Lymphatic Drainage Massage Therapy

The Origin of Lymphatic Drainage Massage

Lymphatic drainage massage as we know it today was developed by Danish physical

therapist Dr. Emil Vodder and his wife Estrid Vodder in the 1930’s. They initially
developed the technique to address chronic sinusitis and immune conditions.

Dr. Vodder noticed that gentle, rhythmic massage movements could help reduce
swelling and improve lymphatic flow in people with respiratory conditions. In 1936, the
Vodders introduced their method of manual lymph drainage at an international
conference in Paris and the technique soon gained recognition and popularity,
eventually spreading the world over.

Today, lymphatic drainage is practiced by massage therapists, physical therapists and

other healthcare professionals. It has become an established modality for managing
conditions such as lymphedema, post-surgical swelling, sports injuries and promoting
general well-being. The technique continues to evolve as more practitioners re-iterate
on its original foundations.

It's worth noting that while specific techniques were developed by the Vodders, the
concept of manual therapy for stimulating lymphatic flow has its roots in ancient healing
systems like traditional Chinese medicine and Ayurveda. The Vodders work refined
these ideas into a systematized therapeutic approach.

The Composition of the Lymphatic System

The lymphatic system is composed of several different components that work together
to perform its functions. These components include:

1. Lymphatic Vessels - a network of thin-walled tubes that resemble blood vessels.

They are the transportation system for lymph fluid.
2. Lymph Nodes - small bean shaped structures located along lymphatic vessels.
They act as filters and are found in clusters around areas such as the neck,
abdomen, armpits and groin. Lymph nodes contain immune cells, particularly
lymphocytes, which help recognize and eliminate foreign substances, pathogens
and cellular debris present in the lymph.
3. Spleen - The spleen is the largest lymphatic organ in the body. It is located in the
upper left abdomen, below the ribcage. The spleen filters blood, removes old red
blood cells and plays a role in immune responses by producing antibodies and
capturing pathogens.
4. Thymus - Located behind the sternum (breastbone) in the upper chest. It is most
active during childhood and plays a crucial role in the development and
maturation of T lymphocytes, a type of white blood cell that is important in
immune responses.
5. Tonsils and Adenoids - Tonsils are collections of lymphoid tissue located at the
back of the throat, while adenoids are similar structures found in the nasal cavity.
They both help to protect against infections by trapping and attacking pathogens
that enter through the respiratory and digestive systems.
6. Bone Marrow - Contributes to the lymphatic system by housing stem cells that
differentiate into various types of immune cells, including lymphocytes. B cells, a
type of lymphocyte involved in antibody production, mature in the bone marrow.
The Primary Functions of the Lymphatic System

1. Fluid Balance - The lymphatic system helps maintain fluid balance by collecting
excess interstitial fluid, proteins and other substances that leak out of the blood
vessels into the surrounding tissues. This excess fluid, lymph, is then transported
back into the bloodstream, preventing the buildup of fluid in the tissues and
maintaining proper fluid balance.
2. Immune Response - The lymphatic system plays a crucial role in the body’s
immune defense. Lymph nodes, the small bean-shaped structures, contain
special immune cells called lymphocytes.
3. Absorption of Dietary Fats - The lymphatic system is involved in the absorption of
dietary fats and fat-soluble vitamins from the digestive system. Specialized
lymphatic vessels called lacteals in the small intestine absorb these fats, which
are then transported as chyle through the lymphatic system. Chyle eventually
reaches the bloodstream, where the fats and fat-soluble vitamins are utilized by
the body.
4. Transport of Immune Cells - The lymphatic system is a transport network for
immune cells. Lymphatic vessels carry lymphocytes and other immune cells to
various parts of the body, allowing them to reach sites of infection, inflammation,
or other injuries quickly. This helps coordinate immune responses and facilitates
the body’s defense against pathogens and foreign substances.
Lymphatic Transport System

The lymphatic system is composed of both deep and superficial vessels and lymph
nodes which prevent the buildup of interstitial fluid. The drainage system is separate
from the general circulatory system and is used to return fluids to it.

