Lymphatic Massage

Lymphatic Massage – also known as manual lymphatic drainage (MLD) – is a highly specialized and gentle massage technique used to increase lymph flow and encourage the natural drainage of the lymph from the body tissues.  It is a very safe and effective technique that is useful for many conditions where lymph flow may be compromised, such as lymphedema, swollen limbs caused by a variety of different things, in diabetics, sports injuries, post surgical, etc.  For example, many clients require lymphatic therapy or lymphatic massage to treat the increased swelling and lymph accumulation that occurs after a mastectomy, or other surgical procedures, especially those where lymph nodes may be removed or damaged.

The lymphatic system relies on intrinsic contractions of the cells that line the walls of the lymph vessels, as well as the contraction and movement of skeletal muscles, to propel lymph through the vessels and to the lymph nodes.  From the these nodes the lymph travels to the lymph ducts, which return the lymph to the cardiovascular system.  Manual lymph drainage uses a small amount of pressure (<9 oz per square inch) and rhythmic movements to stimulate lymph flow. Treatment may also include specific exercises prescribed by your lymphatic therapist, breathing techniques, and compression garments or self-bandaging techniques to further promote lymph drainage after therapy and between treatments.

What is Manual Lymph Drainage?

Developed in Europe in the 1930’s by Dr. Emil and Estrid Vodder, Manual Lymph Drainage (MLD) is a safe, effective, yet gentle approach to cleansing the body’s tissues.  MLD drains excess fluid from the tissues and also has a detoxifying effect.  It is beneficial to healthy individuals, and can be used to effectively treat a variety of different conditions.  The therapeutic effects of manual lymphatic drainage is well documented and prescribed by top physicians in Europe, Canada, and the United States.

Benefits of Lymphatic Massage and Manual Lymph Drainage

The benefits of lymphatic therapy are many:

• removal of metabolic wastes, excess water, toxins, bacteria, large protein molecules and foreign substances from the tissues.
• through its gentle rhythmical and precise hand movements, lymphatic therapy works to alleviate pain by greatly reducing then pain signals sent to the brain.
• relaxation of the sympathetic nervous system, thus helping to relieve stress.
• supports and enhances the immune system
• promotes healing from injuries, surgical trauma, chronic conditions, and edema
• minimizes scar formation.

What is Lymphedema?

Lymphedema is the swelling of a body part, most often an extremity, resulting from an accumulation of fluids.  This swelling is enough to be both visible and palpable.  Lymphedema occurs when the lymph vascular system is not able to fill its functions of reabsorption and transport of the protein and lymph load.  Lymphedema occurs whenever lymphatic vessels are absent, underdeveloped, obstructed, or damaged.

Lymphedema can cause decreased mobility, pain, discomfort and often repeated episodes of infection, cellulitis and lymphangitis.  This can lead to depression and a general worsening of the patient’s quality of life and health.

How Does Lymphedema Occur?

Lymphedema can occur when a stagnation of protein develops in the tissue.  This raises the colloid osmotic pressure and a protein rich edema arises.  There are more protein rich fluids in the tissue than can be transported and the proteins attract water by osmosis.  The affected area becomes swollen, enlarged, and uncomfortable.  This swelling decreases oxygenation of the tissues, interferes with their normal functioning, and makes them heal slower than normal.  The excess protein also serves as a stimulus for chronic infection and can result in formation of excess fibrous tissue.  Lymphedema is a chronic condition and if left untreated, it can progress.  It can, however, be brought under control and managed with appropriate treatment and care from your lymphatic therapist.

Lymphedema may also be due to primary (congenital) causes or secondary causes (caused by a known condition), including removal of the lymph nodes or trauma.

What Is The Treatment for Lymphedema?

Lymphedema is a serious condition where the lymph system is unable to handle the lymph load of the body.  Treatment should begin as soon as lymphedema is diagnosed.  The goal of treatment is to reduce the swelling and facilitate the flow of lymph fluid to the venous circulation of the affected area.

The most effective approach used  by therapists in many European countries is a method called Combined or Complex Decongestive Therapy.  Combined Decongestive Therapy includes Manual Lymph Drainage, compression therapy, remedial exercises, creating techniques, and skin hygiene.

