Lymphatic Drainage
Barbara G. White, LMT, MTI, BCTMB, CLT, CDT is a Certified Manual Lymphatic Drainage (MLD) and Complete Decongestive Therapist (CDT). -Lymphedema Bandaging. Additional Certifications in Neuro-Lymphatics and Head and Neck Lymphatics (HNL) with ALM Certification (treating Head and Neck Caner patients). Post-Op Lymphatic Drainage. She has been practicing Lymphatic drainage since 1999 and teaching since 2004. Her training includes both Vodder and Chickly techniques.
“Healing is a Process, not an Event!”
Manual Lymphatic Drainage
Manual Lymphatic Drainage (MLD) may be recommended in a variety of situations including full body detoxification and immune system boost, post-surgical swelling, and scar tissue reduction. MLD speeds recovery time for overall health and injury recovery. Cancer and post cancer treatment plans frequently include MLD and Complete Decongestive Therapy (CDT) in recovery from lymph node dissection, radiation, chemotherapy, mastectomy and other supporting medical interventions. These are the most common causes of lymphedema in the United States. Axillary Web Syndrome or “cording” occurs in a segment of this population. Complete Decongestive Therapy (CDT) is frequently needed. Other forms of cancer have similar effects. Please visit with your therapist regarding treatment options.
Lymphedema [lim-fa-dee-mah] is a chronic condition where a protein rich fluid called lymph or lymphatic fluid collects in the tissues just below the skin causing swelling. Your lymphatic system runs throughout your body and is like a plumbing system for your lymph fluid.
When this system does not work properly, whether it was poorly developed from birth, damaged from surgery, radiation or a trauma, your body cannot effectively transport lymph fluid. When transport is interrupted and lymph fluid cannot drain properly, it causes swelling where the drainage is disrupted. This swelling can be in any part of the body, most often in the arms and legs, but also the breast or chest wall, abdomen, head and neck, or genitals
When the fluid remains stagnant in the tissue, the body recognizes this excess protein as “foreign” and wants to “wall off” this area to protect it. This can cause a state of inflammation, which then causes fibrosis (scar tissue). That fibrosis can feel hard and tight, and makes it more difficult for the fluid to move out of the area. It also puts patients at higher risk of wounds healing slowly and infections called cellulitis or lymphangitis.
Lymphedema may present following the above listed treatments or any other injury to the lymphatic system. Lymphedema may also be present as a result of untreated or advanced stage CVI or Congenital Malformation of the Lymphatic System. MLD and CDT may be used to remove the swelling and maintain the reduction. Compressive garments and home exercises are needed in conjunction with MLD and as always, staying in compliance is key. Please keep your physician in the loop with any treatment plan you are pursuing.
What is the lymphatic System?
The lymphatic system is a part of the circulatory system. Most people are aware of their cardiovascular system but less commonly aware that the cardiovascular system is only a part of their overall circulatory system.
The Cardiovascular system, with the help of red blood cells (RBC), carries and distributes nutrients, oxygen, neurotransmitters, chemicals and hormones to distal parts of the body through arteries and arterioles. The RBCs and their cargo are dropped off in the tissues for cell use.
The target cells use these substances and create waste products in return. The capillaries pick up these RBCs and wastes and carries them in veins to filter the blood through the kidneys and liver, before returning to the heart and lungs to do it all over again.
The Lymphatics are a series of veins that run from distal parts of the body toward the heart but don’t have a set of arteries leaving the heart. It is a one-way system. The Lymphatic system houses a high concentration of white blood cells and T-cells that are responsibhe Lymphatics are a series of veins that run from distal parts of the body toward the heart but do not have a set of arteries leaving the heart. It is a one-way system. The Lymphatic system houses a high concentration of white blood cells, phagocytes, macrophages, antigens, B-Cells and T-cells that are all responsible for our immune response. When wastes such as dead cells, large proteins, fat cells, cellular waste/bi-products, undesirable chemicals and pathogens are unable to move back into the smaller capillaries of the cardiovascular system the lymphatic system picks them up and moves them through progressively larger lymphatic vessels to lymph nodes.
The human body has between 1,000-1,200 lymph nodes depending on the person. The lymph nodes are the functional part of the lymphatic system where the wastes are churned up inside the nodes and attacked with the WBCs. Phagocytosis (cell eating) takes place and the large waste products and pathogens are disarmed and crushed up before being returned to the bloodstream for disposal.