1. Lymphatic Capillaries - The initial point of entry into the lymphatic system, a
single layer of partially overlapping endothelial cells that create a valve. These
overlapping junctions create an opening, which allows fluid into the capillary
when the pressure outside the vessel is greater than the pressure inside the
vessel. The capillaries then feed fluid into the collecting lymphatic vessels.
2. Lymphatic Vessels - Composed of an endothelial layer with many tight junctions
that has intraluminal valves and pericytes. The pericytes contain smooth muscle
actin, which functions to contract the vessel and pump the fluid through the
system. The valves prevent the backflow of lymphatic fluid and ensure
unidirectional (one-way) flow of the fluid. Lymphatic vessels drain fluid (lymph)
from tissues throughout the body and return the fluid to the venous system via
two ducts (the right and left lymphatic ducts) also called the thoracic duct. These
ducts connect to the subclavian vein, which returns lymph to the bloodstream.
The subclavian vein is a paired large vein, one on either side of the body and
runs below your collarbones.
3. Lymph Nodes - The lymphatic vessels pass through nearby lymph nodes. The
lymph nodes act as filters removing pathogens, foreign substances and debris.
There are about 500-600 lymph nodes in the human body. After visiting the
lymph nodes, the lymphatic fluid flows into efferent (outward or away) lymphatic
collecting vessels or lymphatic trunks.
4. Lymphatic Ducts - Final collecting vessels. They allow for the entry of lymphatic
fluid into the venous system bilaterally, via the opening found in the intersection
of the subclavian and internal jugular vein. The venous system refers to the
network of veins that work to deliver deoxygenated blood back to your heart.

Lymphatic watersheds are defined by the territories drained by specific groups of lymph
nodes. Each watershed corresponds to a particular region of the body. For example, the
axillary lymph nodes in the armpit region drain lymph from the upper limb, chest wall
and breast. The inguinal lymph nodes in the groin area drain lymph from from the lower
limb and genital area. Similarly, there are specific lymphatic watersheds for the head
and neck, abdomen and other regions of the body.
The left duct or thoracic duct collects most of the lymph in the body other than that from
the right thorax, arm, head, and neck which are drained by the right lymphatic duct. It is
38-45 cm in length.

The right duct drains fluid from the upper right side of the trunk (right thoracic cavity),
the right arm (from the right subclavian trunk), and right side of the head and neck (from
the right jugular trunk). It is 1.25 cm in length.
Diseases of the Lymphatic System

Understanding the diseases and disorders of the lymphatic system is important to know
how it can affect the system and person. These are just a few of the main examples of
lymphatic system disorders.

1. Lymphedema - This is a condition characterized by swelling, usually in the arms

and legs due to an impaired lymphatic system. It can occur when the lymphatic
vessels are damaged, blocked, or absent preventing proper drainage. Primary
 lymphedema is often a result of congenital abnormality, while secondary
lymphedema can develop due to surgery, radiation therapy, infection, or trauma.
2. Lymphadenopathy - Refers to the swelling or enlargement of lymph nodes. It can
be caused by various factors, including infections like viral or bacterial,
autoimmune diseases, medications, and cancer. Lymphadenopathy is often
associated with pain, tenderness, and the presence of palpable swollen lymph
nodes.
3. Lymphoma - Is a type of cancer that affects the lymphatic system, specifically the
lymphocytes, which are a type of white blood cell. There is Hodgkin lymphoma
and non-Hodgkin lymphoma. Lymphoma typically presents with swollen lymph
nodes, fever, weight loss, fatigue and night sweats.
4. Leukemia - Is a cancer of the blood and bone marrow that affects the white blood
cells, including lymphocytes. While it usually involves the bone marrow it can
involve the lymphatic system. The abnormal production of white blood cells can
affect the lymphatic system.
5. Lymphadenitis - Is inflammation of the lymphatic vessels usually caused by an
infection. It commonly occurs as a result of bacterial infection entering the body
through a cut, wound, or insect bite. It is characterized by red streaks along the
skin, swelling and fever.
Indications for Lymphatic Drainage Treatment

Lymphatic drainage massage is indicated for a wide variety of conditions and situations
where promoting lymphatic flow and reducing swelling and congestion can be
beneficial.

- Lymphedema (helps stimulate lymphatic flow and reduce fluid retention)

- Post-Surgery recovery (promotes healing and prevents lymphedema)
- Detoxification (removes toxins and waste products)
- Enhanced immune function (boosts immune system by increasing circulation of
lymphocytes and other immune cells)
 - Edema and swelling (helps with pregnancy induced swelling, fluid retention, or
conditions like arthritis)
- Fibromyalgia and chronic fatigue (helps with pain, fatigue and fluid retention)
- Skin conditions (is used to help with skin conditions like acne, rosacea, and
cellulite)
- Stress reduction and relaxation (it is known to elicit a soothing calming feeling in
the body that reduces stress)

Contraindications for Lymphatic Drainage Treatment

- Acute cellulitis (bacterial skin infection)

- Severe cardiac insufficiency (heart muscle pump function is reduced)
- Hepatic cirrhosis (severe scarring of the liver)
- Unstable hypertension (blood pressure that fluctuates abnormally)
- Renal failure (kidneys are not working)
- Untreated tuberculosis (bacteria that usually attacks the lungs)
- Untreated thyroid dysfunction (too little or too much hormone production)
- Metases (spread of cancer cells)
- Primary tumors (cancer may spread from primary tumors)
- Women can have lymphatic drainage massage while pregnant with approval
from a doctor but the abdomen should be avoided. Luckily we have deep
breathing to help out with the treatment