Dr. Vodder’s Combined Decongestive Therapy

Combined Decongestive Therapy involves:

1. Lymphatic Therapy – patients receive Manual Lymph Drainage to remove excess fluid and protein.  The MLD is performed to open lymphatics in the unaffected regions so these can help to train the affected area.  MLD stimulates lymphangions to increase their activity, which results in a decompression and emptying of obstructed lymphatic channels.

2. Compression Therapy – Bandaging of the affected limp follows each MLD session.  This is a precise and accurate procedure using specific bandages and interfacing materials.

3.  Remedial Exercises and Breathing – this further promotes venous and lymphatic flow by activating the muscle and joint pumps.

4.  Skin Care and Hygiene – excellent skin cleansing with antibacterial washes and neutral balanced pH lotions will help to eliminate bacterial and fungal growth and so minimize the possibility of repeated attacks of cellulitis and/or lymphangitis.

Lymph Vessel System

Unlike the blood which circulates, lymph only flows one way.  The lymph vessel system carries away tissue fluids as well as metabolic waste from the tissue.  Lymph is a clear colourless fluid which originates int he tissue spaces.  Excess fluid and proteins from the tissue channels are collected by the initial lymphatics which are in the dermis of the skin of the affected area.  The lymph is transported rom the initial lymph vessels by pre-collector and collector lymph vessels.  These are made of segments called anions and the larger collector lymph anions have smooth muscles which pump the lymph forward.

Lymph, in passing from one region of the body to the next, passes through regional lymph nodes, where cells,  micro-organisms and tissue debris are filtered.  The lymph enters the bloodstream at the venous arch before entering the heart.

It is crucial for the lymphatic system to function efficiently.  If the lymph pathways become congested, damaged or blocked, or lymph nodes are removed or irradiated, more and more proteins build up in the tissue, without the lymphatics being able to remove them.  Thus a protein rich edema forms – lymphedema.

Primary Lymphedema

Primary Lymphedema has no known cause.  Milroy’s disease is a familiar lymphedema which is present at birth.  Meige’s disease is similar but appears no later than puberty.

LYMPHEDEMA PRAECOX is the most common form of primary lymphedema.  This begins in adolescence and occurs predominately in females.  75% of primary lymphedema is praecox.

LYMPHEDEMA TARDA is identical to lymphedema praecox but occurs after the patient is 35 years old.  Both praecox and tarda almost always involve just the legs.

The pathological mechanisms which cause primary lymphedema are an absence of lymphatics (aplasia), inadequate lymphatic drainage, too few lymphatics or too few nodes, or lymphatics which are hugely dilated.

Secondary Lymphedema

Secondary lymphedema is an acquired condition resulting from loss or obstruction of previously normal lymphatic channels.  The most common cause of secondary lymphedema is due to removal of lymph nodes, as part of surgery for malignancies.  The lymph pathways can be interrupted by radiation, surgery, injury, or blockage with parasites.

Trauma or radiation can tear a major lymph trunk or cause the production of excess fibrous tissue, which later constricts the lymph vessel.

Lymphedema may also occur as a result of chronic venous diseases, which always involves the large lymphatic vessels that run beside the veins.

Lipedema

Lipedema is a condition where changes in cellular function of adipose cells lead to fatty tissue edema, thickened collagen fibbers, venous stasis, and lymphostasis.  Lipedema occurs more frequently in women and appears at certain locations such as the thigh, buttocks, lower abdomen and sometimes the arms.  Hands and feet are unaffected and remain slim.  Lipedema occurs in phases and is painful in the advanced stages.  It frequently exists in combination with venous edema and/or lymphedema.

Self Care

After the clinic treatment has been completed the patient is responsible for continuing exercises and breathing techniques.  A correctly fitted compression sleeve or stocking must be worn on a daily basis.  Self bandaging is done every night before bed.  It is advisable to have a check up once a month after the treatment has ended, as well as 6 months later to assess progress.  Garments should be replaced every 3-6 months since they lose their elasticity over time.

At PhysioHealth Studios, lymphatic massage therapy is provided by Lucy Romano, RMT, CDT.