# The Effectiveness of Pump Techniques and Compages: A Systematic Review
## 1 Introduction  
Osteopathic manual techniques were first proposed by [PERSON] to correct somatic dysfunctions, increase blood and lymphatic flow and improve the individual's self-healing capacity [1]. Starting from these bases, in 1920, [PERSON] developed a manual technique called \"thoracic pump technique\", aiming to improve lymphatic flow via intrathoracic pressure changes [2]. By the manipulation of this lymphatic pump, Dr. [PERSON] speculated that an increased lymphatic circulation of the entire body could be provoked [3]. A number of other lymphatic pump techniques have been developed and investigated since Dr. [PERSON]'s time [4]. Some ancient lymphatic pump techniques already in use are abdominal and pelvic pumps and pedal pumps [5]. Other authors deepened the pump techniques, expanding their focus and studying their effects on connective tissues. In the 1970s, [PERSON] studied the relationship between spinal mechanics and respiratory dynamics and between the fascia and venous, lymphatic and lacunar circulation [6]. The fascia was considered as an integrated system;therefore, a facial restriction can be potentially extended to distant areas of the body and can provoke stress/malfunction on any structure that is enveloped by the fascia itself [7, 8]. Based on the studies of Dr. [PERSON], another variation of pump techniques was developed in France. In the 1980s, the physical therapist [PERSON] proposed a technique called pompage and widened its use [9, 10]. Recently, pompages have been further modified and updated according to the most recent developments in treating the connective tissues [11]. Globally, pump techniques aim at promoting the relaxation and elongation of soft tissues and fascia [12, 13, 14], reducing intra-fascial thickening and adhesions, decreasing joint load [15, 16], reactivating joint metabolism, facilitating circulation, and finally, reducing pain and normalizing muscular tone [17, 18, 19]. More specifically, the lymphatic pump techniques are designed to facilitate venous, lymphatic and lacunar circulation, with an action mediated by the alternation of pressure/traction and decompression/relaxation [20]. Lymphatic pump techniques are carried out in two phases. In the first phase (pressure/traction), the clinician applies a tension reaching the \"barrier\" or limit of the physiological elasticity of the fascia, without causing defense reactions by the patient. This tensioning must therefore be painless, but at the same time, it must not be too light to adequately stimulate the fascial tissue [21]. In the second phase (decompression/relaxation), the clinician allows the fascia to return to the initial position without stopping the movement [22, 23]. The alternation of these two phases is rhythmic; the frequency can be slow (e.g., suboccipital release, pectoral traction, doming of the diaphragm, and rib raising), at medium speed--20/30 cycles per minute (e.g., release of the thoracic inlet, abdominal or pelvic lymphatic pump), or at high speed--110/120 cycles per minute (e.g., thoracic lymphatic pump, and pumps applied to peripheral areas). Pompage techniques addressed to joints and muscles are generally slower, and a further phase of maintaining the tension is added [23]. These different modalities and frequencies depend on the treated area and the characteristics of the tissues addressed by each technique. The alternation of rhythmic pressures and decompressions can be applied on the joints (joint/articular pump), the muscles (muscular pump), the abdominal area (abdominal pump), the feet and the lower limbs (pedal pump), or on the patient's chest (thoracic pump) [24, 25]. The pump techniques are generally well tolerated and can be used easily and safely in many clinical presentations. Currently, both the American osteopathic pump techniques and French pompages are performed as a part of a wider family of pump techniques. Despite the widespread use of these manual procedures in clinical practice by osteepaths and physical therapists, their effectiveness was not deeply studied.