*If you suspect anything may contraindicate treatment, refer them out to a physician

The Effect of Lymphatic Drainage Massage on the Body

The effect of lymphatic drainage massage on the lymph system is:

- An increase in lymph reabsorption

- Increased fluid flow into pre lymphatic channels
- The intermittent pressure of the hands-on techniques accelerates the filling and
emptying of the lymph capillaries
- As a result of increased lymph formation, more lymph is transported to the
lymphangion (smooth muscle that propels lymph fluid); therefore the lymph
vessel wall is pushed outward from within. Furthermore, the stationary circle
strokes cause an external dilation of the lymph vessel wall
- As a result of the increased lymph formation and the accelerated lymph
transport, the number of lymphocytes transported per unit of time increases
 - This entire process leads to detoxification, swelling reduction, immune system
support, inflammation reduction, faster waste removal, nutrient delivery and aids
in faster tissue healing and recovery

Manual Lymph Drainage Techniques

Effleurage - which means to “skim” or touch “lightly on” with gentle and slow movement
with the full hand or side of the hand. Usually to begin and end a treatment to clear an
area. We go in one direction in lymph drainage massage.
Stationary Circles - as you would imagine gentle circular motions in one position at a
time. Usually working in one area and then moving to the next closest area. This is
really great when you're doing a self lymphatic drainage massage.
Two-Handed Pump Strokes - skin is stretched using a double handed pumping
motion.
Edema Strokes - usually use the 2 handed pump stroke for edema fluid as opposed to
fingertips. Do not apply edema strokes if there are varicose veins, radiogenic damage or
pain.

*hand strokes should always be delivered slowly and gently as to not overtax the
lymphatic vessels. The vessels have a diameter of less than a millimeter!!

Stretch Phase and Relaxation Phase

In the stretch phase, fluid is pushed in the direction of lymphatic drainage with gentle
hand motions, either circular or pumping actions. It is performed 5-8 times in one
section of the body. The increase in interstitial pressure promotes lymph formation.

In the relaxation phase, when contact is barely maintained with the skin, the lymph is
carried passively out of the tissue so that the vessels can once again be filled up distally
(in the lower portion) creating a suctioning effect through the stretch and relaxation
process.

Work in a one or two second rhythm with 5-8 repetitions in one place of the body
with relaxed hands. Strokes must be performed slowly and carefully to not
overtax the vessels. You can’t be too light or too firm but just enough to pump the
fluid and stretch the skin. Stretch the skin and release, stretch the skin and
release, and repeat. Look at the video lecture to see it in action.
Proximal Pre-Treatment

Deep breathing techniques called diaphragmatic breathing are usually done at

the beginning and end of a lymphatic drainage session to help open up the deep
lymphatic pathways. It’s not only relaxing, but it helps increase movement of fluid
toward the heart.

A proximal area is cleared so that distal fluid can be carried away from stagnant
tissue into the proximal area for drainage. It creates a suctioning effect. This is
usually done by opening up the terminus starting in the neck located in the
supraclavicular fossa (above the clavicle in the hollow). An example would be if you're
treating the chest you would open up the neck and the axillary nodes first before
treatment.

The Standard Rules

- The skin is stretched in specific directions using hand movements without the
use of oils or creams
- Slow repetitive movements are used with a rest period to allow the skin to return
to its normal position
- The pressure and strokes vary depending what your dealing with, if someone
had edema you would use the flat of your hand as opposed to fingertips
- Lymphatic drainage starts centrally and proximally usually starting in the neck
- Deep breathing techniques are used to promote drainage of deep abdominal
lymph nodes and vessels, the return of the lymph caused by inhalation and
exhalation, at the same time, creates a suction effect that drains lymph from the
legs

Self Facial Massage to Practice

Practice this on yourself to start before you go and practice on another person. This is a
15 minute sequence you can use for self-care but you can also take it into your practice
and provide it as a 15 minute add on facial massage service.

- Take a moment to see how your face and neck feel pre-treatment
- Deep diaphragmatic breathing to start to promote drainage, place hands on your
abdomen, breathe in through the nose, belly rises, chest rises, through the throat
and out through the nose slowly letting the breath out. Slowly bring your hands
into your abdomen for a little push to the lymphatic system. Repeat 3-5x
- Place your hands in your armpits and do both sides with circle pumps 5-7x
 - Work right above the collarbone one side at a time 5-7x, stretching the skin down
and letting go push and relax, push and relax, and repeat
- Pitchfork your hands and work around both sides of the ears one side at a time
stretching the skin down and away towards the collarbones. We’re doing one
side at a time to see if we can notice the difference after we’ve done a couple
strokes
- Work in the jaw from the midline out towards the ears and collarbones and repeat
5-7x
- In the chin work down towards the jaw and collarbones 5-7 times, move up one
level in the cheeks and move across and down 5-7x. You can do stationary
circles and finish by draining towards the collarbones but either way works
- Work around the eyes and eyelids very gentle
- In through the forehead
- Finish by going down all the steps we just did going back down one step at a
time to finish at the neck and into the armpits finally
- Then finish with 3-5 diaphragmatic deep breaths
- Take a moment to notice how your face feels

*follow along with me in the video lecture

Lymphatic Drainage Massage Treatments

Treatment Sequence

We’re going to go in an order that makes sense for a pleasant full body treatment,
however we’ll also discuss how you can treat each individual area with indications and
contraindications as well.