The veins pick up 80-90% of the fluids that leak from the arteries and only a part of the cellular waste products from the area. Imagine a bathtub with a drain that will pass 90 gallons in a day and a faucet that lets in 100 gallons in a day. Without an overflow drain, that tub will spill over onto the floor by the end of the day. The spillover of fluids in our hands or feet is exactly like that bath tub. Edemas can form anywhere in the body but are most common in the limbs.
In addition to edemas, cancers form where cells are forced to mutate to survive in toxic environments. Remember, our cells are eating and excreting in the same pool of fluids. Too many toxins surrounding a cell prevent nutrients from moving in and toxins from moving out. Cells reprogram and mutate to survive. Our bodies are designed to fight off these cancer cells but sometimes lose that fight.
With less emphasis on life threatening pathologies, the most common illnesses that we face daily are also combated by the lymphatic system. Opportunistic pathogens can over grow in our bodies if our immunesystems are unable to mount an appropriate defense. The outcome could be the common cold, yeast infections, sinus infections, urinary tract infections, infectious skin infections, staph infections, systemic swelling, and pain and more. The list is endless.
The lymphatic system has the task of picking up the leftover 10 – 20% of fluids preventing edemas and illness. If 10 – 20% does not sound like much, know that a cup of coffee is only 4% coffee and 96% water. There is a big difference between a cup of coffee and a glass of water. In fact, without our lymphatic system, we would not survive more than 2-3 days.
Since the Lymphatic system is only a one-way system moving toward the heart, it doesn’t have the muscular contractions of the heart to propel the fluids and wastes forward. It relies on the rhythmic pressures created from body movement. 70% of the lymphatics are superficial and moveable through manual lymphatic drainage techniques. 30% of the body’s lymphatics are deep and only moveable through abdominal breathing and kinesthetic movements of the body. If the lymphatic system is overloaded or sluggish from a lack of movement (as common in bed ridden patients) the body’s ability to fight off these common pathogens is reduced.
What is Manual Lymphatic Drainage (MLD)?
Manual Lymphatic Drainage techniques closely mimic the body’s natural rhythms.
The lymphangions, or lymphatic vessels, are anchored to the body’s soft tissues. Movement of the body pulls on these anchoring filaments, opening the lymphatic vessels and allowing fluid from the surrounding tissues to enter.
Once the fluid enters the lymphatic vessels, the system can begin transporting it.
The light touch and rhythmic movements used during Manual Lymphatic Drainage gently move the skin and associated anchoring filaments to encourage fluid movement into the vessels.
The order in which MLD strokes are performed is as important as the quality and pressure of the technique.
MLD is a specialized hand technique beginning near the clavicle, where lymph ultimately returns to the cardiovascular system, and then progressing toward more distal lymphatic chains.
Lymph nodes are located throughout the body but are particularly concentrated in areas including:
- Neck and behind the ears — cervical nodes
- Under the chin — submandibular nodes
- Under the arms — axillary nodes
- Deep abdomen
- Inguinal region where the legs meet the trunk
Who Needs MLD?
MLD is considered appropriate for many people, with several important exceptions.
Individuals who are frequently ill, sluggish, or experiencing minor edema may benefit when an overtaxed lymphatic system is contributing to the problem.
More significant edema requires specialized care and additional training.
If you are:
- Post-cancer treatment
- Post-surgical
- Experiencing lymphedema
- Experiencing significant swelling
Ask your MLD provider about their credentials and level of training.
Lymphatic Drainage is a specialty service requiring specialized education.
Certification is considerably more extensive than simply completing an online course or short weekend program. Full certification generally requires extensive consecutive study along with written, verbal, and practical examinations.
Always ask about your provider’s credentials and training.
Your practitioner should also review your health history before beginning treatment.
Do not receive Lymphatic Drainage if you are currently running a fever over 100°F.
Cardiovascular and kidney disorders require special consideration because MLD significantly increases fluid movement.
Anyone who currently has or recently had active cancer should also be carefully evaluated before treatment.
This does not necessarily mean MLD cannot be performed, but special considerations may be necessary, including consultation or a recommendation from the treating physician.
How Should I Prepare?
Eat light and healthy for a few days before and after a Lymphatic Drainage session.
Drinking plenty of water and limiting heavy or fatty foods may help support your body during treatment.
Treating your body well as a matter of habit—and especially when preparing for a lymphatic treatment—is encouraged.
What Should I Wear?
Dress comfortably for your session.
You will be asked to disrobe and lie face-up beneath a sheet. You will remain covered throughout the session so that your warmth and modesty are maintained.
