What Is a Lymphatic Drainage Massage and Does It Work?

What Is a Lymphatic Drainage Massage and Does It Work?

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, this work 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 220,000 posts and is touted as being one of the top beauty crazes of 2020. 

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? To answer this, it is important to look at the traditional narratives of lymphatic massage, its history, and its current applications in the massage industry. 

The winding history of lymphatic drainage massage

Lymphatic drainage massage is based on the hypothesis that congested lymph nodes in a particular area of the body can be encouraged to be “cleared out” by performing a series of rhythmic, compressive strokes along lymph vessels. Practitioners of this method claim that it can reduce edema, swelling, and/or inflammation from lymphatic disorders or trauma to the body. But what does this mean for consumers seeking to differentiate the value of this technique versus other massage styles?

Historically speaking, all massage involves some sort of therapeutic touch. Unlike a traditional massage like Swedish and deep tissue massage, lymphatic drainage massage techniques focus on using feather-light pressure and circular movements no greater than the pressure it would take for one’s finger to move skin. It also vastly differs from traditional styles of massage because it focuses on the body’s lymphatic system instead of the integumentary (skin) and musculoskeletal systems. 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.

In the early 19th Century when Swedish gymnastics instructor Per Henrik Ling began his exploration of his “Movement Technique,” he focused mainly on the movement and hygiene of the body, not the lymphatic system. The “Ling System,” as it was referenced, made more use of active and passive movement of the body, and it was less concerned with what was happening within. Even as this movement technique later became the inspiration for Johann Georg Mezger’s systemization of what are now the foundations of modern massage, the focus was still on the musculoskeletal system and performed as an overall full-body massage. 

In the late 19th Century, the lymphatic system became a focal point of pioneer physician Dr. Andrew Taylor Still as he developed the tenets of what is now osteopathic medicine. Dr. Still became interested in the “fluid continuity” within the connective tissue matrix of the body. 

In his work, The Philosophy and Mechanical Principals of Osteopathy, he expounded “the lymphatics are closely and universally connected with the spinal cord and all other nerves, long or short, universal or separate, and all drink from the waters of the brain.” This work became important as Dr. Still began to develop a medical system that focused on finding and correcting malfunctions in what he termed the “nerve force” of the body. He further conceptualized the idea that areas of the body could be subjugated to “stagnation” which needed to be addressed in order for the body to heal itself—thus began the implementation of lymphatic techniques to address these issues.

From this exploration sprang a number of other osteopathic doctors and researchers who became keen on having a greater ability to treat lymphatic system dysfunctions. As papers began to be published on the efficacy of lymphatic techniques, a growing number of protocols developed to treat lymphatic ailments. One of Dr. Still’s students, Earl Miller, DO, instituted the manual thoracic pump technique in 1920, and a burgeoning of other techniques followed. 

In 1930, advancement of lymphatic drainage massage techniques was promulgated by Danish clinical scientist Emil Vodder, PhD, who made headway with what is now widely recognized as Manual Lymph Drainage (MLD) massage. The notable difference between Dr. Vodder’s approach and the other lymphatic pump techniques was Vodder’s use of a light touch instead of the popular heavy pressure applications. 

Inspired by other Danish scientists’ writings on the lymphatic system, Dr. Vodder began to explore how massage applications could drain “congested” lymph nodes directly, as if opening a gate to remove excess fluids causing imbalances. Along with his wife, Dr. Estrid Vodder, he began to develop a specific protocol of massage strokes that combined a variety of gentle hand strokes to address these lymphatic pathologies without increasing inflammation or fluid. 

He used the concept of “watershed routes” in the body to drain lymph and move it through the lymph nodes and eventually back into the bloodstream. This technique was quite incendiary, as it was taboo at the time to directly touch the lymph nodes. In 1936, Dr. Vodder released his signature method entitled Dr. Vodder’s Manual Lymph Drainage to a convention in Paris. 