*A practice tip is to do each of the individual area treatments and then on another day
do the sequences for the face and neck and full body to practice again and get
feedback post-treatment.

Deep Diaphragmatic Breathing

I like to start most of my treatments with deep diaphragmatic breathing. It helps to

stimulate deeper lymphatic structures and increase lymphatic flow. It helps the body
return fluid to the heart and also to decongest the lymphatic system and boost immune
health.
You can do 3-5 deep belly breaths, place hands on abdomen and chest, breathe in
through the nose, abdomen rises, then chest rises, hold at the top for a couple of
seconds and release, either out through the nose or mouth.

You can advise this as home care for your clients to do a couple times through the day
especially if they have lymphedema.

Neck Treatment

Contraindications - Cardiac arrhythmia, venous thrombosis, overactive thyroid function

Indications - Post-surgery swelling, injury to the neck, health and wellness, improving
skin texture

- In seated or supine with pillow under clients head for better drainage, make sure
their neck isn’t kinked too much, nice and straight to allow for best possible
drainage
- Get the client to relax their neck
- Do light effleurage on the top of the chest with circular strokes 3-5 x
- Do 5-8 pumps above the collarbones to open up the lymph nodes and get the
system warmed up. Can use palm of hands for this or broad fingertip contact
here
 - Apply lymphatic pumps around the cylinder of the neck 5 times at 3 different
levels with a broad hand contact
- Around the back of the neck beside the cervical spine region pump the fluid
towards the collarbone cavity with stationary circles 5 times in 3 segments
- Do stationary circles in front of and behind the ear 5-8 times with pitchfork hand 2
fingers in front and 2 in the back of the ear
- Then if you were just doing the neck specifically you can drain back down
reversing all those previous steps from behind the ear to the cylinder of the neck
and finishing in the hollow above the collarbones
- Finish with effleurage from the ears towards the collarbones and down the chest
3-5 light strokes

Back of Head and Neck Treatment

Contraindications - Same as the neck cardiac arrhythmia, venous thrombosis and

overactive thyroid

Indications - Would be the same as the neck as well, post-surgery swelling, injury to the
area, relaxation of muscles

- In seated, prone or supine with pillows for a seated support for best drainage
 - Do light effleurage from the back of the head to the shoulder towards the top of
the collarbones
- If this was a standalone treatment we would do the shoulders up to the top of the
head and back down again. If your following the neck treatment we just did then
you would start at the top of the head and move down from the top of the head to
the shoulders with stationary circles 5 times in each area moving towards the
collarbones
- With your palms, pump from the upper traps towards the collarbones 5 times
- Move up to behind in the neck on either side of the spine, use pitchforked
fingertips to pump towards the collarbones 5 times. Moving from the midline to
the collarbones
- On the suboccipitals and base of the neck use stationary circles moving towards
the auricular nodes
- On the head make sure the scalp moves as you use the palms of your hands
with a downward movement towards the auricular (ear) nodes
- Move in a downward motion on the head and scalp working towards the auricular
(behind the ear space)
- Now reverse all those steps from the top of the head to the upper traps draining
towards the auricular nodes and nodes in the terminus (above collarbones)
- You can use a couple of gentle effleurage strokes towards the ears and
collarbones in all treated areas (back of head, base of skull, back of neck and
shoulders)

Facial Treatment

Contraindications - Infections of the face

Indications - tissue swelling from chronic inflammation, skin glow, de-puffing, sinus
issues, general face health and relaxation
- Client in supine and can be slightly supported by a pillow or two, with this one I
would be at the head of the client for ease of hand positioning
- If doing as a standalone treatment open up the nodes above the collarbones,
neck, and auricular space first
- Effleurage from the lower jaw, cheeks, forehead from the midline towards the ear
and collarbones to warm up
- Place fingertips under the lower jaw and pump fluid down the neck into
collarbones space 5 times in 3 sets
- Treat the chin with fingertips pumping downward towards the clavicles
- Pump around the lips in a downward direction 5 times
- Pump around the nose 5 times in 3 sets going downwards towards the
collarbone space
- Pump around the cheeks 5 times with 3 sets going towards the collarbone space
direction
- Pump around the TMJ going downwards towards the collarbones 5 times in 3
sets
- Move up around the eyes and forehead but now direct your pumps towards the
ears moving from the midline towards the auricular (ear) space. Moving all the
way to the top of the forehead
- Now reverse all those steps moving in the opposite direction. Top of the forehead
down to the chin
 - You can use a couple of effleurage strokes from the top of the forehead towards
the collarbones to finish

