Lymphatic Drainage

Lymphatic massage, also called lymphatic drainage or manual lymph drainage, is a technique developed in Germany for treatment of lymphedema, an accumulation of fluid that can occur after lymph nodes are removed during surgery, most often a mastectomy for breast cancer. Lymphedema can also be present at birth or develop at puberty or during adulthood. This type, known as primary lymphedema, can affect as many as four limbs and/or other parts of the body. The cause is unknown. Lymphatic drainage massage for conditions other than lymphedema is not medically recommended, although it may be promoted by some therapists.

What conditions is lymphatic massage/lymphatic drainage used for?

Up to 25 percent of breast cancer patients whose surgery includes removal of lymph nodes in the area of the armpit eventually develop lymphedema. The condition can also occur in the legs or other parts of the body if lymph nodes are removed in the course of other types of surgery – for melanoma, colon, prostate or bladder cancer, for example – or are damaged by radiation treatment, infection or trauma. Symptoms include swelling and pain near the site of the removed or damaged lymph nodes. Lymphedema can occur immediately after radiation therapy or surgery, or weeks, months, and even years later.

What should one expect on a visit to a practitioner of lymphatic massage/lymphatic drainage?

A lymphatic massage session for women who develop lymphedema after surgery for breast cancer starts with light massage on the surface of the skin of the neck. The therapist gently rubs, strokes, taps, or pushes the skin in directions that follow the structure of the lymphatic system so that accumulated lymph fluid can drain through proper channels. Lymphatic drainage is very gentle, is not painful, and doesn’t have a stimulating effect. Each session lasts from 45 to 60 minutes, and therapy usually is performed once a day four or five times a week for two to four weeks. One study showed that the greatest reduction in swelling from lymphedema occurs in the first week of treatment and stabilizes during the second week.

Are there any side effects or conditions where lymphatic drainage/lymphatic massage should be avoided?

The National Lymphedema Network lists four circumstances under which lymphatic massage or drainage should be avoided:

1. When patients who have developed lymphedema after surgery experience a sudden, marked increase in localized swelling. Under these circumstances, patients are advised to stop treatment and to see their physicians for evaluation as soon as possible.
2. Patients with a sudden onset of lymphangitis (an infection) should immediately discontinue treatment until the infection is treated and completely clears up. Patients who are at increased risk for blood clotting should be tested to rule out deep-venous thrombosis before being treated. During treatment, these patients should be followed closely, and testing should be performed on a regular basis.
3. Patients who have congestive heart failure must be monitored closely to avoid moving too much fluid too quickly, which could put a strain on the heart.
4. When pain is present, treatment should be discontinued until the underlying cause has been determined and the pain subsides.

Are there other therapies that might work well in conjunction with lymphatic drainage massage?

In addition to lymphatic massage, patients may be advised to do self-massage following instructions from their therapists, as well as special light exercises designed to encourage the flow of lymphatic fluid out of the affected limb. Some patients may also be advised to wear compression garments such as long sleeves or stockings designed to compress the arm or leg and encourage lymphatic flow out of the limb.

Other recommended therapies for lymphedema may include wrapping the affected limb to encourage the fluid to flow back out of the limb into the trunk, or pneumatic compression which involves wearing a sleeve over the affected arm and leg that is connected to a pump that intermittently inflates it, putting gentle pressure on the arm or leg and thereby moving the lymph fluid away from the fingers and toes and reducing swelling. The combination of these therapies plus lymphatic massage is called complete decongestant therapy (CDT). This approach usually is not recommended for patients with high blood pressure, diabetes, paralysis, heart failure, blood clots, or acute infections.

The lymphatic system

● Made up of an extensive network of:
○ vessels
○ glands
○ ducts
○ nodes
○ passes through almost all of the tissue in the human body, including the brain.
● Allows for the collection and transport of lymph fluid.
● Lymph fluid is made up of a variety of substances.
○ proteins, fats, salts, glucose, water, cellular debris, and white blood cells.

The body’s sewer system

● Absorbs excess interstitial fluid, hormones, and cellular waste.
● Breaks down proteins and other cellular debris that are too big for the cardiac
system to break down.
● Lymph nodes contain lymphocytes and phagocytes to break down those
proteins, pathogens, and other cellular waste.
● “Clean” lymph fluid is transported back through lymph ducts to the veins.
● Once lymph fluid is in our veins it’s called plasma.

Things that will slow the lymphatic system:

● Fighting off an infection, bacterial, or viral.
● Primary and secondary lymphedema
● Surgery
● Traumatic event
● Pregnancy
● Lifestyle
○ Sedentary vs active
■ The lymphatic system relies on muscle movement for lymph flow. The less muscle movement, the slower
the system.
■ Sitting for long stretches of time causes muscle stiffness, and impedes the thoracic duct.
■ Standing in one place for long periods of time will cause fluid to pool in the lower extremities.
○ Diet
■ High in sugar
■ High in protein
■ High in fat
■ Heavy coffee drinkers-grounds are broken down by lymph system
■ Dehydration- Not providing the body with enough fluid

A sluggish lymph system results in

● Edema
○ Just like when a septic system gets clogged, the fluid has nowhere to go and ends up building
up, just hanging around waiting. Sitting upon muscles and nerves, causing stiffness and pain.
● Adhesions and scar tissue
○ Eventually, this protein-rich fluid begins to harden creating adhesions and fibrotic tissue within
and around organs and muscles. Creating pain, dysfunction, and a restricted range of motion.
● Illness
○ Flow is stagnating so it’s not getting through the lymph nodes where the pathogens would be
taken care of, allowing them to get into the surrounding cells. Literally breeding disease.
○ The protein-rich fluid that is turning rancid will cause inflammation

Contraindications for MLD

● Major organ failure/ Cardiac Decompensation
● Hypotension
● Fever/acute inflammation
● Influenza
● Deep vein thrombosis within two years
● Blood thinners (depends on the integrity of the skin)
● Conditions of chronic inflammation need to be approached cautiously.
● Infection/ must be on antibiotics for at least 48 hours.
● Recent asthma attack
● The first trimester of pregnancy
● Any trimester of pregnancy when still experiencing morning sickness
● Dental infection
● Those undergoing active oncology treatments would need permission from their treatment team.

Some conditions that have been proven to benefit from MLD:

● Lymphedema- best to see a complete
decongestive therapist for the treatment phase.
● Lipoedema
● Post-surgery swelling
● Lyme disease*
● Chronic sinusitis
● Stroke
● Head injuries/Concussions
● Parkinson’s Disease
● Amputation/Phantom pains
● Burns
● Fractures
● Constipation
● Swelling during pregnancy
● Whiplash syndrome
● Dupuytren’s contracture
● Bursitis
● Tendinitis, tendinous, Periarthritic
syndrome, tendosynovitis, epicondylitis.
● Scleroderma
● Lupus Erythematosis
● Gout in subacute or chronic phase
● Spondylosis
● PTSD
● Cystic Fibrosis
● Diverticulosis
● Acne/Rosacea
● Alzheimer’s Disease

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