Massage modalities are frequently at the forefront of wellness trends, and manual lymphatic drainage massage (MLD) has now entered the ring in a myriad of hot claims.
Developed as a method to combat lymphedema and lymph system ailments, lymph massage may be recommended as part of a Complete Decongestive Therapy plan, or as part of a post-operative breast cancer or other oncological treatment.
Outside of its medical applications, this technique is now being featured as a method for cellulite reduction, facial/jawline sculpting, and “strengthening” immune system function.
Looking at Instagram alone, the hashtag for MLD (#lymphaticdrainage) has more than 284,000 posts and is touted as being one of the top beauty crazes of 2020 and 2021.
Beauty enthusiasts are marketing to those who want to be slimmer and make use of the alleged aesthetic benefits, often with doubtful claims. Is this celebrity bandwagon only good for a passing phase like the current narrative of trigger point therapy, or does it have scientific merit?
What is lymphatic drainage massage good for?
Lymph drainage massage is based on the hypothesis that congested lymph nodes in a particular area of your body can be encouraged to be “cleared out” by performing a series of rhythmic, compressive strokes along lymph vessels.
Practitioners claim that it can reduce edema, swelling, and/or inflammation from lymphatic disorders or trauma to your body.
Historically speaking, all massage involves some sort of therapeutic touch. Unlike a traditional massage like Swedish and deep tissue massage, lymphatic massage focus on using feather-light pressure and circular movements no greater than the pressure it’d take for your finger to move skin.
It also differs from traditional styles of massage because it focuses on the body’s lymphatic system instead of the skin, muscles, and joints. Where traditional methods apply movements as a full body massage, MLD work is performed in a specific and concentrated manner to one area or quadrant of the body.
What does the lymphatic system do?
Medical research of the lymphatic system has come a long way from early historical observations of the “clear fluid” flowing in the human body. In order to assess whether or not MLD techniques can be effective, it’s important to have a simple understanding of how the lymph system works.
The lymphatic system has three primary jobs: acting as part of the body’s immune system, allowing fat and fat-soluble nutrient absorption for digestion, and maintaining the body’s fluid balance between tissues and blood.
The lymphatic system is comprised of three parts:
- Lymph fluid, which is similar to blood plasma, is made up primarily of white blood cells, interstitial fluid called chyle (containing fats, minerals and proteins), and other components, including damaged cells and cancer cells. It circulates throughout the body like blood and is a key element in our immune system.
- The lymphatic vessels only carry fluid away from the tissues. Lymph capillaries are the tiny vessels that are found in all body regions, except for the central nervous system, bone marrow, and tissues that lack blood vessels. These small capillaries then form larger vessels, which become even larger lymphatic trunks that drain larger body regions.
- The body has two main lymphatic ducts, the right lymphatic duct, which drains lymph from the upper right body quadrant, and then the thoracic duct, which drains all of the rest.
Unlike the circulatory system, the lymphatic system doesn’t have a pump, so the lymph fluid moves via pressure gradients from skeletal muscle and respiratory system movements as well as smooth muscle contractions.
Basically, most lymph fluid begins as blood plasma that is forced out of the capillaries and doesn’t get reabsorbed within the capillary beds. The lymph system is built to reabsorb this excess fluid and bring it where it needs to go.
The organs of the lymphatic system include a framework of lymphocyte clusters and connective tissue fibers. The lymphocytes come from red bone marrow and are carried in the blood to specialized organs, which include lymph nodes, adenoids, tonsils, the spleen, and the thymus gland.
When foreign substances get into the body, an immune response is triggered, and lymphocytes multiply and are sent to the affected body site to destroy the microorganisms. And when a more serious infection occurs, the lymph nodes may swell up and enlarge, which is why this is often checked as an initial symptom of illness.
There are about 600 to 700 bean-shaped lymph nodes in the body that filter and cleanse the lymphatic fluid. The primary location of lymph nodes are inside the center of the abdomen and chest, the armpits, neck, and groin.
The specialized lymph organs (adenoids, tonsils, spleen and thymus) house specific defense cells for the body that are built to fight infections. Peyer’s patches line the intestines in a lymphatic tissue network that monitors bacteria in the intestinal walls, and the appendix also has lymphoid tissue to destroy bacteria before it can be absorbed into the intestines.
The lymphatic system not only transfers nutrients but also keeps the fluid balanced within the body. The human body forces 20 liters of fluid within the capillary system, and only 17 liters is reabsorbed by venous return. The remaining 3 liters becomes the lymphatic fluid, which is eventually returned back to the bloodstream.
Consider that if this volume was not returned to the circulatory system, blood pressure would drop, cellular wastes would accumulate, and there would be a decline in oxygen delivery.
