instructions for manual lymph drainage
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instructions for manual lymph drainageYour lymphatic system helps eliminate your body’s waste. A healthy, active lymphatic system uses the natural movements of smooth muscle tissue to do this. However, surgery, medical conditions, or other damage can cause fluids to build up in your lymph system and your lymph nodes, a condition known as lymphedema. If you’ve ever had a surgery on or involving your lymph nodes, your doctor may have suggested lymphatic drainage massage performed by a certified massage or physical therapist. However, lymphatic massage is not recommended for people with the following conditions: congestive heart failure history of blood clots or stroke current infection liver problems kidney problems Lymphedema Procedures that affect or remove your lymph nodes can cause lymphedema as a side effect. Lymphedema will only occur in the area near a surgical site. For example, if you have lymph nodes removed as a part of cancer surgery to your left breast, only your left arm, not your right, might be affected with lymphedema. Lymphedema can also occur as a result of an injury or medical conditions such as congestive heart failure (CHF) or blood clots in the body. To move waste fluids away from the damaged area, lymphatic massage, which uses a gentle pressure, can help. It’s one technique used to reduce lymphedema. Raakhee Patel, PT, DPT, CLT, is a physical therapist and certified lymphedema specialist who trains people to perform their own lymphatic massage after surgery. “We don’t talk enough about lymphedema,” says Patel. Fluid build-up is uncomfortable and causes pain and heaviness in the affected area. And, according to Patel, “Stage 3 lymphedema can be devastating,” causing significant depression and lack of mobility that could complicate healing. When performing a lymphatic massage, it’s important that the massage include more than just the affected area. The entire lymphatic system of the body, except the head, right side of the chest, and right arm, drains near the left shoulder.http://mail-business.ru/uploads/ic-recorder-icd-st25-manual.xml
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So, a massage should include all areas to drain properly. Clearing and reabsorption Patel teaches two stages of lymphatic massage: clearing and reabsorption. The purpose of clearing is to create a vacuum with gentle pressure so that the area is prepared to bring in more fluid, creating a flushing effect. Clearing involves: supraclavicular lymph area: located directly under the collarbone axillary lymph area: located under the arms inside of the elbows Clearing motions can be repeated as many as 10 times a day. Patel advises, “Always massage both sides of your body, not just the side with the lymphedema.” A guide to clearing There are three stages to clearing. Be sure to clear the supraclavicular area, axillary area, and inner-elbow area, in that order. To clear the supraclavicular area: Begin by lying on a comfortable, flat surface. Cross your arms on your chest, with your hands resting just below the collarbones. Then lift your elbows slowly. The muscle action is as much pressure required to prepare the area to flush lymphatic fluid. Next, clear the axillary area: Lay one hand above your head. Use your other hand to gently scoop the underarm area from top to bottom. The only pressure required is gentle enough to move the surface of the skin. Finally, clear the area inside the elbows: Lay your arm straight at your side. Use the fingers of your opposite hand to gently pull the skin inside the elbow an inch at a time. Only very gentle pressure is required. “In lymphatic massage, you’re only working the superficial skin structure,” says Patel. That’s where the fluid is trapped. How to perform lymphatic massage on the legs The goal of lymphatic massage on the legs is to open the lymphatic vessels to let excess fluid drain back up into the lymph nodes located in the groin. There are different techniques used to perform lymphatic massage on the legs, but all have the same end goal: to release the fluid to go back up through the lymph nodes.http://akonedestek.com/userfiles/ic-realtime-el-2000-manual.xml To perform a lymphatic massage on the legs, you can follow these steps: Perform lymphatic massage of the upper body before beginning with the legs. Follow the three stages of clearing in the supraclavicular area, the axillary area, and the inner-elbow area, in that order. This ensures that the system is clear to allow fluid to drain up. Use light pressure. If you can feel the muscles underneath your skin, you are pressing too hard. Begin the leg massage at the furthest point away from the injury or affected area and work your way down. For example, if your ankle has swelling, start the massage on the upper part of the leg. Starting at the top of the leg, put one hand on the inside of the leg and the other on the back of your leg. With gentle pressure, stretch the skin from the inside of your leg up and out, toward your hip. Continue this motion down the leg until you reach the knee. When you reach the knee, stretch the skin up, with alternating hands, toward your armpit. Repeat 10 to 15 times. You have now completed the clearing step of the lymphatic massage. A guide to reabsorption The second part of lymphatic massage is reabsorption. To perform this stage of massage: Begin at the affected part of the body farthest from the core of the body. For example, begin at the tips of the fingers