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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 53 liken the capillaries to the senior doctor who may shunt tasks they don't want or have time to deal with to the resident—in this case, the lymphatic capillaries. In more physiological terms, circulatory capillaries fi lter about 20 liters of blood every day, with the blood vessels themselves reabsorbing 17 of those fi ltered liters. The remaining 3 liters remain in the interstitial fl uid to be processed and returned to the circulatory system via the lymphatics. Included in those 3 liters are the aforementioned metabolic waste, cellular debris, and sometimes even cancerous cells. Lymph nodes are the small (0.1–2.5 centimeters) kidney-shaped "organs" of the lymphatic system. They are surrounded by a fi brous capsule—fascia. Depending on which source you read, humans have anywhere from 450 to 600 lymph nodes. While the nodes are located throughout the body, there are large clusters found in the neck, chest, underarm, abdomen, and groin areas. Unless one is getting a specifi c lymphatic drainage treatment, these nodes are mostly in areas that tend to be less served in many bodywork modalities. UNDERSTANDING THE RELATIONSHIPS Research is underway to look deeper into the relationship among the circulatory capillaries, lymphatic capillaries, collagen, and our favorite intermuscular and intercellular lubricant—hyaluronic acid. Once that research is complete, we should have an even better understanding of how the lymphatic system and fascia interact. Still, even with the facts currently at hand, we can make some highly informed postulations. While the circulatory system has the heart to keep blood pumping throughout the body, the lymphatic system has no such specialized pump and instead must rely on muscular contractions. This includes both smooth and skeletal muscles, as well as the act of breathing. Lymph circulates through movement. As we move from an industrial society to a digital society, our daily tasks—and indeed our online hobbies—tend to limit much of our movement. They usually involve repetitive, functional shortening of specifi c myofascial units such as the anterior scalene, sternochondral fascia, pectoralis minor, biceps, rectus abdominis, psoas, and the pectineus. All these units also happen to be areas with large populations of lymph nodes. The fascial system is a wonderfully adaptive, plastic system designed to respond to supply and demand, with the collagen-producing fi broblasts responding to repetitive pressures, postures, and movements (or lack thereof ), and producing more collagen to better reinforce and support our body in whatever it is we do. One can easily hypothesize that chronic contractions (over a period of several months to several years) in the areas mentioned above could lead to more stiffness and less movement in those areas, thereby greatly slowing down and inhibiting the circulation of lymph in the body. We also know that when the size of lymph nodes increases due to infl ammatory diseases, the fascia hardens around those areas, which also inhibits movement. 1 But this is a two-way street. We have the opportunity to improve the situation by altering the mechanical input into those areas, thereby increasing range of motion and ease of movement. We have the potential to increase the size of the interstitial space, increase the speed limit of the lymphatic system, and allow the metabolic traffi c therein to be less congested. We look forward to the research that will help guide the way. Note 1. A. Mallick and A. R. Bodenham, "Disorders of Lymph Circulation: Their Relevance to Anaesthesia and Intensive Care," British Journal of Anaesthesia 91, no. 2 (2003): 265–72. David Lesondak is an allied health member in the Department of Family and Community Medicine at the University of Pittsburgh Medical Center, and is board- certifi ed in structural integration. He is the author of Fascia: What it is and Why is Matters, editor of Fascia, Function, and Medical Applications, and host of the podcast "BodyTalk." Learn more at davidlesondak.com. Fascia Defined The fascial net is one continuous structure throughout the body. It is a complex, holistic, self-regulating tissue and system, and while it can be dissected into pieces, it is no less a singular unit in nature than the skin. It is flexible and sturdy in equal measure—a substance that surrounds and penetrates every muscle, coats every bone, covers every organ, and envelops every nerve. INTERESTED IN LEARNING MORE ABOUT THE LYMPHATIC SYSTEM? Join us for the ABMP CE Summit: Lymph on October 25. This online event is free. www.abmp.com/summit PODCAST: "FASCIA: USE IT OR LOSE IT" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Listen!