This backup of fluid would cause edema that could restrict blood flow and result in complications in the body. It’s this potential for fluid backup may appeal some people of getting a lymphatic massage.
How is lymphatic drainage massage supposed to work?
Lymphatic massage focuses on taking advantage of lymph circulation. In a normal system, lymph fluid circulates in a one-way trip around the body. It’s transported by lymph capillaries, collected by larger lymphatic vessels, and circulated all the way around to veins near the collarbone (subclavian).
Because it doesn’t have its own independent pump system, the fluid is moved upward against pressure by the pumps created by the active and passive muscle and joint movements. Specialized valves ensure there’s no back flow of fluid.
During this journey, lymph nodes filter the fluid as it passes through them and makes its way to the base of the neck. Once this cleaned lymph fluid reaches the subclavian veins, it’s returned into the bloodstream.
The premise of MLD is to assist the flow of lymphatic fluid through the body, which stimulates the lymph nodes and reduces “stagnation” of fluids in specific areas.
Although there are various methods that have branched off the original set of techniques, most of the modalities focus on four main strokes.
Each of these strokes is performed at a level of pressure that is rather light, often described as the pressure one would use to “stroke a newborn baby’s head.” The intention is to stretch the tissue beneath the skin enough to manipulate the lymphatic structures, but not enough pressure to close off the lymphatic valves or affect underlying muscular structures.
All strokes go from the farthest point of your body toward your heart. Every stroke also has both a resting and working phase and can be performed using one or both hands.
Lymphatic drainage massage techniques
The following strokes are the basis of most manual lymph drainage massages:
- Stationary Circles: These strokes are applied with the palmar surfaces of the fingers or hand, stretching the skin continuously with an oval- or spiral-shaped motion. These movements are typically used on the lymph node areas in the groin or armpits, and also on the neck and face.
- Pump Technique: Therapists use the entire palm of the hand and upper parts of the fingers to apply circular pressure to the skin. The pump techniques are used mostly to manipulate the lymphatic vessels in the extremities, using one or both hands.
- Scooping Technique: Scoops are applied mainly to the body’s lower extremities in a spiral-shaped movement. Palms face up, fingers outstretched (like a scoop), this is a dynamic movement performed with either one hand or alternating hands.
- Rotary Technique: This stroke is used on the larger surfaces of the body. The entire surface of the hand and fingers are performed using elliptical movements and applied in a continuous, dynamic way. Typically this is applied with one hand, but like scooping, if both hands are used, it is in alternating strokes.
As mentioned before, there are a number of MLD techniques that have been developed as specialized protocols. However, they tend to have these four basic strokes in common, along with other standardized features.
Typically, lymphatic massages are performed with you lying on your back. Diaphragmatic breathing is used to start and end the session, and the gentle strokes are applied with slow and rhythmic movements.
Therapists will begin with treating the unaffected lymph nodes and regions first before areas that are noted to be congested. Each protocol involves a different number of strokes in a “working” phase of pressure down to a “resting” pressure of zero.
Although the purpose of MLD is to reduce swelling and inflammation, many advocates of this technique claim that there are relaxing effects that can be experienced when receiving lymph massage. Because of the stretching and compression to your body, your parasympathetic nervous system is activated, and that may reduce your fight-or-flight response.
Stimulation of the mechanoreceptors in your skin may elicit an analgesic effect, which may decrease some level of pain relief.
Is massage good for lymphedema?
Current evidence say that massage for lymphedema “might not add any effect” to treating or preventing this disease among breast cancer patients, based on a 2020 systematic review of 17 studies that was published in Medicine.
Having analyzed the results by various factors, like the age, sample size, and the type of breast cancer surgery, some of the trials found “no benefit to the prevention of lymphedema” compared to other treatments, like compression garments and exercise.
While the technique might not “work” well, touch itself and having the presence of another person would likely alleviate stress and loneliness that cancer patients often experience.
Lymphedema is an abnormal accumulation of fluids under the skin that becomes so severe that it begins to obstruct lymphatic vessels or lymph nodes. It can be caused by any disease that damages the lymphatic system itself.
Over time, the fluids released from arterial capillaries are incapable of being drained properly, resulting in fluid accumulating under the skin. Most instances of lymphedema occur in the extremities, but it can develop in the breasts, genitals, head, neck, or torso.
There are two distinct types of lymphedema: primary (or hereditary) and secondary.
Cases of primary lymphedema involve lymphatic damage that is present at birth. In the case of Milroy’s Disease, swelling is seen at the time of birth. However, symptoms of primary lymphedema often appear later in life, beginning in early teen years or adulthood.
Secondary lymphedema is the most common type of lymphedema. It most often occurs with surgical procedures or cancer treatments that end up damaging the lymph system.