Chest Treatment

Contraindications - Inflammation caused by infection, cancer that may spread

Indications - Pre-treatment for lymphedema of the arm, fullness feeling in the chest

- Client in supine
- If doing a standalone treatment open up the clavicular and axillary nodes on both
sides first with 5-8 pumps and do deep breathing 3-5 times
- Following the full body sequence you would just open up the axillary nodes as we
already did the clavicular nodes
- Effleurage with 3 strokes from the middle of the chest to the armpits
- Move along the midline of the chest wall and breasts working towards the armpits
- You would do this on both sides of a healthy person, if someone had
lymphedema or nodes removed you would move into the unaffected side armpit
and the affected sides inguinal nodes as watersheds for drainage
- Move your way down the chest wall to the bottom of the ribcage and then back
up always moving your strokes towards the armpits. 5 pumps in all lines. As you
 can see by now, you go up and then back down always directing the strokes in
one direction
- Finish with effleurage strokes from the midline of the chest wall to the armpits on
both sides

Arm Treatment

Contraindications - Same contraindications as above apply here

Indications - Local edema post-surgery, swelling, sports injury

- Client in supine, lift the arm up for optimal drainage

- If this is a standalone treatment open up the clavicular and axillary nodes first
with 5-8 pumps
- To start effleurage up the arm from the hand to the armpit 3 times with light
strokes
- Do both arms on a healthy person and the swollen one on a lymphedema client
- Move in four zones, the top of the arm, elbow area, bottom of the arm, and hands
- On the top of the shoulder and outer arm move towards the top of the arm axilla
and clavicle
- On the top of the inner arm and bicep move towards the axilla 5 pumps in 3 lines
- With the palm down pump in the lower arm towards the elbow 5 pumps in 3 lines
 - With the palm up pump in the lower arm towards the elbow 5 pumps in 3 lines
- With the palm down pump up towards the wrist 5 times
- With the palm up pump towards the wrist 5 times
- Stroke in the fingertips 5-10 times on each fingers towards the webbing
- Now reverse and do the same process moving in an upward direction towards
the axilla and clavicle
- Finish with effleurage up the entire arm with 3 strokes towards the armpit and
clavicle
- Finish with 5 pumps in the axilla and 5 in the clavicular space if this is a
standalone treatment

Abdomen Treatment

Contraindications - Pregnancy, menstruation, diverticulitis, blocked intestines

Indications - Edema, fluid stagnation, lipedema, digestive disorders, provide

homeostasis in the GI tract

- Client in supine, two pillows under the legs with the knees bent to allow the
abdominal muscles to relax
- If this was a standalone treatment you would pump the clavicular, axillary nodes
first and also do 3-5 deep diaphragmatic breaths
 - Effleurage from the right bottom to the right top, across the top middle, and down
the left side bottom around the large intestine
- On the top of the abdomen underneath the ribs on both sides do 5 stationary
circle pumps towards the heart

-
- On the middle of the abdomen on both sides move upwards towards the heart
with 5 stationary circle pumps
- On the bottom of the abdomen on both sides move upwards towards the heart
with 5 stationary circle pumps
- Work around on the back pumping towards the abdomen in a straight line
- The repeat all the same steps in the front of the abdomen moving in the bottom,
middle and upper portion with 5 stationary circle pump and lift techniques
towards the heart
- 5 deep breaths to finish to bring the fluid throughout the body for optimal
drainage

Inguinal Area

Contraindications - The same as previous treatments

Indications - Inguinal lymph nodes help your body fight off infection and filter out bad
fluid and inflammation

- Client in supine, knees bent or pillow to support legs to relax the muscles in the
area
- Stationary circles over the inguinal nodes 5-8 times, a primary site to open up
before working on the legs, low back, glutes
- Move towards the femoral vessels in the inguinal triangle with stationary circles
or moving towards that general inguinal area in an upwards direction