However, it was not immediately accepted in the scientific community until much later. In the 1950s, the Vodders were encouraged to promote their method throughout Europe. According to the Vodderschool website, “In the early 1960’s a German general practitioner, Dr. Asdonk, heard of Vodder and became interested in this method.” This was the springboard for the Vodders’ work to become taught as a physical therapy technique in a formal training capacity. 

Since the growth of lymphatic drainage massage techniques, there have been many offshoots of the Vodders’ methods. The most known modalities in addition to the Vodder method are the Földi, Leduc, and Casley-Smith methods. The Vodder Method incorporates specific hand movements that vary depending on the area of the body being worked. 

The Földi method has a basis in the Vodder method, but it emphasizes “relaxation, encircling strokes and compression.” The Casley-Smith method uses more ulnar effleurage movements, and the Leduc method developed particular “call up” and “reabsorption” protocols to bring up lymph into surrounding tissues. All of these methods are generally considered when Complete Decongestive Therapies are prescribed as a treatment in cases of lymphedema. 

Basic functions of the lymphatic system

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 is important to have a simple understanding of how the lymphatic system works

The lymph system has three primary responsibilities: acting as part of the body’s immune system, facilitating fat and fat-soluble nutrient absorption for digestion, and also maintaining the body’s homeostatic fluid balance between tissues and blood. 

lymphatic system

The lymphatic system is comprised of three parts; lymph fluid, lymphatic vessels, and the lymphatic organs. Lymph fluid, similar to blood plasma, is made up primarily of white blood cells, intestinal fluid called chyle (containing fats, minerals and proteins), and other components of interstitial fluid (including damaged cells, foreign invaders and even cancer cells). It circulates throughout the body in a similar way that blood does and is a key element in our immune system. 

The lymphatic vessels of this system only carry fluid away from the tissues. Lymph capillaries are the tiny vessels that are found in all body regions, with the exception of 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 does not have a pump, so the lymph fluid moves via pressure gradients from skeletal muscle & respiratory system movement as well as smooth muscle contractions. Basically, most lymph fluid begins as blood plasma that is forced out of the capillaries and does not get reabsorbed within the capillary beds. The lymphatic 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 are introduced to the body, an immune response is triggered, and lymphocytes multiply and are sent to the affected body site to destroy the invading 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. 

In addition to providing an immune system role for the body, 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 of this volume, only 17 liters is reabsorbed by venous return. The remaining three 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 (swelling) that could restrict blood flow and result in complications in the body. It is this potential for fluid backup that sheds light on the appeal of having manual lymphatic drainage massage.

How is lymphatic drainage massage supposed to work?

Lymphatic drainage massage focuses on taking advantage of lymphatic circulation. In a normal system, lymph circulates in a one-way trip around the body. It is transported by lymph capillaries, collected by larger lymphatic vessels, and circulated all the way around to the subclavian veins of the neck. 

Because it does not have its own independent pump system, the fluid is moved upward, against hydrostatic pressure, by the pumps created by both active and passive muscle and joint movements, and specialized valves ensure there is no back flow of fluid. During this journey, lymph fluid is filtered by the lymph nodes as it passes through them and then makes its way to the base of the neck. Once this cleaned lymph fluid reaches the subclavian veins, it is returned into the bloodstream.

The premise of lymphatic drainage massage is to assist the flow of lymphatic fluid through the body, in effect stimulating the lymph nodes and reducing “stagnation” of fluids in specific areas. Though there are various methods that have branched off of Dr. Vodder’s original set of techniques, most of the modalities focus on four main strokes to accomplish the goal of clearing areas of congestion and assisting reabsorption of excess fluid. 

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 of this type of pressure 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 are applied to the body proximal to distal, that is, beginning at the farthest point of the body, moving inward toward the 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 manual lymph drainage massage techniques that have been developed as specialized protocols. However, they tend to have these four basic strokes in common, along with other standardized elements. Typically, lymphatic drainage massages are performed with clients lying down, facing upwards. 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, with each protocol involving 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 in congested areas of the body, many advocates of this technique claim that there are relaxing effects that can be experienced when receiving lymphatic drainage massage. Because there is stretch and compression being applied to the body, often the parasympathetic nervous system is activated, and it is possible that there is a reduction in the fight-or-flight response of the body.

