The Effects of Osteopathic Manipulation Techniques on the Lymphatic System

Osteopathic manipulation techniques (OMT) have been utilized by osteopathic physicians to treat a variety of conditions including musculoskeletal dysfunctions, edema, inflammation, and disease. However, the mechanisms by which OMT aides the body in healing are not well understood. The long-term goal of our research is to advance our understanding of the impact of OMT during inflammatory disease, such as sepsis. The purpose of this study was to develop a swine model and to establish surgical techniques that will be used in future studies investigating the impact of OMT on the lymphatic system during disease. We hypothesized that the abdominal lymphatic pump technique (LPT) would enhance thoracic duct lymph (TDL) flow. Four swine subjects (two male and two female) were placed under anesthesia. The thoracic duct was exposed via thoracotomy then cannulated using an angio-catheter. TDL was collected from the four pigs during four-minutes of baseline, four-minutes of LPT, and four minutes post-LPT. TDL flow was measured by timed collection during each condition. TDL was centrifuged to remove the cellular components, and the supernatant was stored for biomarker analysis. Results: TDL flow at baseline was 2.2 ± 1.0 mL/min and LPT increased lymph flow rate to 5.58 ± 1.8 mL/min. In two experiments, thoracic lymph nodes and thoracic duct lymph were collected, and leukocyte were isolated to optimize the flow cytometry staining protocol. In our pilot study, LPT increased TDL flow approximately 2-fold in our swine subjects and demonstrated surgical feasibility. In future studies we will study the physiological effects of OMT, including LPT, during sepsis. This knowledge would provide an evidence-based foundation for the use, or contraindication, of OMT during sepsis and aid osteopathic physicians during their therapeutic decision making.