Written by Marissa Hoen | July 20 2021
What is the lymphatic system?
(Derrickson, 2017)
I like to think of the lymphatic system as the vascular system’s supportive best friend- always there to pick up the pieces, clear out the garbage, and give back what is needed. You may know that nutrients circulating in our arteries exit these vessels to supply all of our cells with nourishment. But how do these nutrients get to the cell? They diffuse through the interstitial space, or the space between cells. The fluid that holds these nutrients and proteins is called interstitial fluid, and in excess this fluid is referred to as swelling or edema. When reabsorbed by lymph vessels, this fluid again changes its name to lymphatic fluid, or lymph!
In addition to reabsorbing excess edema, the lymphatic system plays a role in initiating immune responses and transporting lipids from the digestive system into the blood. This one way system requires pressure changes (through muscle contraction, gravity, breathing) to move lymph along the vessels. When damaged through systemic inflammation, certain diseases, and/or lymph node removal, certain areas of the system become inefficient and another route must be taken for the lymph to make it all the way back to the heart. That is where Manual Lymphatic Drainage comes in!
What is involved in Manual Lymph Drainage?
(Rattray & Ludwig, 2005)
Manual Lymphatic Drainage, or MLD, incorporates massage techniques aimed to pump lymph fluid away from areas of damage and into healthier, more effective lymph vessels
Techniques are mostly gentle, as large amounts of lymph vessels lie just below the skin
These techniques alternate between stretching and releasing the skin using palmar/fingertip stroking or circular kneading
The techniques may be deeper in areas of more fibrous tissues (like scars) or around bony joints
Diaphragmatic breathing and abdominal massage are also involved to incorporate the deep lymph nodes
Usually treated in a supine position, but can be done seated, standing, or in side lying
MLD reduces edema (swelling) as well as pain and stress when done slowly and rhythmically
Uzkeser et al. (2015) found that complex decongestive physical therapy (CDT), which is the combination of manual lymphatic drainage, physical exercise, use of compression clothing, and skin care, is effective at reducing lymphedema in patients following a mastectomy. CDT is considered the gold standard treatment for lymphedema.
Can I practice self MLD?
Stimulating lymphatic flow can be done by anyone, but before you begin read below to see if you are at risk for adverse effects. There are countless videos online demonstrating self MLD. My all time favorite technique is one that can be done anytime: diaphragmatic breathing with some added pressure:
Place your hands on your belly
With an inhale let your belly expand with your hands giving a bit of resistance
With an exhale let the belly relax and push gently into the abdomen
Repeat for several breaths
Another great self MLD technique is dry brushing- which is exactly what it sounds like! Grab a dry brush that won’t irritate your skin and:
Begin stimulating the lymph nodes of the neck and armpit area with circular brush strokes
Move to the front of the hip, at the level of the hip crease
Then you can begin the rest of the body, brushing with straight strokes in the directions shown below. When brushing your arms and legs, begin at the top of the limb and make your way to the end (still brushing up toward the armpit). Complete the limb by brushing your way back up from bottom to top.
Are there any potential risks with this treatment?
As this treatment may increase the return of blood flow to the heart, MLD for people with heart conditions such as congestive heart failure and cardiac insufficiency is contraindicated. Therapists should practice caution with those with systemic hypertension, as MLD may increase blood pressure. Esmer et al. (2019) found that in healthy participants, change in blood pressure varied depending on the area of body treated- for example neck MLD led to a reduction in blood pressure whereas abdominal MLD raised BP. The authors attributed some of these changes to the position of the body, so if you experience large fluctuations in blood pressure when you go from sitting to lying down (or vice versa), talk to your doctor or take caution before having MLD.
Contraindications include:
(Rattray & Ludwig, 2005)
Chronic heart failure
Acute conditions (bacterial/fungal)
Recent Thrombosis
Edema due to Kidney dysfunction
Malignant Cancer
Precautions include:
(Wittlinger Lymphedema Clinic):
Edema following carcinoma treatment
Thyroid dysfunction
Chronic inflammation
Bronchial asthma
Diabetes
Summary:
Manual Lymphatic Drainage is effective at reducing swelling/edema in many populations
You can receive MLD from a massage therapist, or at home with dry brushing, diaphragm breathing, and self massage
Those with heart conditions, acute infections, and chronic inflammation should consult their Doctor before receiving MLD
References
Derrickson, B. (2017). Human physiology. Wiley & Sons Inc.
Esmer, M., Keser, I., Erer, D., & Kupeli, B. (2019). Acute cardiovascular responses to the application of manual lymphatic drainage in different body regions. Lymphatic Research and Biology, 17(3), 362-367. https://doi.org/10.1089/lrb.2018.0043
Manual Lymph Drainage (MLD) - contraindications. Wittlinger Lymphedema Clinic . (n.d.). https://www.lymphedema-clinic.com/manual-lymph-drainage/contraindications.html.
Rattray, F. S., & Ludwig, L. (2005). Clinical massage therapy: understanding, assessing and treating over 70 conditions. Talus Incorporated.
Uzkeser, H., Karatay, S., Erdemci, B., Koc, M., & Senel, K. (2015). Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: A randomized controlled trial. Breast Cancer (Tokyo, Japan), 22(3), 300-307. https://doi.org/10.1007/s12282-013-0481-3