if you have lymphedema in your hand, arm, and shoulder. Using a gentle, sweeping motion with just enough pressure to shift the surface of the skin, massage from fingertip to hand, from hand to elbow, and from elbow to shoulder. “Patient compliance is the hardest part of self-care, especially for women, who are so used to taking care of others,” says Patel. She advises people to set aside at least 20 minutes a day for lymphatic drainage massage. “If you only have a brief amount of time, perform the clearing stage of massage.” To begin reabsorption on the legs, you will use a pumping motion behind the knee: Place both hands behind your knees.https://formations.fondationmironroyer.com/en/node/11160 Pump the back of the knee with a rolling, upward motion 10 to 15 times. Your knee is now ready to take in fluid from the lower leg, so you can proceed to massaging the lower legs: Put one hand on the top of the shin and the other behind the leg. Stretch the skin in an upward motion, then release it. Continue down toward the ankle area. Repeat down through the ankle and feet, always stroking upward. End the massage by gently pushing fluid in the toes upward with your fingers. Measuring effectiveness How do you know if lymphatic drainage massage is effective? “This is a maintenance technique,” says Patel. “Your lymphedema should not get worse if you regularly practice lymphatic massage.” Also, drink water. Well-hydrated tissue helps moves out waste materials. Managing your lymphedema can also include: using a compression sleeve to prevent fluid buildup seeing a qualified therapist for in-office drainage massage When choosing a therapist, learn as much about their education as possible. “Massage is very good for you, but deep tissue massage can be too heavy for someone with lymphedema, so don’t assume you can just go to a massage therapist.” Look for someone who is a certified lymphedema therapist (CLT) and preferably a physical or massage therapist with oncology and pathology training. Last medically reviewed on February 26, 2019 Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — Written by Elea Carey — Updated on February 27, 2019 related stories Lymphatic Dysfunction (Lymphedema) What Is Non-Pitting Edema and What Causes It. What’s Causing My Armpit Pain. What’s Causing My Swollen Feet. Cervical lymph node group Read this next Lymphatic Dysfunction (Lymphedema) Medically reviewed by Steve Kim, MD Lymphatic dysfunction is a poorly working lymphatic system. Medically reviewed by Daniel Murrell, M.D. Non-pitting edema is a type of swelling that’s usually due to a problem with your thyroid or lymphatic system.https://acbc.wa.edu.au/images/canon-kiss-f-manual.pdf Medically reviewed by Gerhard Whitworth, R.N. Muscle strain, skin conditions, swollen lymph nodes — these and many other conditions can cause armpit pain. Medically reviewed by Deborah Weatherspoon, PhD, RN, CRNA Swollen feet aren’t usually cause for concern, but they could be a sign of another health condition. Here’s what might be causing the swelling. READ MORE Cervical lymph node group Medically reviewed by the Healthline Medical Network The lymphatic system, made up of lymphoid tissues known as nodes and vessels, is part of the human immune system. Written by Kris Gunnars, BSc Drinking enough water can help you burn fat and increase your energy levels. This page explains exactly how much water you should drink in a day. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information. About Careers Advertise with us OUR BRANDS Healthline Medical News Today Greatist PsychCentral. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Cite article It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics. Techniques The video below gives a very brief explanation of Manual Lymphatic Drainage It also includes treatment of fibrosis It helps in management of edema through 'encircling strokes'. The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis). Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position. The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage. Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy. The lymphatic drainage starts centrally and proximally with treatments usually starting around the neck. Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas. There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated. Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes. MLD is often given as part of Complete Decongestive Therapy (CDT). It can achieve a 45-70 reduction in lymphedema volume. Components of CDT includeManual Lymph Drainage History (MLD). Available from: (Accessed 3 September 2020) International consensus. London: MEP Ltd, 2006. International Consensus. London: MEP Limited;2006.58 Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Cite article It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics. Techniques The video below gives a very brief explanation of Manual Lymphatic Drainage It also includes treatment of fibrosis It helps in management of edema through 'encircling strokes'. The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis). Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position. The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage. Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy. The lymphatic drainage starts centrally and proximally with treatments usually starting around the neck. Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas. There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated. Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes. MLD is often given as part of Complete Decongestive Therapy (CDT). It can achieve a 45-70 reduction in lymphedema volume. Components of CDT includeManual Lymph Drainage History (MLD). Available from: (Accessed 3 September 2020) International consensus. London: MEP Ltd, 2006. International Consensus. London: MEP Limited;2006.58 Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Cite article It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics. Techniques The video below gives a very brief explanation of Manual Lymphatic Drainage It also includes treatment of fibrosis It helps in management of edema through 'encircling strokes'. The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis). Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position. The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage. Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy. The lymphatic drainage starts centrally and proximally with treatments usually starting around the neck. Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas. There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated. Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes. MLD is often given as part of Complete Decongestive Therapy (CDT). It can achieve a 45-70 reduction in lymphedema volume. Components of CDT includeManual Lymph Drainage History (MLD). Available from: (Accessed 3 September 2020) International consensus. London: MEP Ltd, 2006. International Consensus. London: MEP Limited;2006.58 Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Cite article It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics. Techniques The video below gives a very brief explanation of Manual Lymphatic Drainage It also includes treatment of fibrosis It helps in management of edema through 'encircling strokes'. The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis). Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position. The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage. Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy. The lymphatic drainage starts centrally and proximally with treatments usually starting around the neck. Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas. There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated. Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes. MLD is often given as part of Complete Decongestive Therapy (CDT). It can achieve a 45-70 reduction in lymphedema volume. Components of CDT includeManual Lymph Drainage History (MLD). Available from: (Accessed 3 September 2020) International consensus. London: MEP Ltd, 2006. International Consensus. London: MEP Limited;2006.58 Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Cite article It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics. Techniques The video below gives a very brief explanation of Manual Lymphatic Drainage It also includes treatment of fibrosis It helps in management of edema through 'encircling strokes'. The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis). Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position. The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage. Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy. The lymphatic drainage starts centrally and proximally with treatments usually starting around the neck. Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas. There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated. Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes. MLD is often given as part of Complete Decongestive Therapy (CDT). It can achieve a 45-70 reduction in lymphedema volume. Components of CDT includeManual Lymph Drainage History (MLD). Available from: (Accessed 3 September 2020) International consensus. London: MEP Ltd, 2006. International Consensus. London: MEP Limited;2006.58 Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more. This article has been cited by other articles in PMC. Abstract Background Lymphoedema is a common and troublesome condition that develops following breast cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic Drainage in the treatment of postmastectomy lymphoedema in order to reduce the volume of lymphoedema and evaluate the improvement of the concomitant symptomatology. Methods A randomized, controlled clinical trial in 58 women with post-mastectomy lymphoedema. The control group includes 29 patients with standard treatment (skin care, exercise and compression measures, bandages for one month and, subsequently, compression garnments). The experimental group includes 29 patients with standard treatment plus Manual Lymphatic Drainage. The therapy will be administered daily for four weeks and the patient's condition will be assessed one, three and six months after treatment. The primary outcome parameter is volume reduction of the affected arm after treatment, expressed as a percentage. Secondary outcome parameters include: duration of lymphoedema reduction and improvement of the concomitant symptomatology (degree of pain, sensation of swelling and functional limitation in the affected extremity, subjective feeling of being physically less atractive and less feminine, difficulty looking at oneself naked and dissatisfaction with the corporal image). Discussion The results of this study will provide information on the effectiveness of Manual Lymphatic Drainage and its impact on the quality of life and physical limitations of these patients. Thus, breast cancer-related lymphoedema is one of the main complications and most dreaded sequela of breast cancer