Massage Therapy Journal Winter 2024

42 • Massage Therapy Journal

AMTA Continuing Education

cellular matrix—is the matter that lies between the cells. It is here where the initial lymphatic vessels are located and begin the process of removing excess tissue fluids. The lymphatic vessels are subdivided into four types of vessels: lymphatic capillaries, pre collectors, collectors, trunks and ducts. These are then divided further into the superficial system, which drains the skin and subcutis, and the deeper system, consisting of vessels that are larger in diameter and located deeper in the body. These vessels receive lymphatic fluid from subfascial regions of the extremities and the trunk, the muscles, joints, tendons and nerves. Lymphatic capillaries originate in the interstitium and form an extensive network throughout the body. Their main function is to absorb interstitial fluid, which contains water, proteins, fats and cells. The wall of the lymph capillary is made from flat endothelial cells that overlap to form inlet vents that are often likened to the layout of roof tiles and allow the influx of interstitial fluid from the interstitial space. Anchoring filaments are attached to the exterior surface of these cells and serve as an opening mechanism for the inlet vents. Because the filaments are also connected to the fibers of the interstitium, an increase in interstitial fluid causes the filaments to become taut, subsequently opening the inlet vents and allowing the influx of interstitial fluid into the capillary. Lymphatic 2

load is the name given to interstitial fluid that has entered the lymphatic vascular system. The lymphatic load consists of: • Protein transported through the lymphatic system in a 24-hour period, believed to total approximately 75 to 100 grams • Water that has moved from blood capillary from filtration • Cells , including lymphocytes and dead cells • Fats , including long chain fatty acids and fat soluble vitamins from fat digestion in the small intestines • Other , including plasma, electrolytes, amino acids, carbohydrates and hormones Lymphatic capillaries are the only lymphatic vessels that do not contain valves. Lymph collectors. Once the lymphatic capillary is full, the collected lymph fluid moves into a pre-collector , and is then transported further to collectors . A lymph collector is where the lymphatic fluid starts to move in a structured direction of flow. Collectors are similar in structure to veins in the circulatory system. They are made up of a three-layer wall with bicuspid valves that maintain a one-way proximal lymph flow by preventing flow distally when closed. Their walls are thinner, however, and the valves are located in shorter intervals. The sections between the distal and proximal valves are known as lymphangions . 4 3

Stages of lymphedema

1

Lymphedema

Disturbed lymph flow, and fluid collection

NORMAL

Swelling

Fluid

Healthy lymphatic system

Disrupted flow

Lymph node

Lymph node

HEALTHY

LYMPHATIC OBSTRUCTION

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