About Lymphatic system and Lymphatic drainage generally

In the following lines we will answer these questions:
What is the difference between the manual and mechanical lymphatic drainage? How should the correct lymphatic drainage look? What exactly is the lymphatic drainage? What to look out for when visiting therapies with mechanical lymphatic drainage? Is it harmless technique or not?

What is lymph?

Lymph is clear liquid containing waste material from cellular metabolism, dead cells, viruses, bacterias, but also nutrients, enzymes, vitamins, fats, carbohydrates and proteins furthermore iron, copper, calcium… and mainly lymphocytes, which is a type of white blood cells, thanks to which the lymph is participating on the immunity of the organism. Nodules of the nape


In case there is a damage in the lymphatic system (injury, infection, operation, physical activity, oncological illness, …) it will lead to damaged flow of the lymph, its congestion in tissue (for example sprained ankle, leads to edema in ankle area), if the lymphedema is not taken care of, it will lead to fibrotisation and permanent damage of the lymphatic system.

Lymphatic drainage/Pressotherapy

Lymphatic drainage (either manual or mechanical) is incorrectly called as “lymphatic massage”. This implies that the provider or therapist likely didn’t go through professional training in area of lymphatic system. Visit by such “specialist” can harm you.

  • Mechanical lymphatic drainage is used for healing of edemas with compressive bags (for legs, arms, trunk, …). Inside these bags are chambers, which are inflated according to pre-set program. Simple rule is, the more chambers are in the bag, the more effective the therapy is. On our market are usually bags for legs and arms with 3 chambers (which is for treatment of the lymphedema insufficient), or leg air bags with 24 chambers, and arm bags with 14 chambers (this number is ideal). At the same time, the rules of setting optimal pressures, is important so that the compression would be sufficient and at the same time the pressure would not damage the lymphatic system.
  • Manual lymphatic drainage is therapeutic technique, when therapist applies light pressure with his hands, by applying exact touch which releases the lymph and and its further flow from extracellular space through capillaries, lymphatic vessels and lymphatic nodes and further absorption of the lymph into the bloodstream, when the main lymphatic vessel is flowing into superior vena cava (thoracic duct) which is close to the heart.

IMG 1741 

Before every mechanical and manual lymphatic drainage the therapist should perform opening of the sentinel nodes. If this is not performed it can automatically open lymphatic conjunctions. in chest and groin area, and the lymph flowing through these spokami may create swelling with the feeling of pressure and even genitalia pain, thighs and lower part of the abdomen or armpits, headaches, swelling face and neck and impaired breathing and swallowing.

Before every therapy, the person should drink up at least 0,5 l (16,9 oz) of water, and drink during the therapy (people usually get thirsty during the therapy). After therapy is it optional to drink again about 0,5 l (16,9 oz) of water.


Manifestation you can observe and feel after correctly performed therapy:

  • Lightweight sensation in the lower and upper limbs (after completed drainage)
  • Swelling relief and increased movement momentum in the affected area
  • During the first lymphatic drainages you may observe darker urine with different odor (because the waste material is drained from the tissues)
  • After long term therapy, there is visible decrease in waist circumference, hips, upper limbs or chest

Manifestation you can observe after incorrectly performed therapy:

  • Headache typically in the middle of the forehead, temple and neck (eye circles)
  • Increased swelling or formation of new edema

How often and when to go first time to lymphatic drainage?

After acute injuries, after oncological illnesses, after operations, suffering with lymphedema 2-3 times in week. We recommend to people after operation to start lymphatic drainage after 7-10 day, in time when the wound is healed, and the stitches are relatively freshly taken out. Starting the therapy like that, helps to heal the wounds much faster, and even support further growth of the lymphatic vessels through the scar. If the therapy is not started soon after the operation, the lymphatic vessels will envelop around the scar. Furthermore, each layer of skin and subcutaneous tissue may lead to adhesion, which can cause stiffness and immobility of the scar.

Did you know that, intermittent preventive lymphatic drainage in between 30-50 years, may visibly increase later quality of life?



People, who are regularly going to lymphatic drainage, consider their health condition as very satisfying. They have decreased intensity of pain in leg joints, spine and pelvis. They have lower risks of forming and progressing arthrosis of knee and hip joints, which leads to more peaceful sleep, during which they are not woken up by joint pain and their physical condition increases in accordance with bigger physical activity.
People are able to enjoy their free time, mainly in form of tourism, riding a bicycle etc… Regular lymphatic drainage therapy increases better biomechanical features of muscle tissue, joints and generally whole skeletal system.



Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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