and its therapies, and can have long-term physical and psychosocial consequences for patients. It consists of the accumulation of lymph in the interstitial spaces, principally in the subcutaneous fatty tissues, caused by a defect in the lymphatic system. Three stages of lymphoedema have been described. Stage I presents with pitting and is considered reversible; some women in this stage have no increased arm girth or heaviness and no signs of pitting oedema. As the oedema progresses, it becomes brawny, fibrotic, non-pitting and irreversible (stage II). In advanced lymphoedema (stage III), which rarely occurs following breast cancer treatments, cartilaginous hardening occurs, with papillomatous outgrowths and hyperkeratosis of the skin. Some quality of life scales are available to determine how the affected patients define, admit and explain their personal experience regarding the symptoms they experience and in which way these symptoms have an influence on the degree of functionality regarding daily activities and interpersonal relationships. In 1980 The European Organization for Research and Treatment of Cancer (EORT) created a group to study the quality of life in patients with cancer and developed the EORT Quality of Life Questionnaire (EORT QLQ-C30). Subsequently EORT QLQ-BR 23 was developed to assess the specific aspects of lymphoedema in patients with breast cancer. Definitively, lymphoedema is one of the most severe sequelae that affects health-related quality of life in treated breast cancer patients. Lymphoedema treatment remains a problem even with modern treatment modalities, since clear therapeutic protocols do not exist. Several methods have been used with varying results. Complex Physical Therapy, also called Complex Decongestive Physiotherapy, is a treatment regimen that includes meticulous skin hygiene, manual lymph drainage, bandaging, exercises and supportive garments. This therapy is carried out in two phases; in the first phase (treatment), the aim is to mobilize the lymph accumulated, reduce the fibrous tissue and improve the health of the skin using mainly daily Manual Lymph Drainage (MLD) during a variable period of time. In addition, patients receive instructions regarding skin care, prophylactic measures and the use of multilayer bandages. Several authors suggest that this technique should be reserved only for selected cases. The proof of concept for using CPT to stimulate the lymph drainage has a profound physiological basis, but the quality of evidence on the relative effectiveness of therapies is poor. Manual Lymph Drainage (MLD) is a massage technique that involves the skin surface only and follows the anatomic lymphatic pathways of the body. A session of manual lymph drainage starts centrally in the neck and trunk to clear out the main lymphatic pathways, thereby facilitating drainage from the arm. Unlike other types of massage, it produces neither blush nor pain and it does not even have a stimulant effect. To successfully complete this technique, a knowledge of the anatomical distribution of the lymphatic and superficial ganglions and of their interconnections is necessary. The MLD is carried out in a descending manner to facilitate the flow of the lymph from the affected areas to those not affected. It is possible to carry out MLD in the case of late or latent lymphoedema three days postsurgery if contraindications do not exist. There are several schools (Vodder, Leduc, Foldie), but they all agree on the fundamental aspects. The MLD must be applied by a physical therapist trained for it. Its application demands a long period of time (from 45 to 60 min.) and it is usually performed once a day (four or five times a week) for 2 to 4 weeks. The results from several case studies (including over 400 patients) clearly showed that treatment with MLD and compression bandaging had a volume-reducing effect. However, the interpretation of these results is limited due to the methodology used, and their design did not offer the possibility to investigate the extent to which MLD treatment contributed to the reduction of lymphoedema. Only three small, randomized, controlled trials have assessed MLD for arm lymphoedema but contradictory results have been found. Two of the studies showed statistically significant differences in the reduction of oedema that favored the group on combined treatment with MLD, despite the fact that in one of the studies, MLD was only administered for one week. There was a trend in mean volume reduction and a statistically significant difference between the 2 groups in the percentage reduction in volume in favour of the combined treatment. The third published randomized trial, involving 42 women with modest stage I or II lymphoedema compared standard therapy alone with standard therapy plus MLD and training in self-massage (level I evidence). Standard therapy included the use of a custom-made sleeve-and-glove compression garment worn during the day, instruction in physical exercises, education in skin care, and information and recommendations about lymphoedema. Both groups obtained a significant reduction in limb volume, a decrease in discomfort and increased joint mobility over time. This study investigated the effect of eight sessions of MLD over two weeks, so the MLD course was relatively short and the study group was limited to those with mild to moderate swelling (20-30 of difference). Information about quality of life was gathered using the questionnaire EORT QLQ-C30, but the results were not considered in the final evaluation.