Legs

Contraindications - The general contraindications

Indications - Lymphedema of the legs, relieve congestion and swelling from injury,
restless leg
- Client in supine, knee bent or supported up with two pillows
- If it was a standalone treatment open up with neck pumping, abdominal
breathing, and inguinal node pumping
- Have the knees bent to start to work around the top of the leg
- Move from the level above the knee in the inner leg across the middle of the
quads into to inguinal nodes pumping 5 times in 3 lines
- Moving from the level above the knee on the outer leg pump up towards the top
of the inguinal area 5 times in 3 lines
- Pump behind the knee with the knee bent slightly lifting up 10 times *a dense site
of lymph nodes
- Work beside the knee on both sides with flat hands, 5 times at 3 levels moving
upwards towards the inguinal region
- In the calves work in the upper, then the middle, then the lower third always
moving with 5 pumps in 3 lines up towards the back of the knee
- With fingertips on either side of the achilles tendon pump upwards 5-8 times
- On the top and bottom of the foot pump towards the ankle 5 times around the
foot. If swollen pump in the middle, then the two outer edges so it would be 5
times in 3 segments
- Stroke each individual toe moving towards the webbing 10 times
- Reverse the steps and do the exact same thing moving from the foot all the way
up to the inguinal nodes and finishing with upwards strokes in the abdomen and
 pumping the neck nodes to finish and deep breaths. Creating that suctioning
effect through the body

Back Treatment

Contraindications - The general contraindications

Indications - Swelling in the back, back pain

- Either in prone or in seated

- If this was a standalone treatment open up the clavicular nodes first, axillary
nodes, and inguinal nodes
- Effleurage in the lower back towards the inguinal area and then in the middle
back towards the axillary space and in the upper back towards the clavicular
nodes
- Start in the upper traps moving towards the clavicular space then in the middle of
the back move towards the axillary space slowly moving down, pumping across
into that armpit
- In the lower back (lumbar area) you then transition into moving your strokes
towards the inguinal region
 - Then reverse the steps moving back up the back draining the low back (lumbar
area) to the inguinal nodes, the middle back (thoracic area) to the axillary space
and finally the upper back (shoulder level) into the supraclavicular space
- Finish with effleurage from the low back up to the top of the back 3 times going
towards the appropriate drainage sites for each level and deep breaths as an
option as well if its a standalone treatment

Lumbar Area and Glutes

Contraindications - Look at general contraindications

Indications - Local swelling, sciatica

- Client is in prone with option for seated

- Pre-treatment as a standalone treatment would be the neck, abdominal breathing
and the inguinal nodes
- Effleurage from the low back and outer glutes all the way around to the inguinal
nodes. In the inner half of the glutes and inner leg effleurage towards the groin
- In the lower back and outer half of the lateral glutes work around with 5 pumps in
3 sections towards the inguinal region
- In the medial inner half of the glutes and inner leg you can pump 5 times in 3
segments towards the groin
 - Reverse those steps now going from the inner portion of the upper third of the
upper leg into the inner glutes and then the outer half of the glutes all the way to
the top of the hip going towards the inguinal region
- Do effleurage following the same path from lower to upper
- You can pump in the inguinal nodes, do deep breathing and pump the
supraclavicular nodes to finish if this was a standalone treatment

Deep Diaphragmatic Breathing to Finish

Turn the client back to supine.

You can do 3-5 deep belly breaths to finish the treatment. Place hands on abdomen and
chest, breathe in through the nose, abdomen rises, then chest rises, hold at the top for
a couple of seconds and release, either out through the nose or mouth.

You can advise this as home care for your clients to do a couple times through the day
especially if they have lymphedema.

Face, Neck and Head Lymphatic Drainage Treatment Practice

This is a very popular, fun and easy treatment to do. You can do this as an add on
service wherever you work and it will be good for a lot of different things.

It can help with any post-surgical swelling, neck injury, reducing puffiness and wrinkles
in the skin, improving circulation, acne, immune system issues affecting the neck/face
and reducing stress and anxiety.

*See the video in the course to practice along with

Full-Body MLD Wellness Treatment Practice

This is another very popular treatment or standard service you can add to your practice.
It something that will do well in a clinic or spa.

It can help with debloating and depuffing, breaking down cellulite and fat cells, give skin
a healthy glow, anti-anxiety, relaxation and boosting immune health (especially during
cold and flu season).

*See the video in the course to practice along with

Lymphedema Management for Upper Extremities

Swelling in the arm is common especially if you’ve had lymph nodes removed. You can
give this sequence as home care as long as you teach the client how to do manual
lymph drainage properly. Keeping th arm raised above the level of the heart, whenever
possible, allow gravity to help drain accumulated fluid, especially after doing lymph
drainage massage whether that be you or them doing it.

The treatment is pretty simple and easy to do, just make sure you complete all the steps
and then do them in reverse order. It should take 20-30 minutes depending on the body.

