NMM/OMTREVIEW ARTICLE
Abstract
Context: Chronic venous insufficiency (CVI) and peripheral arterial disease (PAD) are associated with significant morbidity, often manifesting as edema, pain, and nonhealing ulcers. Despite standard therapies such as compression, pharmacologic management, and surgical interventions, recurrence rates remain high, and outcomes are limited. Osteopathic manipulative medicine (OMM) lymphatic drainage techniques, including pedal pump maneuvers, aim to enhance venous return, reduce interstitial stasis, and improve overall vascular and lymphatic function. Such approaches may complement conventional therapies by addressing physiologic barriers to healing. Literature addressing OMM lymphatic drainage techniques in this population is sparse, creating a gap in evidence-based options for improving vascular and wound-healing outcomes.
Objectives: The objective of this study is to systematically evaluate the evidence regarding the effectiveness of OMM lymphatic drainage techniques on wound healing, symptoms, and quality of life in patients with CVI and PAD.
Methods: A systematic literature search was conducted to cover all available literature from database inception through January 20, 2024, with searches performed from February 26, 2023, to January 20, 2024, by four authors (IA, LS, ER, GNU). The databases searched included PubMed, World Health Organization (WHO) Global Health Library, Google Scholar, and ResearchGate. The keywords and Medical Subject Headings (MeSH terms) utilized were “lymphatic drainage,” “pedal pump,” “thoracic outlet,” “pelvic inlet,” “venous insufficiency,” “peripheral arterial disease,” “lower-leg ulcers,” and “osteopathic manipulative medicine,” combined with Boolean operators. Articles were included if they assessed OMM lymphatic drainage interventions in patients with CVI or PAD. Exclusion criteria were noninterventional design, lack of OMM focus, or irrelevance to PAD/CVI. Screening followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines: duplicates were removed, titles and abstracts were screened, and disagreements among reviewers were resolved collectively.
Results: A total of 65 records were identified (PubMed=41, Google Scholar=12, ResearchGate=9, WHO=3). After removing duplicates, 32 remained; 27 were excluded following abstract screening, therefore five full-text articles were included. These consisted of one pilot case-control trial (n=30, PAD), one randomized controlled trial (n=20, immobile nursing home residents), one nonrandomized before-after community trial (n=8, lower-extremity ulcers), and two healthy-volunteer trials (n=17 and n=30). The reported outcomes included improvements in endothelial function, ankle–brachial index, treadmill performance, wound surface area, leg volume, blood lactate clearance, and platelet count. Collectively, these studies suggest the physiologic and clinical benefits of OMM lymphatic drainage, although the small sample sizes and heterogeneous methodologies limit generalizability.
Conclusions: Emerging evidence indicates that OMM lymphatic drainage techniques may provide meaningful physiologic and clinical benefits for patients with CVI and PAD. However, current studies are limited by small sample sizes, heterogeneity, and variable treatment protocols. Larger randomized controlled trials are needed to confirm the efficacy, establish standardized approaches, and clarify the role of lymphatic OMM in multidisciplinary vascular care.