Massage Therapy Journal Winter 2024

44 • Massage Therapy Journal

AMTA Continuing Education

jugular trunks then into the right lymphatic or thoracic ducts. The largest lymph vessel in the body is the thoracic duct, which is situated anteriorly to the spine lying deep within the trunk, starting approximately at L2, penetrating the diaphragm, terminating at the left venous angle (the junction where the left internal jugular and left subclavian vein meet). The cysterna chyli, a saclike structure that receives intestinal lymph known as chyle, is at the base of the thoracic duct. Chyle has a milky white appearance due to the fat absorption taking place in the small intestines. The chyle enters the thoracic duct and is transported to the cardiovascular system, where it becomes part of the blood circulating around the body. Three-quarters of the body, which include both lower extremities, both lower trunk quadrants, left upper trunk quadrant, left upper extremity and left side of head and neck, drain into the thoracic duct. The remaining quarter of the body, right upper trunk quadrant, right upper extremity and right side of head and neck, drain into the right lymphatic duct, which terminates at the right venous angle. Interstitium and Interstitial Fluid: How It Works and Potential Problems Connective tissue supports the framework of all parts of the body, is the most extensive tissue found in the human body, and is classified according to its degree of hardness. • Soft connective tissue is a semiliquid material found between cells, including adipose tissue (fat). • Fibrous connective tissue , such as ligaments and tendons, is densely packed with fibroblast cells that produce the fibers that provide strength and durability. • Hard connective tissue is more solid and includes cartilage and bone. • Liquid connective tissue is the fluid that circulates around the body, such as blood and lymph.

It is estimated that at least one-sixth of the human body is made up of a type of soft connective tissue known as the interstitium or the extracellular matrix, a gelatinous-like substance that supports our cells while acting as a medium for the transportation of nutrients and removal of waste. The interstitium contains numerous substances, including proteoglycan filaments, fibroblasts, collagen fibers, polysaccharides, hyaluronan, glycoproteins and fluid, each of which play an important role in the maintenance and repair of our cells and tissues. • Proteoglycan filaments are comprised of proteins and sugar molecules that help to regulate the movement of water through the interstitium. • Fibroblasts play a crucial role in the synthesis of collagen, control interstitial tissue pressure and develop into preadipocytes, the precursor to a fat cell. • Collagen fibers support the structure of interstitial spaces and hyaluronan—sometimes referred to as the goo molecule—contributes to the movement of water within the interstitium. An accumulation of hyaluronan can contribute to extracellular edema. Alfred Pischinger, a professor of histology and embryology at the University of Vienna and author of The Extracellular Matrix and Ground Regulation , wrote extensively about the extracellular matrix. He states that cells have a reciprocal relationship with their environment and the fluid surrounding the cell can be likened to seawater. He also found that the very existence of all organ cells depends on the intact functioning of the system that guarantees their environment. Blood capillaries transport oxygen and nutrients to the periphery so that cells and tissues can receive essential nutrients to survive. The nutrients leave the blood capillary by a process known as diffusion, which is the movement of molecules from areas of high concentration to low concentration to establish equilibrium. The movement of these molecules is dependent upon the surface area, temperature and size of the molecules.

It is estimated that at least one-sixth of the human body is made up of a type of soft connective tissue known as the interstitium or the extracellular matrix, a gelatinous-like substance that supports our cells while acting as a medium for the transportation

of nutrients and removal of waste.

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