Due to the stimulation of the mechanoreceptors in the skin with many of the MLD techniques, an analgesic effect can also occur. With the slow and rhythmic nature of this type of massage, it is possible that the affected receptors could result in some level of pain relief for clients as the body relaxes. 

Lymphedema and lymphatic drainage massage

There are many manifestations of lymphatic disease that can occur in the human body. However, the most well-known are edema and lymphedema.  Any swelling that is the result of the accumulation of excessive fluid in cells, tissues and organs is referred to as edema. This can be caused by a number of maladies, including trauma or injury, infection or chronic vein issues. Edema tends to be temporary and easily treatable, as it often occurs as a secondary symptom of something else. When too much fluid is let into tissues, the lymph system can get overwhelmed, thus creating swelling and inflammation. 

Lymphedema, however, is an abnormal accumulation of fluids under the skin that becomes so severe that it begins to obstruct lymphatic vessels or lymph nodes. This disorder tends to be progressive in nature, and indicative of damage to the entire lymph system. Lymphedema 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, though less commonly it can develop in the breasts, genitals, head, neck, or trunk of the body. When lymphedema progresses, it can block the ability for nutrients to circulate, and infections of the body can increase significantly. 

There are two distinct types of lymphedema: primary, or hereditary, lymphedema and secondary lymphedema. 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. 

Stages of lymphedema 

There are many stages of lymphedema, and it tends to begin in the external extremities first. 

Stage 0: There is injury to the lymph system but no visible swelling. Signs can manifest as tingling, the sense of fullness, or numbness. 

Stage I: Swelling becomes visible, and becomes pitting edema, indicated by a dent or pit left behind on skin when pressed with a finger. Elevation of the affected body part often results in the swelling reducing, but comes back later. 

Stage II: Swelling does not resolve without intervention. Tissues harden and thicken from fibrosis (scarring). Increases in skin problems can occur, including infections. 

Stage III: Swelling becomes so large that it interferes with ability to move limbs. The surrounding skin becomes hard and scaly, and lymphorrhea (leaking fluid from skin breaks) begins to occur. Recurrent infections become more common. 

Diagnosis of lymphedema

Lymphedema has a range of times in which it occurs, and it is not predictive who will develop it. 

If lymphedema is suspected, medical professionals may order various tests to check the function of the lymph system if it is not immediately apparent that the swelling is caused by lymphedema. Doctors may check for infection (cellulitis), blood clots, or other conditions that have intense swelling as a symptom. 

Other tests may include using various scans (MRI/CT), lymphoscintigraphy, Doppler ultrasound, or bioimpedance spectroscopy

Lymphedema treatments 

Once it is determined that lymphedema is the cause of swelling and symptoms, it is often treated quickly and aggressively. Though there is no cure, there are interventions that can control it.  Methods such as Complete Decongestive Therapy (CDT) can be employed, which make use of Manual Lymph Drainage massage, compression therapy, laser therapy, exercise and movement therapies as well as skin and nail care to prevent infections. 

In extreme cases where CDT is less effective, pneumatic compression pump therapy may be employed, as well as exploring surgical options. These options may include lymphovenous bypass, lymph node transfer, or even liposuction to remove accumulated fat during late stages of lymphedema.

When untreated, lymphedema could cause life threatening complications. Permanent changes to the skin, such as thickening, scaling and growths could occur. Repeated infections can also decrease a patient’s quality of life over time. In rare and very extreme cases where lymphedema is untreated, the condition elephantiasis can occur. The affected area of swelling develops thick, dry and pebbled appearance and can become dark, pitted and ulcerated.

Because of the potential severity of lymphedema and the wide range of complications it can create, it is important to explore all therapies possible to treat this condition as early as possible. 