- Client in Supine with pillows to prop them up a bit

- Stimulate the lymph nodes just above the clavicles with 5-8 pumps. Angle your
fingers towards the middle of the neck. You can do both sides at the same time
- Place your hand in the unaffected side armpit, pumping upwards towards the
clavicle 5-8 times
- On the unaffected top side of the chest, stretch the skin laterally towards the
unaffected armpit with 5-8 pumps in three lines
- On the affected top side of the chest move laterally towards the unaffected side
5-8 times
- Do deep belly breaths 3-5 times
- On the affected side pump in the inguinal nodes 5 times
- On the affected side abdomen, stroke downward towards the inguinal nodes 5
times in 3 lines
- In the trunk just below the breast or scar stroke downward towards the inguinal
nodes 5-8 times
- In the top of the affected shoulder, stretch the skin upward towards the neck area
5 times in 3 sets
- On the outside of the upper arm, move towards the top of the shoulder 5 times in
3 sets moving from the back side of the elbow up
- On the inside of the upper arm, move towards the armpit 5 times in 3 sets
- In the affected extensors, with the palm facing down, move up towards the elbow
5 times in 3 sets
- In the affected flexor muscles, with the palm facing up, move upwards towards
the elbow 5 times in 3 sets
- In the top of the affected hand, with the palm facing down, stretch the skin up
towards the wrist 5 times in 3 sets
- In the affected palm, with the palm facing up, stretch the skin towards the wrist 5
times in 3 sets
- In the fingers, stroke down towards the web spaces 5 times for each finger
 - Now reverse all those steps moving from the palm back towards the clavicular
space (under the collarbone space) on the unaffected side and down to the
inguinal nodes on the affected side
- With the client in seated to finish, on the back top side of the affected shoulder,
move towards the clavicular space 5-8 times at 3 different levels
- On the affected side middle to lower end of the back, move towards the inguinal
area downward 5 times in 3 sets, covering the entire middle and lower end of
back

Lymphedema Management for the Lower Extremities

Lymphedema can be caused by surgery, cancer related surgery, radiation therapy,

trauma etc.

Just like the arm keep the leg elevated when the client can, especially after lymph
drainage is performed either by you or them. Once again perform all the steps and then
do them in reverse. Allow the leg to be elevated for a little bit after you’ve done the
sequence for better results. It will take 15 to 30 depending on the body and severity of
the swelling.

- Client in Supine
- Start in hollow of the neck above the collarbone on both sides with 5-8 circular
motions moving inward toward the middle of the neck
- On the affected side armpit, move upward towards the neck area 5-8 times
- On the affected side only, just above the lower ribs, stretch upwards towards the
armpit 5 times in 3 different lines
- On the affected side only, in the lower abdomen above the groin, stroke 5 times
in 3 lines upwards towards the axillary space
- Do deep abdominal belly breaths 3-5 times
- On the affected thigh only with the knee bent, from the inside to outside of the
thigh, stroke 5 times in 3 different lines making sure to cover the whole area
pumping towards the inguinal area
- On the knee of the affected side only, on the lower portion of the knee, place both
hands on both sides, stretch the skin up towards the hip and inguinal node area,
5 times in 3 sets
- Place both hands behind the affected knee, stretch the skin up towards the thigh
with 15 strokes
- On the top of the affected calf with the knee bent, stretch towards the thigh 5
times in 3 sets
- Move your hands lower on the calf and stroke up towards the knee 5 times
 - Now move down again above the ankle area and stroke up towards the knee 5
times
- Place both hands on either side of the achilles tendon stroke upwards 5 times
- On the top and bottom of the foot stoke 5 times towards the ankle
- Stroke up each individual toe towards the web spaces 10 times on each toe
- Repeat the whole process now going from the foot all the way up to the neck
- In seated on the affected side, stroke from the hip and side body up to the armpit
5 times in 3 sets covering the whole low back and side body area

Complimentary Lymphatic Drainage Treatments

Managing lymphedema often requires a team and systematic approach. The gold
standard treatment of lymphedema according to the International Society of Lymphology
is known as Complete Decongestive Therapy (CDT). Many studies have shown that it
improves swelling and pain. It is used to improve mobility and range of motion and
increase quality of life.

It is usually a 4 step approach that uses MLD, compression bandaging, exercise and
skin care.

Other support services like counseling and nutritional advice can be really helpful for the
mental and physical component of the person. Of course refer out to professionals in
those fields for their specific expertise.

Phases

Phase 1 - Consists of mobilization of the fluid

● The number of weeks depends on the amount of swelling and tissue firmness.
● Complete decongestive therapy for one-hour sessions, 4 to 5 days per week.
● Bandages with foam are worn about 23 hours per day and often only removed to
bathe.

