Update on osteopathic medical concepts and the lymphatic system.

The osteopathic medical profession has long recognized the importance of the lymphatic system in maintaining health. A review of scientific studies shows much information on the mechanisms and importance of lymph circulation. Many osteopathic manipulative techniques designed to treat patients with tissue congestion are based on early research recognizing that lymph flow is influenced by myofascial compression. Osteopathic manipulative treatment of the diaphragm was substantiated when pressure differentials created by the thoracic diaphragm were shown to influence lymph flow. Current research demonstrates that autonomically mediated, intrinsic lymphatic contractility plays a significant role in lymph propulsion, supporting the use of osteopathic manipulative techniques directed at influencing the autonomic nervous system to improve lymphatic circulation. Although research provides an explanation of how osteopathic manipulative techniques influence the lymphatic system, experimentation to test the direct influence of manipulation on lymph circulation is needed. Clinical outcomes studies are also necessary to substantiate the clinical efficacy of osteopathic manipulative techniques.