These interventions not only promote the flow of lymph where impeded, prevent other complications and slow progression of the disorder, but they can also allow patients to have a better quality of life as they get treatment. 

What does research say about lymphatic drainage massage? 

Though MLD is consistently used as treatment options for lymphedema and various other lymphatic disorders, there is a general consensus that more research is necessary to determine its ultimate efficacy. However, there are three areas in which there is expansive interest in applying this technique, and it merits exploration in research. 

Lymphatic drainage massage and breast cancer treatments

MLD has been featured in several studies in regard to breast cancer-related lymphedema. In one review by Huang TW, Tseng SH, Lin CC, et al., the researchers investigated whether or not lymphatic drainage massage would prevent lymphedema in women who had recently had breast-cancer surgery.

They  reviewed randomized controlled trials from the six databases and searched for studies that evaluated the efficacy of MLD in postoperative lymphedema patients. In particular, the trials needed to meet certain criteria to be considered in the study. All trials needed to identify the following:

“1) the inclusion and exclusion criteria used for patient selection

2) the MLD technique used

3) the compression strategy used

4) the definition of lymphedema

5) the evaluation of lymphedema severity”

The MLD efficacy was evaluated by determining the severity of the lymphedema, as well as how much fluid volume reduced at “1, 3, 6, 9 and 12 months” after the treatment was performed. This was then compared to the original arm measurement before the treatment. The final study identified 10 RCTs with 566 patients, with outcomes that 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, despite this limitation, the research team came to the conclusion that “the current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. Meta-analysis indicated that the addition of MLD to compression and exercise therapy for the treatment of lymphedema after axillary lymph-node dissection for breast cancer is unlikely to produce a significant reduction in the volume of the affected arm.” 

It is important to note that despite evidence that lymphatic drainage is not overwhelmingly effective in preventing lymphedema in cancer patients, it is still widely used in complementary therapeutic treatments for this condition. 

Can lymphatic drainage massage decrease cellulite?

Due to the growing popularity of MLD in the beauty industry, it is important to examine whether or not that there is 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 for whether or not there would be significant reduction of cellulite on the skin after consistent applications of MLD. 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 study looked at “healthy women aged from 20 to 40 years who presented with cellulite grade II or III on the buttocks, according to the classification by Nürnberger and Müller. After clinical evaluation, MLD sessions were carried out once a week for 14 weeks. In these sessions, movements of physical stimulation and massage on lower limbs and buttocks were performed according to the techniques proposed by Vodder and Leduc.”

After the 14 weeks and the application of ultrasound to assess change, the researchers concluded that “manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary.”

As appealing as it would be to have a massage treatment significantly decrease cellulite in the body, it seems that this claim is not backed by hard data as yet.

Manual lymph drainage and 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 is natural that it would be of interest to athletes subject to sprains and strains, similar to sports massage.

In 2009, Vairo, Giampietro et al. offered a review of the MLD application within the sports rehabilitation realm. The team analyzed 100 peer-reviewed journals published between 1998 and 2008 from five databases. They chose studies that had patients who “suffered from medically diagnosed musculoskeletal ailments, which included bone fracture, acute ankle sprain, fibromyalgia, orthopaedic trauma, and Bell’s palsy.” Participants had “acute skeletal muscle damage” who also had exercise as a later treatment.

The research team had some limitations as far as having sufficient and consistent evidence “on which to establish clinical practice guidelines for the use of MLDTs in rehabilitating athletic injuries. Likewise, it is difficult for a manual therapist to administer a sham or placebo intervention without being cognizant of such during treatment.”

Despite the limitations of the review, they concluded the following:

“Manual lymphatic drainage techniques remain a clinical art founded upon hypotheses, theory, and preliminary evidence. Researchers must strive to clarify the biophysical effects that underpin its various proposed therapeutic applications in the human organism. Randomized controlled trials and longitudinal prospective cohort studies are required to establish the efficacy of MLDTs in producing positive outcomes for patients rehabilitating from sports-related injuries.”