In surgical situations, the more lymph nodes that are removed or damaged, the higher the risk of developing lymphedema. Radiation therapy, active cancer, post-surgical infection, heart or vascular disease, arthritis, eczema or obesity can also contribute to higher risks of lymphedema.
Does lymphatic drainage massage work?
Although MLD is often used as treatment options for lymphedema and various lymphatic disorders, there’s a general consensus that more research is necessary to determine its ultimate efficacy. But there are three areas in which there is expansive interest in applying this technique, and it merits exploration in research.
Breast cancer treatments
MLD has been featured in several studies in regard to breast cancer-related lymphedema. In one review, the researchers investigated whether or not lymphatic massage would prevent lymphedema in women who had recently had breast-cancer surgery.
Based on 10 randomized controlled trials with a total of 566 patients, they found found “no significant difference in the incidence of lymphedema between the MLD and standard treatment groups.”
The study had limitations in that there were conflicting reports about the efficacy of MLD among the published studies, as well as the “methodological quality of the original studies.”
However, the research team concluded that “the current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema.”
They added that adding MLD to compression and exercise therapy is “unlikely” to reduce the affected arm significantly.
Even though research shows its lack of effectiveness for lymphedema, lymph massage is still widely used in complementary treatments for this condition.
Can lymphatic massage decrease cellulite?
Due to the growing popularity of MLD in the beauty industry, it’s important to examine whether or not that there’s scientific evidence behind the celebrity hypes and trends. One such trend is the ability for lymphatic drainage to reduce cellulite.
In a study from 2014, Bianca Schonvvetter et al. studied 15 women (ages 20 to 40) for whether or not there would be significant reduction of cellulite on the skin of their buttocks after consistent treatments of MLD once a week for 14 weeks.
They used ultrasound to measure any changes in affected and treated areas. The limitations of the study were its small “sample size, low adherence, lack of control and randomization, number and duration of MLD sessions.”
The researchers concluded that “manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management.”
As appealing as it sounds, it seems that this claim isn’t backed by hard data as yet.
Sports medicine and rehabilitation
Another area where MLD is becoming of interest is within sports medicine. Because of the claims that this modality can reduce inflammation and swelling, it’s natural that athletes would be interested since they get sprains and strains, similar to their interest in sports massage.
In 2009, researchers from Pennsylvania State University analyzed 100 peer-reviewed journals and concluded that there is “insufficient and inconsistent ensemble of evidence” to establish clinical guidelines for rehabilitating athletes.
Much like many limitations of massage studies, where it’s hard to establish a true control group, it’s hard to establish a solid baseline of measurable results.
However, with the expansion of interest in a wider pool of demographics (e.g. athletes), it may be possible to get a larger pool of subjects and eventually be able to establish better-designed randomized-controlled trials in the future.
All of these studies reflect what is commonly concluded to MLD and all massage techniques: it’s widely used, generally considered safe, but fairly inconclusive in regard to its results.
Although many practitioners use MLD, most conclude that research for its effects is limited with inconsistent results. However, a case can be made for the importance of having therapists stay current with research being done on this modality as funding and interest grow.
How to perform lymphatic drainage massage
It’s important to remember that manual lymphatic drainage varies in its techniques and applications. Generally, therapists take a continuing education course for their chosen method in this type of modality.
According to practitioner Sean Riehl, all MLD techniques have to preventing lymphedema: pressure, direction, rhythm, sequence and contraindications.
- Pressure: Pressure should always be mindful of moving the skin, not the musculature beneath. The touch should be deep enough to deform the skin, but not so deep as to close any of the channels of lymph beneath the skin layers.
- Direction: Lymphatic strokes should always be performed by pushing the lymph toward the correct nodes. Though a therapist would not necessarily do any harm, they would be negating the efficacy of the movements.
- Rhythm: Correct speed and rhythm of the strokes is important to establish a type of pump for the fluid; the initial lymphatics will be allowed to open and shut in a manner that the lymph can move down the vessels. Also, by providing a rhythmic protocol, this will help stimulate the parasympathetic nervous system, allowing the client to further relax.
- Sequence: The order of strokes can be vital for this treatment to work. Therapists should always start near the node they are draining the fluid toward, then pushing the lymph toward that node.
As the sequence progresses, the therapist will work further away from the node but still pushing the lymph fluid back in the direction of the node. Doing this clears the path for the fluid to move, in essence making a pump and suctioning effect.
Contraindications: As always, the therapist should always keep in mind any contraindications for the session. The goal of MLD is to provide relief to a client, not do further harm.
How often should you get a lymphatic massage?
As with any type of massage therapy, there is no gold standard for how many sessions are recommended. Each client will have individual needs and goals and these should be discussed with the MLD practitioner.
