD (Leduc method) and osteopathic lymphatic pumping techniques. These techniques can be applied to a wide range of clientele within the orthopedic community.

Lymphatic Balancing builds on the principle- based concepts of Dr. Still while incorporating the use of gentle, rhythmical pumping techniques, both long and short levers, to encourage the healthy flow of lymph. First developed by Earl Miller DO, the lymphatic pump is a manual technique that makes the use of both long and short levers to re-establish the rhythmical flow of lymph. Pumping techniques can be easily integrated into a multitude of manual treatment approaches without the need for special draping or taping. It is a non-invasive approach in which the risk to benefit ratio is exceptional.

Benefits of Lymphatic Balancing
The outcomes of a Lymphatic Balancing include the restoration of proper joint biomechanics, functional range of motion and optimal postural alignment. This gentle, hands-on approach is efficacious in the treatment of back pain, sciatica, neck pain, headaches, rib pain, upper and lower extremity orthopedic dysfunctions, swelling, and postural asymmetry.

The Lymphatic Balancing courses at the D’Ambrogio Institute topics include:
• How to first decide if lymphatic balancing is a priority.
• The history, principles, and neuromuscular basis of Lymphatic Balancing and the significant anatomy of the lymphatic system and supporting structures.
• How to conduct a thorough specific orthopedic evaluation using ARTS (Asymmetry, Range of Motion, Tension Tests and Special Tests) of the cranium, spine, thorax, abdomen (viscera), and upper and lower extremity.
• Charting results of the evaluation and formulating a treatment plan
• How to determine the proper sequence of treating the Total Body Lesion
• Performing Lymphatic Balancing on the nodes, vessels, and tissues of the cranium, spine, thorax, abdomen, and upper and lower extremity.
• The clinical importance of Lymphatic Balancing for the treatment of excess fluid, swelling, or lymphatic stagnation in relation to muscular skeletal dysfunctions.
• Integrating Lymphatic Balancing with other treatment modalities taught at the D'Ambrogio Institute.

Lymphatic Balancing is taught as three courses (Total Body Approach and a Local Approach for the Upper & Lower Quadrant).

The courses can be taken in any order.

Lymphatic Balancing; Total Body Approach (LBTB)
: This course teaches you how to perform a Total Body Evaluation (ARTS), and treat excess fluid or swelling in the body. This class teaches you a total body approach to lymphatic balancing. LB is a useful place to start for new patients before performing specific LB on local regions of the body, or as maintenance for the patient.

Lymphatic Balancing; Local Approach - Upper Quadrant (LBUQ): This course teaches you how to perform a local evaluation (ARTS), and treat excess body fluid or swelling in the cranium, cervical spine, thoracic spine, thorax, upper abdomen (viscera), and upper extremities (shoulder, elbow, wrist and hand).

Lymphatic Balancing; Local Approach - Lower Quadrant (LBLQ): This course teaches you how to perform a local body evaluation (ARTS), and treat excess body fluid or swelling in the lower abdomen (viscera), lumbar spine, pelvis, sacrum, and lower extremities (hip, knee, ankle and foot).

LB helps reduce swelling in the cranium, spine, rib cage, visceral system, and the upper (shoulder, elbow, wrist and hand) and lower extremities (hip, knee, ankle and foot).

LB helps to restore proper joint biomechanics, functional range of motion, and postural alignment.

LB is appropriate with the following patient populations: pediatrics, adolescents, young adults, adults, and geriatrics.

For more information regarding Lymphatic Balancing, how it can benefit your patients, and training seminars, please go to

Last revised: August 20, 2016
by Dr. Kerry D’Ambrogio, D.O.M., A.P., P.T., D.O.-M.T.P.

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