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Osteopathic Considerations for Pneumonia and Other Respiratory Disorders

Lisa Marie Foreman, B.Sc., DO-MTP, M.OMSc. - Osteopath

patient coughing

The lymphatic system is essential in health and good lymphatic flow increases the body’s immune response. There is an increased demand during disease, tissue dysfunction, physiologic stress, infection and any other interstitial fluids. Congestion occurs when production outstrips removal in an area. Therefore, it arises with any obstructed pathways and/or dysfunction of abdominal action (the primary pump). [C]

When applied to the management and other respiratory disorders, manual manipulation techniques bolster lymphatic flow, respiratory function and immunological defense targeting anatomical structures involved in these systems. [B] Treatments that assist thoracic cage motion reduce the impedance of lymphatic flow by respiratory structures which are located in the thoracic inlet/outlet area. Myofascial restrictions in the clavicular region can impede the terminal drainage of lymphatic vessels. [B] Moreover, increased rib cage excursion improves pressure gradients, which further promotes lymph flow. [B]

Specifically, we will discuss and demonstrate three routine techniques that address autonomics, lymph drainage and rib cage mobility:

1. Rib raising

2. Thoracic pump

3. Doming of abdominal diaphragm [B]

Rib Raising

Effective rib raising techniques lift and rotate the rib heads and they in turn pull on the fascias (connective tissues) that are common to the rib head and its sympathetic chain. The primary purpose of this manipulation is to inhibit the sympathetic system and it is also long lasting. [A] The rib raising technique augments lymphatic flow by improving respiratory excursion. [B]

Thoracic Pump

Fascial torsion or restriction of the inlet should be diagnosed and treated to remove any hindrance to this terminal drainage site. [A] It’s aim is to increase the flow of lymph and other immune cells through a rhythmic, phasic compression of lymphatic vessel walls and regional lymph tissue. [B]

Doming of the Abdominal Diaphragm

Normal contractions of the abdominal diaphragm produce changes in volume between the thoracic and abdominal cavities. When the diaphragm is well domed, the volume changes produce the effective pressure gradients between the thoracic and abdominal cavities. The diaphragm is the primary pump for the lymphatic system. [A] Flattening of the diaphragm seriously decreases volume displacement and the pressure gradient that the diaphragm is able to produce between the thorax and abdominal cavities. In such a situation, there is a decrease in the pressure between these two areas at any given moment. Decreased lymph flow increases congestion of the tissues and can decrease cardiac output as well. [A]

Under normal conditions, lymphatic return to the heart in a 24 hour period is equal to the entire serum volume of the body. Chronic lymphatic congestion with poor oxygenation of cells is associated with increased infection, increased healing time and increased fibrosis and scarring if healing does occur. [A]


Osteopathic medicine, when applied to pneumonia patients, aids in restoring health by encouraging normal circulation and immunological function. This is achieved in three sequential steps: removal of dysfunctions obstructing drainage, maximization of respiratory function and augmentation of flow through lymphoid tissue. Literature suggests that techniques targeting lymphatic flow are advantageous for treatment of pneumonia by way of altering pressure differentials in the thoracic diaphragm, enhancing antibody response, reducing edema and increasing the abundance of white blood cells in peripheral blood. [B]


A Osteopathic Considerations of Systemic Dysfunction. M.L. Kuchera & W.A. Kuchera 1994

B Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia. Sheldon Yag, John Hassan, Martin Gagne, Gebe Gesige and Wofgang Gillar 2014

C Osteopathic Principles & Practice. M.L. Kuchera & W.A. Kuchera 1991

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