Many practitioners will recommend anywhere from three to five sessions to achieve a particular short-term goal, and then recommend monthly or quarterly maintenance.
If clients are working with a medical practitioner for prescribed treatments, this will also be variable. For elective MLD work, each client can discuss with their practitioner what is feasible in regard to schedule, finances, and results.
So does lymphatic drainage massage work at all?
Whether or not manual lymphatic drainage massage “works,” we need to examine the claims that are often made by practitioners. Many claims state that the benefits can include:
- reducing swelling;
- removing metabolic wastes, excess water, toxins and other foreign substances from tissues;
- alleviating pain by greatly reducing pain signals sent to brain;
- calming the sympathetic nervous system to help relieve stress, and supporting/enhancing the action of the nervous system;
- lose weight or cellulite.
As the previous section’s research citations show, many of the studies for the measured efficacy of MLD are inconclusive. Other studies may have slightly positive results, but the limitations of the studies lie in poor research methods, lack of control groups, or small clinical samples.
This has not prevented this technique from being prevalently used in medical treatments for edema and lymphedema, in part, because it’s such a gentle technique that it’s relatively safe, even if its application is a placebo effect or resulting in positive feelings after treatment.
If you seek out this modality for beauty reasons, you need to weigh the realistic aspects of MLD. For example, in weight loss, look closely at the before-and-after pictures and you may find that there is a reduction in localized fluid rather than actual weight loss.
There may be alleviation of bloating and water retention, but these results are only temporary.
Typically, in regard to flushing “toxins” or enhancing lymphatic efficiency, if you’re relatively healthy with an undamaged lymphatic system, you’re already effectively moving lymph, nutrients, and metabolic wastes through your body on their own. It’d be unnecessary to seek out MLD treatment in these situations.
MLD can offer you a positive experience similar to that of merely receiving gentle therapeutic touch. Because sessions typically begin and end with diaphragmatic breathing, this can also yield a calming result for you, even if there’s no significant reduction of swelling.
The gentle manipulation of mechanoreceptors in sustained and focused MLD protocols could also support stress reduction by creating a positive response of the nervous system. Although the traditional narrative of manual lymphatic drainage may not be currently measured by hard data, there are merits to increasing the quality of life of a client by offering an overall sense of well-being.
Whether or not MLD “works” is subjective to the recipient and will require further study and scrutiny in order to have its claims substantiated with hard data.
Lymphatic massage precautions and safety
What should you consider before getting a lymphatic drainage massage?
As with any massage, it’s important for you to consider any contraindications that you may have before seeking this treatment. If you suspect that you have edema or lymphedema, you should have the approval of your primary medical provider before signing up for massage.
Other contraindications for manual lymphatic drainage massage are:
- Cardiac problems, including impairments and edema
- Congestive heart failure
- Acute inflammation or infection of any kind
- Blood clots
- Active cancer (it’s important to note that massage cannot spread cancer throughout the body, but contraindications of this sort are often due to risks with chemotherapy and radiation, and sensitivity of the patient)
How to find the best lymphatic massage near you?
Because there can be contraindications for massage, find someone who is qualified to perform manual lymph drainage techniques. The Lymphatic Education and Research Network encourages you to seek practitioners who have completed a minimum of 135-hour training course, and are Certified Lymphatic Therapists (CLTs). However, some physicians, nurses, physical therapists, and massage therapists are trained and licensed to practice MLD.
Getting referrals is often a useful tool in narrowing the right-fit practitioner for you, and there are often many resources to find qualified therapists. If you have lymphatic disorders, your doctor would have recommendations and referrals for you.
However, those who are not under the care of a medical professional may need additional resources and guidance. Ask practitioners how much training they have had, where they trained, and if they have taken any continuing educational courses. The Lymphology Association of North America (LANA) also has a set of standards and guidelines specific to those who are seeking to find a qualified MLD practitioner.
Although there are many appealing benefits to receiving manual lymphatic drainage massage, remember that the clinical efficacy of MLD needs to be studied further. Very few of the clinical trials yielded strong positive data in support of MLD alone preventing lymphedema in postoperative breast cancer patients, and other studies used MLD in conjunction with compression bandages and other treatments.
This weakens the case for MLD being an effective standalone treatment in reducing swelling and inflammation.
Regarding beauty treatments, its prevention of lymphedema and toning the body are only temporary. Similarly, there’s not enough evidence to prove that lymphatic drainage massage is an effective adjunct treatment in sports medicine applications.
If you are seeking wellness with MLD, chances are, if you don’t suffer from some sort of lymphedema or similar condition, this type of massage would be unnecessary.
However, if you enjoy the style for the sake of its gentle quality of touch, there’s generally no harm in receiving it.