Manual lymphatic drainage

IMG 1743 (1)What is manual lymphatic drainage, and how it works?

Manual lymphatic drainage is therapeutic technique, therapist is applying soft pressure with his hands and performs specific touches that enables the lymph getting released, and moves further down the extracellular space and through capillaries, lymph vessel and nodes, the lymph then gets into the bloodstream where the
main thoracic duct flows into superior vena cava (located near the heart)

Before every lymphatic drainage therapy, the sentinel nodes have to be opened. If the drainage is performed incorrectly, it can lead to headaches, faster tiredness, vomiting, opening the lymphatic conjuctions and formation of new edemas (lymphedema) or worsened present lymphedema. Pressure created by the hands and fingers of the therapist, should be very soft but firm enough, so that the therapist would not slip on the mat, but at the same time the therapist should not push the subcutaneous structures (muscle, bone, …). Manual moves above the lymphatic vessels are always thrusted towards lymphatic nodes. These moves are stimulating movement of the lymph in direction to right collarbone, where is located the main thoracic duct and the lymph are poured into the bloodstream.

IMG 1748 (1)

Summary of correctly performed manual lymphatic drainage

  • Correct pressure should be very pleasant. Pressure should be deep enough, the hands of the therapist should not slip on the skin, but at the same time the pressure is softer so that the therapist would not have a feeling that he is pushing tissues beneath the skin. Therapist applies high pressure if he is trained for deep-tissue massage (muscles,fascitiis, and other techniques) . sometimes it is hard to believe that such soft manual technique, can be so effective. On the other hand, if high pressure is applied, it can lead to collapse and even damage of lymphatic structure which can lead to worsened condition of the patient.
  • Direction of “fondling” is very important, because the lymph has to be thrusted into the right lymphatic nodes. Therefor is the pressure is developing in wrong direction, the therapy can never be effective.
  • Rhythm and speed of performed massage is slow. Lymphatic vessels and nodes are opening and closing, which causes expulsion of the lymph into other sections towards the thoracic duct. The corresponding rhythm is activating parasympathetic nervous system, which leads to relaxation of the patient.

When is the mechanical lymphatic drainage optional (indication)

IMG 1754 (1)

  • For athletically active people, lymphatic drainage supports faster reduction of inclusion bodies from intermediary metabolism, regeneration of muscles and other tissues (for example: runners, hockey players, footballers etc…)
  • After joint operation, after 12 days (the wound must be healed)
  • After oncological illness (when the K-markers are negative in the blood examination)
  • With gynecological problems from example: dysmenorrhea (painful menstruation), sterility
  • Chronic venous insufficiency (varicose veins, tromboflebitis, atherosclerosis, phlebitis,...)
  • Prevention of zanět hlubokého žilního systemu before and after planned operation
  • In therapy of venous ulcers (ulcus cruris)
  • For diabetics (neuropathy, angiopathy)
  • In therapy for arthrosis of hips, knees and ankle
  • Primary and secondary lymphedema
  • Oncological indications only after treatment of carcinoma and metastasis (ablace mammy, resekce uzlin, after radiotherapy, …)
  • Pain of blood vessel origin (atherosclerosis of arteries, venous thrombosis, varicose veins, blockage of lymphatic system, ...)
  • IMG 1775 fill 212x141Therapy of venous ulcers (resting stage)
  • Blood circulatory disorder (Reynaud´s disease, acrocyanosis)
  • Extreme muscles overload
  • Cellulite - (lymphatic drainage servers as auxiliary method in therapy, ultrasound, cryotherapy)
  • Liposuction (after operation and non-invasive procedures)

When not to use the mechanical lymphatic drainage (contraindication)

  • Skin diseases, (mycosis, inflammation of skin and soft tissues, open wounds, purulent wound, bedsore in acute stage) = health reasons
  • Oncological disease in acute phase = risk of spreading the disease
  • Heart diseases (coronary artery disease, angina pectoris, myocardial infarction, uncontrolled hypertension, hypotension, …) = increased circulation of lymph leads to pouring of bigger amount of lymph into bloodstream. Heart muscles has to manage the increased
  • IMG 1784 (1)capacity flow
  • Serious lung diseases (bronchial asthma, chronic bronchitis, obstrukční choroba plicní, pulmonary edema, …) = also linked to heart capacity
  • Serious kidney and liver diseases = can lead to bigger overload of internal organs
  • Stroke
  • Hyperthyroidism (excessive production of thyroid hormone by the thyroid gland)
  • Neurological diseases (epilepsy, neuropathy, plexopathy, …)
  • Undiagnosed stomach problems
  • Acute vein inflammation (Thrombophlebitis)
  • Acute infectional disease (flu virosis, increased physical temperature, …)
  • Osteosynthesis and endoprosthesis in healed area



Author: Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague

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