The Lymphatic System: anatomy, physiopathology, diagnosis and management

Dates:18-19 January 2020

Course Leader: Dr Raymond Perrin

Cost: £256-320


About the course

This course aims to improve the practitioners’ knowledge of  the immune system and to teach enhanced palpatory skills in assessing the health of the patient’s lymphatic system. You will learn different strategies to aid lymphatic drainage in conjunction with other forms of osteopathic techniques. The course begins with a history of the lymphatic system in medicine and osteopathy. It also covers relevant anatomy, pathology and diagnosis of the lymphatic system and its disorders. Manual techniques will be demonstrated and practised:

  • The anatomy of the lymphatic system from the smallest lymphatic vessel to the cisterna chyli and the thoracic duct.
  • The immune system – the difference between B and T cells, the acute and chronic immune response and the significance of the relationship between the lymphatic system and the immune system.
  • The physiology of the lymphatics system.
  • The pathology of the lymphatics system including examination in the diagnosis of lymphatic disease.
  • The neuro-lymphatic (glymphatic system) and its disorders – including the pathogenesis of Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) and fibromyalgia, physical symptoms and diagnostic signs.
  • Management of lymphatic disorders including contra-indications and cautions to treatment.


Summary of Osteopathic Practice Standards (Updated) and other CPD elements covered

A) Communication and patient partnership- A1, A2, A3, A4, A5, A6

B) Knowledge, skills and performance - B21, B2, B3, B4

C) Safety and quality in practice - C1, C4, C6

D) Professionalism - D2, D10


Learning Outcomes

  • Understand the pathogenesis of lymphatic disorders from a biomechanical perspective.
  • Learn how to examine a patient for the early physical symptoms and diagnostic signs for possible lymphadenopathies and learn the differences between healthy and non-healthy systems including splenomegaly, Hodgkin’s and fibromyalgia.
  • Learn how to manage patients focussing on the lymphatics plus specific disorders such as lymphangitis, lymphoedema and other forms of lymphadenopathy.
  • Gain an understanding of how to integrate the evidence-based medicine discussed in the workshop into better patient care in all realms of clinical practice.


 Day 1:    

 09:00-09:30 Registration/Coffee

 09:30-11:00 The history of lymphatic discovery, the anatomy of the lymphatic system and the immune system

 11:00-11:15 Tea/Coffee break

 11:15-12:30 The physiology of the lymphatics- practical session surface anatomy

 12:30-13:30 Lunch 

 13:30-16:00 Applied Pathology: lymphatic disorders. The neurolymphatic system and disorders. Case studies: Q and A on diagnosis and clinical management of the patient. (4 real case studies will be discussed)  

 16:00-16:15 Tea/Coffee break                      

 16:15-17:30 Practical training: Examination in the diagnosis of lymphatic disease; signs and symptoms, red flags, safety of the patient

Day 2:

09:30-11:00 Manual treatment of lymphatic disorders:  

Based on the latest osteopathic principles and practice (Foundations of Osteopathic Medicine 4th Edition, Seffinger MA ed.  AOA, 2018. Using data from osteopathic research into lymphatics supporting manual lymphatic techniques including Creasy et al 2013, Hodge et al 2010 & 2015, Huff 2010. 

11:00-11:15 Tea/Coffee break

11:15-12:30 Diagnosis of neurolymphatic disorders

12:30-13:30 Lunch

13:30-16:00 Practical examination of the neuro-lymphatic system and disorders. (Hives L et al 2017)

16:00-16:15 Tea/Coffee break                      

16:15-17:30 Practical training: Treatment of neuro-lymphatic disease including indications and contraindications for treatment. (Perrin R et al. 1998 and 2011)


Course Suitability

The course is suitable for osteopaths, physiotherapist and chiropractors.



Delegates are requested to bring towels and oil/cream (none nut based) for effleurage techniques.


About the course tutor

Dr Raymond Perrin qualified in 1984 from the then British School of Osteopathy. Whilst at the BSO he spent 3 years working in the children’s clinic with Jonathan Curtis-Lake where he gained much experience in cranio-sacral techniques.

He has extensive experience treating top sportsmen and women including Olympic athletes. In 1991 he was appointed official osteopath to the World Student Games, Sheffield.

Dr Perrin’s research since 1989 into Chronic Fatigue Syndrome /ME has expanded our knowledge of the disease and how to diagnose treat it. In July 2005 he was awarded a doctorate by the university of Salford, UK for his thesis on the involvement of cerebrospinal fluid and lymphatic drainage in CFS/ME.

From 1996 onwards he has been the Research Director of F.O.R.M.E. Trust;

Since 2007 he has held the academic post of Honorary Senior lecturer at the Allied Health Professions Research Unit, University of Central Lancashire, in Preston, UK.

He was appointed member of the scientific committee for the 2nd, 3rd and 4th World Congress on Neurobiology and Psychopharmacology affiliated with the European Association of Psychiatrists Annual Conference, Greece.

In a study between 2015-16 he was chief investigator of joint UCLan & NHS research project: Examining the accuracy of a physical diagnostic technique for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, REC reference number 12/NW/0877.

In 2015 he joined the international faculty of the German School of Osteopathy, Hamburg; and teaches osteopathic theory and practice to students in colleges all over Europe. He has run workshops training fellow osteopaths, physiotherapists, chiropractors and physicians in the manual techniques he has developed in The USA, South Africa, Gibraltar, Germany, Czech Republic, The Netherlands, Ireland, Sweden, Norway, Finland, Sicily and Russia.

He has lectured internationally and in the UK to CFS/ME patient groups and the medical profession on the Osteopathic treatment of CFS/ME. He has published papers in major medical journals and his book, The Perrin Technique: How to beat CFS/ME was published by Hammersmith Press, London in 2007.

For his service to osteopathy Dr Perrin was appointed a vice-patron of The British School of Osteopathy, now The University College of Osteopathy and was he was the proud winner of the inaugural Research and Practice Award from the Institute of Osteopathy in 2015.

Ray lives with his family in North Manchester where he runs a multi-disciplinary clinic. He also sees patients at The London Neurology and Pain Clinic and in Bushey Heath, Herts.

Dr Perrin treating image resized.jpg


Recommended Pre-Course Reading

The Perrin Technique, Raymond N Perrin, Hammersmith Press, London 2007.

Hives L, Bradley A, Richards J, Sutton C, Selfe J, Basu B, Maguire K, Sumner G, Gaber T, Mukherjee A, Perrin RN. Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study. BMJ Open 2017;0:e017521. doi:10.1136/ bmjopen-2017-017521


Cancellation Policy

The UCO regrets that no refunds can be made for cancelled places unless a substitute participant can be found.  The UCO cannot guarantee that any course will run.  In the event of your course being cancelled, all paid fees and deposits will be refunded in full.