Phase 2 - Maintenance phase maintains the swelling reduction. Phase 2 usually lasts
for months or for years. Elastic compression garments that fit like a second skin are
worn during the day.
● Often bandages with foam are worn at night to decrease daily daytime swelling.
● Exercises are done while wearing compression garments.
● Self manual lymphatic drainage is done for 15-30 minutes per day
Compression Therapy
Even when MLD is performed correctly, patients would still need compression therapy to
decrease the swelling. Compression bandages should remain on the extremities until
the next session of MLD.
For moderate to severe lymphedema you will be working with a team including doctors.
Bandaging involves creating a soft cast by wrapping with multiple layers. This is the
main component of the complete decongestive therapy.
Bandaging is a reductive therapy, meaning it makes the limb smaller. The bandage cast
helps prevent fluid from flowing back into the limb. Compression garments are designed
to keep a continuous pressure on the swollen/affected area to assist the drainage of
fluid and minimize swelling.
This can be done by a physiotherapist or perhaps massage therapist if it’s within your
scope of practice wherever you are in the world. I would check and see but most of the
time this requires specialized training and is done by a physiotherapist.
Exercise
Initial exercises consist of gentle stretching and range of motion exercises (helping the
muscles contract and relax, which is thought to help push the lymph along) and also
strengthen the lymphatic system. An example would be making a fist and extending
fingers; doing wrist curls; or gentle punching motions to extend and flex the elbow. You
can use these same principles and exercises with the foot and leg for lower extremity
swelling.
Once symptoms improve and the lymphedema is stable, the exercise plan expands to
include aerobic exercise (improves physical fitness and reduces body weight). This kind
of exercise includes swimming, cycling, walking, dancing, gentle yoga, and lifting light
weights, depending on clients status.

Skin Care
Proper skin care is very important in the treatment process. The skin of patients with
lymphedema is usually very dry, itchy and sensitive due to disturbances of skin
metabolism, as a result of the macro-and microcirculation alterations making it
susceptible to inflammation and infection.
Due to the impaired healing process it can lead to severe inflammation and infections
like cellulitis, ulcers, or even worsening of their condition. Therefore, therapeutic and
protective measures are essential components of skin care.
The system involves washing daily, making sure skin folds are clean and dry, monitoring
for changes, applying moisturizers, avoiding scented irritating products, and avoiding
sunburn. Avoiding extreme temperatures is also helpful because it may irritate the skin.
Advise them to consult with a doctor if you suspect infections or abnormal issues.

Dry Brushing for Lymphatic Drainage

Dry brushing will help stimulate the lymphatic system for lymphedema and is generally
stimulating for the nervous system and good for skin exfoliation. It is a very inexpensive
and easy to do treatment in your clinic or spa and also to give your clients for home
care.

You can do this before bathing in the morning on dry skin, without any oils or lotions on,
and it will help to invigorate and wake up your body. Avoid sensitive or broken skin, if
your skin becomes red or irritated discontinue use. You can do 3-5 minutes or 15
minutes depending if you want to focus on a specific area for longer or do the whole
body. BUT try not to overdo it, once a day is fine.

The lymphatic vessels that are right under the skin are going to be affected by the dry
brush. Focus on going towards the lymph node stations like the neck, armpits, inguinal
region as opposed to going towards the heart. If you have lymphedema move fluid away
from affected lymph nodes into a healthy area. Eg. If you had lymph nodes removed
from your right arm you would want to move the fluid towards the left axillary space or
down the body towards the inguinal region.

- Start on the abdomen with brush strokes upwards

- In the front body go towards the armpits in a healthy person or one side in
someone with lymphedema, brushing upwards to towards the axillary nodes
- On the arm move up and towards the armpit area. Start in the upper arm then the
lower arm
- Then do the hand
- Then work your way all the way back up to the drainage site at the axillary nodes.
Work downwards to clear the area and then back up to clear the system
- On the legs in the lower extremities, work up from the upper leg in short strokes
towards the groin. Working in all areas the outside, middle, inside and around the
leg
- Work around the entire knee cap area
- Work on the bottom leg working upwards even around the back of the knee
where there is another watershed site
- Work towards the foot working around the entirety of the foot
- Then work your way all the way up the leg again. Downwards to clear the system
and all the way back up to drain the lymph
- Finish by working in the abdomen area with brushes upwards
- Then do the other leg with the same sequence
- After you finish it’s a good idea to bathe, pat yourself dry and then apply your
moisturizer
- A guaranteed way to feel invigorated in the morning!
Full-Body Lymphatic Self-Massage Routine

See video inside the course for a little bonus self-massage full body routine so you can
see how a treatment feels in your own body. This is meant for someone who is pretty
healthy with little to no lymph swelling or lymph nodes removed.

Conclusion

No matter which direction you decide to head with lymphatic drainage, learning
lymphatic drainage massage is very beneficial for a wide variety of clients and a very
useful skill to have in your practice. If you really want to go the more medical route and
learn how to treat a wide variety of medical conditions, I personally advise doing an
in-person training as you would be dealing with more serious issues. Given this is a
hands-on approach, having skilled teachers in person will fine tune your skills.

I hope you enjoyed the course and you’ll join me again for future classes. It was an
honor to teach you and most importantly, be well and take care.

- Mike