The vascular return relies on 2 systemic systems, the venous system and the lymphatic system. The 2 systems are both divided in 2 sub-systems, the superficial one and the deep one.
Contrary to the venous system where the deep one is the preponderant sub-system (over 85% of the lower extremity venous return flows through the deep veins), the lymphatic circulation relies mostly on the superficial sub-system.
The muscular contraction is a commonly accepted benefit to the deep venous return. However, the muscular contraction is almost inefficient on the lymphatic circulation. Indeed, the main lymphatic flow, superficial or extra-fascicular, is unaffected by the muscular contraction pulses.
The superficial venous drainage of the lower extremities communicates with the deep veins through multiple perforating branches. Therefore, deep venous insufficiencies have a considerable effect on the superficial venous sub-system. Once more the lymphatic system differs here from the venous system in the poverty of channels between the superficial and the deep sub-systems.
Trophic changes linked to vascular return deficiency, be it venous or lymphatic, are largely dependent on lymphatic control. This fact explains the good clinical outcomes identified when the treatment approach addresses the efficiency of the superficial circulation.
Clinical signs present in vascular return insufficiencies are multiple and variable. Therefore, only the vascular deficiencies that do benefit from an adequate manual treatment are presented.