Fluid Articular Release-Lower (FAR-L) - Orthopedic LDT

This wonderful class will teach students to use a specific synovial fluid to release restrictions specific to all body articulations, including "fused" embryological articulations.

This material has been successfully taught for over 20 years in the lymph curriculum and has no prerequisite.

Learn articulation fluid release techniques for the:

• Peripheral (appendicular) articulations: lower extremity from the hip to the foot articulations - embryological structures
• Pelvis: articulations of the sacrum, pubic symphysis, superior pubic ramus, iliac crest, sacro-iliac and Iliolumbar joint, and embryological structures

Some material from the upper body will be introduced in this class:
Intra-oral articulations: zygoma, premaxilla, maxilla, palatine, pterygoid process, sphenobasilar articulation

• Face and skull and Associated structures
• Midline structures of the Skull
• Zygoma relationship: 5 relationships
• Sphenoid relationships: 9 relationships
• Vomer Bone relationships 5 relationships
• Ethmoid Bone relationships: 6 relationships

When the bony framework is out of place numerous types of pathologies can happen from pain and dysfunction, discomfort, asymmetry/misalignment, range of motion abnormalities, tissue/tone changes, affecting the muscles, fascia, viscera, or bones themselves.

A wide range of pathologies can be associated with joint dysfunction and may be alleviated by these techniques, including:

• Musculoskeletal pain in general
• Joint pain such as hip pain, knee pain, foot pain, etc.
• Low back pain
• Chronic sciatica
• Plantar fasciitis
• Treatment of accidents and injuries, including some whiplash
• Work injuries
• Sport injuries
• Repetitive stress injury (RSI), joint or muscle overuse
• Arthritis, rheumatoid arthritis
• Some gastrointestinal disorders (somato-visceral reflex)
• Some nerve entrapment
• Stress, general vitality, and well being

These techniques use fluid and are non-invasive and can be applied with ease and great success to babies, elderly, and even animal.

Class length 3 days
This is an introductory/basic level class.

You will need gloves in this class for the intraoral techniques.

Scientific Facts:

• Did you know that radiopaque substances injected in human articulations are drained/found a few minutes later in the lymphatic vessels? Lymphatic dysfunction is found in degenerative joint disease. It may begin to explain how lymphatic techniques can help joint release.

- Albuquerque M., De Lima J.P. Articular Lymphoscintigraphy in Human Knees Using Radiolabeled Dextran. Lymphology. 1990, 23, P.215-218.

- Vittas D., Reimann I., Nielsen S.L.. Intraarticular Lymphoscintigraphy of the Human Knee Joint: A Preliminary Study. Lymphology. 1987, 20, P.98-101.

• Lymphatic vessels are distributed in soft tissues around the joint capsule, ligaments, fat pads, and muscles of normal knees. The number of lymphatic vessels, particularly the number of capillaries, are significantly increased in joints of mice with mild osteoarthritis (OA), while the number of mature lymphatic vessels was markedly decreased in joints of mice with severe OA. OA knees exhibited significantly decreased lymph clearance (manual therapist can help stimulate lymph flow). The number of both capillary and mature lymphatic vessels was significantly decreased in the joints of patients with OA.

- Shi J, Liang Q, Zuscik M, Shen J, et al. Distribution and alteration of lymphatic vessels in knee joints of normal and osteoarthritic mice. Arthritis Rheumatol. 2014 Mar;66(3):657-66. DOI: 10.1002/art.38278. PMID: 24574226

• There is decreased drainage from the joint during an arthritic flare (manual therapist can help stimulate lymph flow). Alterations in lymphatic flow may be of importance in the fluctuating course observed in chronic inflammatory diseases. In TNF-Tg mice, a model of inflammatory–erosive arthritis, the popliteal lymph node (PLN) enlarges during the pre-arthritic ‘expanding’ phase, and then ‘collapses’ (i.e. reduction in lymph node volume and contrast enhancement) with adjacent knee flare associated with the loss of the intrinsic lymphatic rhythm/pulse.

- Bouta EM, Wood RW, Brown EB, et al. In vivo quantification of lymph viscosity and pressure in lymphatic vessels and draining lymph nodes of arthritic joints in mice. J Physiol. 2014 Mar 15;592(6):1213-23. DOI: 10.1113/jphysiol.2013.266700. Epub 2014 Jan 13. PMID: 2442135

• Recent studies in mice demonstrated alterations in lymphatics from affected joints precede flares (so possibility of a potential preventative manual therapy).

- Bouta EM, Wood RW, Perry SW, et al. Measuring intranodal pressure and lymph viscosity to elucidate mechanisms of arthritic flare and therapeutic outcomes. Ann N Y Acad Sci. 2011 Dec;1240:47-52. DOI: 10.1111/j.1749-6632.2011.06237.x. PMID: 22172039

• The lymph generated in RA joints, as well as lymphatic flow, are increased during disease progression and contain significantly elevated levels of pro-inflammatory cytokines and chemokines. Manual drainage can help evacuation of these pro-inflammatory molecules.

- Olszewski WL, Pazdur J, Kubasiewicz E, et al. Lymph draining from foot joints in rheumatoid arthritis provides insight into local cytokine and chemokine production and transport to lymph nodes. Arthritis Rheum. 2001;44:541–549.

• The blockade of lymphangiogenesis at the beginning of arthritis development increased the severity of joint tissue injury. Again, Manual drainage can help drain these joints.

- Guo R, Zhou Q, Proulx ST, et al. Inhibition of lymphangiogenesis and lymphatic drainage via vascular endothelial growth factor receptor 3 blockade increases the severity of inflammation in a mouse model of chronic inflammatory arthritis. Arthritis Rheum. 2009;60:2666–2676.

• Many studies suggest that there is a direct relationship between lymph flow dysfunction and inflammation. First, loss-of-function studies have shown that inhibition of lymphangiogenesis with anti-VEGFR3 neutralizing antibodies decreases lymphatic flow from the foot and increases the severity of ankle joint inflammation. Secondly, lymphangiogenesis induced via intra-articular injection of recombinant adeno-associated virus that overexpresses VEGF-C, significantly increased lymph flow and reduces inflammation in arthritic joints.

- Zhou Q, Wood R, Schwarz EM, et al. Near-infrared lymphatic imaging demonstrates the dynamics of lymph flow and lymphangiogenesis during the acute versus chronic phases of arthritis in mice. Arthritis Rheum. 2010 Jul;62(7):1881-9. DOI: 10.1002/art.27464. PMID: 20309866

Conflict of Interest: All classes presented by Chikly Health Institute have no financial conflict of interest.

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