Much like many limitations of massage studies (that it is hard to establish a true control group, because either a treatment is applied, or it is not, and it is impossible to not know that one is receiving massage treatment), it is difficult to establish a true baseline of measurable results. 

However, with the expansion of interest in a wider pool of demographics (in this case, the sports medicine demographic), it may be possible to acquire 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 in regard to MLD (and in essence, all massage) techniques; that it is widely used, generally considered safe, but fairly inconclusive in regard to its results. Though many practitioners employ this type of massage modality, most conclude that research for the effects of MLD 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.

[More recent research on lymphatic drainage massage and its effect on lymphedema among breast cancer patients]

How to perform lymphatic drainage massage

It is 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 master five different things: 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 drainage 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. Generally speaking, 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.

Does lymphatic drainage massage work? 

In terms of 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. There are also numerous claims by the celebrity trend industry that MLD can help clients to lose weight or cellulite. 

As the previous section’s research citations show, many of the studies for the measured efficacy of Manual Lymphatic Drainage massage 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 is such a gentle technique that it is relatively safe, even if its application is a placebo effect or resulting in positive feelings after treatment. 

Clients who seek out this modality for beauty reasons need to weigh the realistic aspects of MLD. When sought for weight loss, for example, looking closely at before and after pictures often reveals that there is a reduction in localized fluid rather than actual weight loss. 

Expectations for this type of treatment need to be realistic in that 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 a person is relatively healthy with an undamaged lymphatic system, they are already effectively moving lymph, nutrients and metabolic wastes through their body on their own. It would be unnecessary to seek out MLD treatment in these situations. 

In terms of claims to alleviate pain and relieve stress, MLD can offer clients a positive experience similar to that of merely receiving gentle therapeutic touch. Also, because sessions typically begin and end with diaphragmatic breathing, this can also yield a calming and beneficial result for clients, which in turn may be able to increase their feelings of well being overall, even if there is not significant reduction of lymphatic fluid. 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. Though 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 drainage massage precautions and safety

What should you consider before getting a lymphatic drainage massage?

As with any massage, it is important for you to consider any contraindications that you may have before seeking this treatment. If you suspect that you have edema or lymphedema, it is important that you 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 is 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 drainage massage near you?

Because there can be contraindications for massage, it is important to consider finding someone who is qualified to perform manual lymph drainage techniques. The Lymphatic Education and Research Network encourages clients to seek practitioners who have completed a minimum of 135-hour training course, and are Certified Lymphatic Therapists (CLTs). However, it is important to note that 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 each client, and there are often many resources to find qualified therapists. For those who have lymphatic disorders, it would be expected that the medical professional treating a client would have recommendations and referrals for treatment. 

However, those who are not under the care of a medical professional may need additional resources and guidance. It is encouraged to 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. 

Conclusions about manual lymphatic drainage massage

Though there are many appealing benefits to receiving manual lymphatic drainage massage, it is important to remember that the clinical efficacy of MLD needs to be studied further. Very few of the controlled 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. 

In regard to its applications in beauty treatments, it is unlikely that MLD could reduce cellulite and tone the body given its temporary efficacy. Similarly, there is not enough evidence to prove that lymphatic drainage is an effective adjunct treatment in sports medicine applications. 

For those seeking to increase their wellness with MLD, the chances are most likely that if a client does not suffer from some sort of lymphedema or correlating condition, that this type of massage therapy would be unnecessary for general health practices. However, if clients enjoy the style and modality for the sake of its gentle quality of touch, there is generally no harm in receiving it.

heather thuesen
Heather Thuesen, LMT
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Heather Thuesen has been a Licensed Massage Therapist in Colorado since 2014. Her areas of interest and specialization are in athletic and movement work, chronic pain conditions, anxiety-related disorders, and working with adolescents and teens ranging in age from 10-17.

She is continuing her studies in psychology and PTSD/trauma-related conditions. In addition to creative writing, she has an avid interest in travel, social culture and photography. Her favorite travels involve chasing storms, good coffee, homemade pie and Kerouac-inspired road trips.