No lotions or oils are used during the session.
What Should I Expect From an MLD Session?
MLD is not traditional massage, but it is typically very relaxing.
The touch is extremely gentle and rhythmic, and many clients fall asleep during treatment.
Quiet is generally encouraged to enhance relaxation. Questions may be asked before the session or whenever necessary during treatment.
Your therapist may begin with a gentle cervical pull and myofascial compression over the sternum while asking you to take several cleansing breaths.
Once you begin to relax, rhythmic movements are applied near the clavicle and then progress upward through the neck.
The stroke does not glide across the skin like traditional massage. Instead, it gently moves the superficial layers beneath the therapist’s hands.
Treatment may progress across the front of the body and, depending on the goals of the session, portions of the posterior torso.
Can I Feel Different After an MLD Session?
Some clients may experience temporary changes in how they feel following a session.
Pay attention to how your body responds and communicate any unusual or significant symptoms to your therapist.
If symptoms are severe, unexpected, or do not resolve appropriately, consult a qualified healthcare provider.
Many clients report feeling relaxed and refreshed following Lymphatic Drainage sessions.
How Often Should I Get Lymphatic Drainage?
Lymphatic Drainage is often most productive when performed as a series of treatments.
For general wellness or detoxification-focused sessions, a series may include approximately three sessions.
A typical session lasts approximately 45–60 minutes.
The second appointment may be scheduled within several days of the first, followed by another session several days later.
Your therapist may determine that additional sessions are helpful or that fewer are necessary based on how your body responds.
Once an initial series is completed, maintenance sessions may be scheduled according to your individual needs.
Lymphedema Treatment Frequency
When receiving MLD for lymphedema, more frequent treatment may be necessary.
Complete Decongestive Therapy may require treatment several times per week for multiple weeks depending on:
- The affected limb or body region
- The stage of lymphedema
- Individual response to treatment
Treatment may include:
- Manual Lymphatic Drainage
- Compression bandaging
- Therapeutic exercises
- Home care
- Compression garments
Lymphedema is a lifelong condition requiring ongoing management to reduce the risk of future complications.
Post-Surgical Lymphatic Drainage
Post-surgical MLD may initially be performed two or three times per week, depending on the surgical procedure and recommendations of the treating physician.
Some surgeons may recommend more frequent treatment.
Every person heals differently, so the number of sessions required will vary.
Factors that may affect treatment frequency include:
- Type and extent of surgery
- Individual healing response
- Post-operative complications
- Amount of swelling
- Use of compression garments
- Compliance with physician instructions
Always follow your surgeon’s recommendations regarding post-operative care.
Other Common Recommendations
Water
Drink plenty of water according to the recommendations of your healthcare provider.
Reducing water intake does not necessarily reduce swelling and may interfere with normal fluid balance.
Pineapple and Bromelain
Some surgeons recommend pineapple or bromelain during recovery.
Pineapple juice is naturally high in sugar, so clients with diabetes or blood sugar concerns should discuss this with their physician.
Bromelain supplements are also available.
Always consult your physician before adding supplements to your recovery plan.
Cell Saver
Before cosmetic surgery, you may wish to ask your surgeon whether a “cell saver” is appropriate.
A cell saver collects, cleans, and returns a patient’s own blood during certain surgical procedures.
Your surgeon can determine whether this is appropriate for your specific surgery.
Flying After Surgery
Many patients travel for cosmetic surgery.
Changes in atmospheric pressure during air travel can affect post-operative swelling and discomfort.
If travel is necessary following surgery, discuss timing and precautions with your surgeon before scheduling your flight.
Remember: Healing is a process, not an event.
Healing occurs gradually. Be patient with your body and remain committed to your recovery plan.
Beware of Fads
Wood Therapy and what I refer to as the “Squeegee Technique” are among the techniques commonly promoted through Instagram, YouTube, Facebook, and other social media platforms for post-operative cosmetic surgery.
Online information can vary greatly in quality.
Some information may be accurate and useful, while other techniques may be demonstrated by individuals without appropriate training or licensure.
My years of experience as a lymphatic practitioner and instructor have shown me that some providers practice techniques without sufficient understanding of anatomy, physiology, tissue healing, or the lymphatic system.
Providers may have good intentions, but inadequate training may increase the risk of harm.
Tissue Replication and Fibrosis
Cosmetic surgery creates significant tissue injury, and swelling may continue while those tissues heal.
