{"id":3347,"date":"2021-09-01T17:31:00","date_gmt":"2021-09-01T17:31:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3347"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"omm-question-of-the-day-treatment-of-the-lymphatics","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics","title":{"rendered":"OMM Question of the Day: Treatment of the Lymphatics"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#E_Mandibular_drainage_Galbreath_technique\" >E. Mandibular drainage (Galbreath technique)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#A_Submandibular_myofascial_release\" >A. Submandibular myofascial release<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#B_Splenic_pump\" >B. Splenic pump<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#C_Counterstrain_of_the_mandible\" >C. Counterstrain of the mandible<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#D_Active_thoracic_pump\" >D. Active thoracic pump<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today&#8217;s OMM question involves a 36-year-old man with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in his ears. Which of the following techniques should be avoided in this patient?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 36-year-old man presents to your clinic with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in his ears. He has no fever, myalgias, shortness of breath, or cough. Past medical history is significant for mononucleosis when he was 16 years old; bilateral&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Temporomandibular_joint_dysfunction\" target=\"_blank\" rel=\"noreferrer noopener\">temporomandibular joint dysfunction<\/a>, for which he sees a dentist and otolaryngologist; and mild intermittent&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Asthma\" target=\"_blank\" rel=\"noreferrer noopener\">asthma<\/a>. His temperature is 37.8 \u00baC (100.0 \u00baF), pulse is 90\/min, respirations are 12\/min, and blood pressure is 133\/78 mmHg. On physical examination, he has tenderness to palpation along his maxillary sinuses. There are mildly tender and symmetrically enlarged lymph nodes at both angles of his mandible. There is a small amount of fluid behind both tympanic membranes and some mild erythema of his posterior oropharynx. His nasal turbinates are erythematous with a thick yellow mucus. Which of the following techniques should be avoided in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Submandibular myofascial release<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Splenic pump<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Counterstrain of the mandible<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Active thoracic pump<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Mandibular drainage (Galbreath technique)<\/strong>Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at AT Still University in Arizona\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/IPt_c5eUueo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Mandibular_drainage_Galbreath_technique\"><\/span>E. Mandibular drainage (Galbreath technique)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s OMM Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Submandibular_myofascial_release\"><\/span>A. Submandibular myofascial release<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This is an indirect and gentle technique in which you move the submandibular tissue into its directions of ease. This can be used safely in virtually any patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Splenic_pump\"><\/span>B. Splenic pump<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While splenomegaly or active mononucleosis is a contraindication to this technique, having mononucleosis 20 years ago is not a contraindication.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Counterstrain_of_the_mandible\"><\/span>C. Counterstrain of the mandible<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Counterstrain of the mandible is a gentle technique which can be used safely in virtually any patient. It can sometimes help with mandibular or temporomandibular joint dysfunction.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Active_thoracic_pump\"><\/span>D. Active thoracic pump<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/Asthma\" target=\"_blank\" rel=\"noreferrer noopener\">Asthma<\/a>&nbsp;that is uncontrolled or in exacerbation is a contraindication to this technique. In this patient it is mild and intermittent, and he does not clinically appear to have an exacerbation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">There are many osteopathic techniques that can be used to help improve lymphatic drainage and are usually safe in active ENT infections. Lymphatic treatments should always begin with treating the thoracic inlet to maximize&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Lymphatic_system_anatomy_and_physiology\" target=\"_blank\" rel=\"noreferrer noopener\">lymphatic flow<\/a>&nbsp;toward the thoracic duct. After that, there are several ENT and thoracic techniques, as well as splenic pump, hepatic pump, pedal pump, and many others to help improve lymphatic drainage.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mandibular drainage (Galbreath technique) works well for improving cervical lymphatic drainage. It involves gently and repetitively pulling the mandible anteriorly and medially at the angle of the mandible in a rhythmic fashion, causing distraction at the<a href=\"https:\/\/www.osmosis.org\/learn\/Temporomandibular_joint_dysfunction\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;temporomandibular joint (TMJ)<\/a>. Galbreath technique is contraindicated in patients with TMJ dysfunction as it involves repetitive distraction at that joint.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">There are many osteopathic techniques that can be used to help improve lymphatic drainage and are usually safe in active ENT infections. Mandibular drainage (Galbreath technique) works well for improving cervical lymphatic drainage but is contraindicated in patients with TMJ dysfunction as it involves repetitive distraction at that joint.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_041429.png\" alt=\"Learn more and forget less create an osmosis account.\" class=\"wp-image-3350\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_041429.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_041429.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more OMM Questions as well as practice questions for USMLE\u00ae Step 1 and Step 2 CK?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>&nbsp;Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Today&#8217;s OMM question involves a 36-year-old man with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in his ears. Which of the following techniques should be avoided in this patient? A 36-year-old man presents to your clinic with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3349,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,34,16],"tags":[],"class_list":["post-3347","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm","category-do"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: Treatment of the Lymphatics - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-treatment-of-the-lymphatics\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: Treatment of the Lymphatics - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Today&#8217;s OMM question involves a 36-year-old man with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in his ears. 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