Manual lymphatic drainage

Manual lymphatic drainage (ML) is a massage that stimulates, promotes and accelerates the circulation of the lymphatic system.

Water retention and cellulite mean a congestion of the lymphatic fluid in the tissue structures.
During the massage, only a slight pressure should be applied to the skin, because the lymphatic system runs superficially; therefore this therapy has a beneficial and relaxing effect.

Lymphatic drainage is used in the following cases:

  • limb with water retention,
  • cellulite,
  • Stretch mark
  • after liposuction,
  • after lymph node removal, causing the limbs to swell, e.g. lymphedema of the arm after breast cancer surgery.

The lymphatic massage should be done without the use of oils or creams, so that the patient’s skin remains grippy; however, for dry skin, the suppleness of the massage can be improved by a few drops of oil. There are two different techniques of lymphatic drainage:

  • the Vodder method,
  • the Leduc method.

In the warmer seasons, i.e. in spring and summer, the legs often swell and retain more fluid, so treatment during this time is particularly useful.


How does lymphatic circulation work in the human body?

In the human body, the cycle consists of:

  • arteries that originate from the heart and transport the acid- and nutrient-rich blood into the tissue structures;
  • veins that absorb the blood full of cellular waste products and carry it to the heart;
  • Lymphatic system: a complex system of vessels, capillaries, lymph nodes and lymphatic organs that ensures the removal of fluids contained in the tissues.

The lymphatic system consists of a narrow network of the finest vessels, the lymph vessels, and oval organelles, the lymph nodes, which can be found throughout the body.
This network is used to absorb and filter the lymph.
The lymph flows through the entire body, just like the blood; a yellowish fluid called plasma emerges from the blood vessels and mixes with water and tissue fluids, and then surrounds the cells of the various tissues.
This mixture contains nutrients, the blood cells of the immune system and also the waste products released by the cells.
The lymphatic system absorbs this fluid as lymph in the lymphatic vessels and transports it to the lymph nodes, which contain immune cells.
Since the lymphatic system does not have its own transport system, it is the movement of the muscles that carries the lymphatic fluid to the heart.
When the lymph reaches the lymph nodes, it is filtered and any pathogens present are killed.

Lymphatic organs include:

Spleen: receives the dead or damaged red blood cells and contains the white blood cells to fight disease;

Thymus: produces white blood cells;

Tonsils (tonsils) and adenoids (polyps): protect the digestive system and especially the respiratory system.

The pressure generated by the heart is the driving thrust of the blood circulation, while the lymphatic system has no internal pressure; the only way to remove the lymphatic fluid is an increase in pressure achieved by tensing the muscles.

If the excess fluid has a certain volume, a so-called lymphedema develops, which refers to the accumulation of lymphatic fluid in the tissue.
The lymphatic system runs parallel to the venous flow, because it originates from the body tissue and pours into the thoracic veins before they reach the heart.
The lymph consists mainly of water, proteins, viruses, bacteria and dead cell debris.
Along the lymphatic channels are the lymph nodes, which produce antibodies and represent a filter station for waste, viruses and bacteria. If the flow stops at the level of the lymph nodes, the lymph accumulates in the intercellular space and forms lymphedema.

How is manual lymphatic drainage performed?

The technique of manual lymphatic drainage according to Vodder consists in “pumping” the lymph towards the heart; it must be gentle and parallel to the course of the circulation, it is not pushed into the body.
The first phase of treatment is called the decongestion phase, because existing blockages and blockages must be released at the level of the lymph nodes.
Then the lymph is pressed to the heart, the handles used are reminiscent of a “pump”. Treatment begins with the regions near the trunk of the body and ends with the most distant zones.
The lymphatic drainage must not cause pain and must not be too intense, because this would cause vasodilation with increased blood circulation, which would be counterproductive.

This therapy must be carried out by trained professionals who know exactly where and how to act and have the necessary dexterity not to cause damage.

At the end of the session, a compression bandage or Kinesio tape (neuromuscular) can be applied.

What techniques are used?

In order to perform a lymphatic massage, one must first familiarize oneself with the technique; for this purpose, certificate training courses are offered at approved teaching institutes.
Lymphatic massage is used to treat conditions that cause lymphedema, which means blockage of the lymph nodes in the arms and legs. The lymphatic massage is an effective measure to detoxify the body, i.e. to rid it of waste products.
The massage technique consists in the execution of gentle thrust movements in the direction of flow of the lymph in order to decongest the blocked lymphatic vessels and to promote the lymph flow, so that the waste products can be removed from the body.
In lymphatic drainage, a physiotherapist with certificate training performs various, usually circular grip techniques on the patient’s skin.
The massage is carried out on bare skin, without the use of essential oils, aromas or lotions; the treatment is most effective when performed with bare hands.
The therapist uses one of the following grip techniques, which are a very effective decongestion therapy.

Standing circle: the therapist continuously performs circular spiral movements, with the finger firmly on the skin and moving the underlying tissues (lymphatic vessels).
This technique is used on the neck, face and lymph nodes.
The lymphatic drainage must be gentle and towards the heart.

The pump handle: the therapist places both hands on the patient’s skin, pressing the fluid towards the heart with his thumb, index finger and the area in between.
Oval thrust movements are performed to promote the flow of lymphatic fluid.
This lymphatic massage technique stretches the walls of the lymphatic vessels and promotes the removal of unwanted fluids.

The twist handle: the therapist massages the skin with cyclic movements, with the palms facing the patient’s body; the wrists increase or decrease the pressure exerted.

The scoop handle: the masseur holds the palms upwards while the fingers are stretched so that the hand takes the shape of a ladle. The rotating massage movements on the skin are intended to promote the elimination of cell waste.

How many massage treatments are necessary? How long does a session last?

In order to achieve a good effect in the medium term, treatment cycles of 10 sessions of 45 minutes each should be scheduled.

What are the contraindications of lymphatic drainage?

Manual lymphatic drainage is contraindicated in the following cases:

  • Cancers
  • Infections
  • acute inflammation or phlebitis
  • Hyperthyroidism
  • hypotension
  • non-edema heart disease

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