What is a lymphatic drainage massage?
Lymphatic Massage is aka manual lymph
● Developed first in France in 1932 by Danish
physiotherapist Dr. Emil Vodder.
● Since 1932 MLD has been widely researched
and used in Europe.
● Migrated to the United States over the last
● In this country, we hear most about MLD in the
treatment of lymphedema, but has so many
What is Manual lymphatic drainage massage?
Manual lymphatic drainage (MLD) is a specialized, gentle type of massage and an important part of lymphoedema treatment. The aim is to encourage the extra lymph fluid to move away from the swollen area so it can drain normally.
A light touch manual therapy technique using different gentle and slow
● Assists the lymphatic system function by promoting lymphangiomotoricty.
● Lymph fluid usually flows at a rate of 10-12 bpm. Unlike the cardiac system,
the lymphatic system does not have a pump, it relies on muscle movement,
manual lymph drainage, or hydrostatic pressure.
● Following an hour-long lymphatic massage, the flow rate will be
approximately 100 to 120 bpm, and will gradually slow over the proceeding
What is involved in a lymphatic massage?
● Oil may be used if the client’s skin is especially taut, but only in a small amount. Usually, no lotions or oils are used.
● 15- to 60- minutes in length.
● Prenatal clients in their second and third trimester start with 15-minute sessions.
● Frequency of lymphatic work can be daily for some conditions and up to every 2 or 3 months for someone healthier and without medical conditions.
● Clients remove all constrictive clothing and/or bandaging, unless not cleared to do so by their physician.
● Clients who are seeking lymphatic massage for edema will be measured before a session, and some will be remeasured after the session, depending on session goals.
● Clients who are receiving five series of lymphatic massage will be measured prior to the first session,
and proceeding the last session in the series.
Why lymph drainage is important?
Lymphatic Massage Therapy
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:
- 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.
- 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.
- 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.
- 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:
○ 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
● Traumatic event
○ Sedentary vs active
■ The lymphatic system relies on muscle movement for lymph flow. The less muscle movement, the slower
■ 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.
■ 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
○ 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.
○ 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
● Fever/acute inflammation
● 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.
● Post-surgery swelling
● Lyme disease*
● Chronic sinusitis
● Head injuries/Concussions
● Parkinson’s Disease
● Amputation/Phantom pains
● Swelling during pregnancy
● Whiplash syndrome
● Dupuytren’s contracture
● Tendinitis, tendinous, Periarthritic
syndrome, tendosynovitis, epicondylitis.
● Lupus Erythematosis
● Gout in subacute or chronic phase
● Cystic Fibrosis
● Alzheimer’s Disease
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.