Fluid accumulation does not simply disappear after being manually pushed from an area. Swelling may continue to return until the underlying injury has healed.
Your surgeon performed the actual body contouring. Swelling must gradually resolve before the final surgical result becomes visible.
Healing takes time.
Tissue can heal in different ways.
When an optimal healing environment exists and enough healthy cells remain, tissue may regenerate with minimal visible evidence of injury.
When tissue damage is more severe or healing tissue is repeatedly disrupted, heavier collagen fibers may develop and form scar tissue.
Fibrosis is the term commonly used for this scar tissue.
Early tissue regeneration begins with delicate granulation tissue.
If this new tissue is repeatedly damaged, the healing process must begin again.
Techniques that aggressively rub, squeeze, roll, or compress recently injured tissues may disrupt delicate healing structures.
Lymphatic Drainage is Not Traditional Massage
Properly trained lymphatic practitioners understand that much of the lymphatic system is superficial.
The pressure used for Lymphatic Drainage is therefore very different from traditional Swedish or deep-tissue massage.
MLD uses very light, rhythmic techniques designed specifically for the lymphatic system.
Traditional massage pressure, aggressive rubbing, excessive heat, or hard tools are not the same as Manual Lymphatic Drainage.
Always research the credentials and training of the person providing your post-operative care.
Medical Procedures Require Medical Professionals
Reopening wounds, removing drain tubes, and performing needle aspirations are medical procedures.
These procedures require the appropriate medical training and licensure.
Massage therapists are not trained or legally permitted to perform procedures outside their professional scope of practice.
When wounds are reopened or invasive procedures are performed, infection risk may also increase.
Drain tubes should be removed according to the criteria established by your surgeon and by an appropriately licensed medical professional.
Cavitation
Cavitation therapy has become increasingly popular in cosmetic surgery recovery.
Cavitation is a non-invasive body-contouring treatment that uses ultrasound technology to target fat cells in specific areas.
Ultrasonic cavitation is intended for body contouring rather than significant weight loss.
After cosmetic surgery, however, cavitation used too early in the healing process may interfere with delicate tissues.
Treatment should generally wait until wounds and incisions are fully healed and the appropriate healthcare providers determine that treatment is safe.
Proper training and professional licensure are important for anyone providing these services.
Lymphatic Drainage and cavitation are different therapies and should not be treated as interchangeable.
Certificate vs. Certification
There is an important difference between receiving a certificate and earning a professional certification.
A certificate generally indicates that a licensed professional attended or completed a specific educational course.
The course may include:
- Classroom instruction
- Weekend training
- Online education
- Hands-on instruction
The amount and quality of training may vary considerably.
A certificate does not automatically mean that the practitioner has completed a comprehensive professional certification program.
Ask questions about:
- Number of training hours
- Hands-on experience
- Instructor qualifications
- Testing requirements
- Clinical experience
- Professional licensure
Lymphatic Drainage is a specialty service and is not automatically included in basic massage therapy licensing education.
Holding a Massage Therapist license does not necessarily mean the therapist has been trained in every specialized form of soft-tissue manipulation.
Lymphatic Certification
Certification standards established by professional lymphatic organizations require significantly more extensive training.
Comprehensive Certified Lymphedema Therapist programs may include approximately 135 hours or more of practical and classroom education along with multiple examinations.
Training may include:
- Written testing
- Practical examinations
- Hands-on instruction
- Lymphatic anatomy and physiology
- Manual Lymphatic Drainage
- Complete Decongestive Therapy
- Compression and bandaging
- Clinical treatment planning
Fully Certified Lymphedema Therapists commonly use professional credentials such as:
CLT — Certified Lymphedema Therapist
CDT — Complete Decongestive Therapist
Always ask providers about their actual education, professional license, and certifications.
Watching online videos alone does not qualify someone to provide professional lymphatic treatment.
Hands-on, instructor-supervised education is an important part of learning these techniques safely and effectively.
Our Commitment to Lymphatic Care
We provide approximately 120 lymphatic sessions each week in addition to our other therapeutic services.
As certified therapists, a significant part of our work involves educating clients about their bodies, treatment options, and recovery process.
Proper education allows clients to participate more actively in their own recovery and make informed decisions about the care they receive.
It is easier to avoid unnecessary complications than to correct them later.
For additional information about Lymphatic Drainage or to discuss your individual needs, please contact us.
We’re here to help with your recovery.
Barbara G. White
LMT, MTI, BCTMB, CLT, CDT
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