Lymphatic drainage-Queen of massages


The body’s lymphatic system acts as drainage system and runs in parallel to the venous system. It is a vital part of our circulatory system, the body’s primary waste elimination system and is the body’s primary means of immune defence.
Lymph fluid is found in and between cells throughout the body bathing the body’s tissues just under the skin. Lymph fluid is thicker and moves more slowly than blood. It meanders along a network of collection vessels to and through the body’s lymph nodes. These nodes are a one-way valve system filtering out anything the body does not want, such as bacteria, toxins, dead cells, infectious organisms, and cancer cells. Specialised white blood cells attack and break down the unwanted bacteria or wastes, sending them to the ‘organs of elimination’, including the liver, kidneys, bowel, bladder, lungs and skin etc. The filtered lymph is then carried back to the bloodstream.
If the balance between filtration and re-absorption is disturbed, fluid remains in the intercellular space. This, along with the interruption of the collectors and/or removal of the regional nodes, if left untreated will exceed the lymphatic system’s transport capacity. This abnormal amount of protein-rich fluid will stagnate, causing swelling and allowing lymphoedema to develop. There are two types of lymphoedema: primary or congenital, and secondary. Primary or congenital lymphoedema can appear before birth, or at the onset of puberty or in adulthood. With this type, nodes/vessels are not present, or they are defective or undeveloped, or ther are too many or too few. Secondary lymphoedema is caused by extraction, closure or interruption of the lymph vessel/nodes, which can occur as a result of surgery, operations for cancer (mastectomy, lumpectomy, pelvic), radiation/ radiotherapy treatment, chronic venous insufficiency or trauma. It may also occur to an area which is at risk from an infection, insect bite, aircraft travel or sunburn. Secondary lymphoedema can develop immediately, or weeks, months or years later. Some of the signs and symptoms of lymphoedema to watch for in your clients are:
• A full, heavy or tight sensation and increase in limb size
• Any swelling or heat following an operation or the removal of nodes
• Pins and needles or lack of feeling
• Joints becoming swollen, puffy and/or aching
• Inability to pick up or fold skin on a digit between finger and thumb
• Node groups are swollen on touch
• When skin is pressed it remains pitted
• Pain or tenderness around node groups in the groin and armpit
• Redness and heat which may indicate infection
Lymphoedema vs oedema
Lymphoedema and Oedema should not be confused. Oedema occurs when the lymphatic system is overwhelmed, due to injury, a pathology or damage to blood vessels. The area’s body tissues will contain an excessive amount of tissue fluid. Causes such as allergic reactions, sprains, strains, fractures, protein and renal insufficiency, jaundice or cirrhosis of the liver and pericarditis can cause oedema, mostly in the lower limbs. The swelling is usually only temporary because tissues heal and excessive leaking of blood vessels no longer occurs. It is important not to treat oedema without knowing the cause.
Lymphatic drainage defined
Lymphatic drainage is a non-invasive, painless and very effective therapy for lymphoedema and other conditions. It has been used successfully in Europe for decades and is now widely recognised in England, Australia, Canada, the United States and here in New Zealand.
It is an advanced therapy which uses a range of specialised and gentle rhythmic techniques to move the skin in the direction of the lymph flow, improving the activity of the lymph vessels by a mild mechanical stretching of the wall of the lymph collectors. It re-routes the lymph flow around blocked areas into more centrally located lymph vessels or gently clears congestion in the nodes to assist drainage into the venous system.
The hand movements used – Stationary Circle, Pump, Scoop and Rotary Technique – are quite different from those used in any other modality. Each stroke has a pressure then release and/or a pumping, pushing type of stroke. Practitioners must be aware of both the lymph pathways and the watersheds around the body to be fully effective in moving fluid from one side of the body to the other or around from front to back, especially when one side may be blocked or there are not enough nodes to cope with the amount of lymph that needs to be moved to healthier nodes/vessels.
It is important to clear the unaffected side properly first before moving fluid across the watersheds. Each move takes several seconds to complete, with an active and passive phase. Pressure is feather light as heavy pressure may hamper the flow and in some cases damage the lymph vessels.

Conditions suitable to treat
This is not a full list. Before proceeding with massage, do a full medical history to understand the underlying causes and to ensure there are no contra-indications. If you are unsure, ask the client for a clearance from their doctor.
• Oedema of the legs in pregnancy • Lymphoedema
• Post-cosmetic and liposuction surgery – helps in healing lymph vessels, skin tissue, scars and to reduce swelling (Do not work immediately over area.)
• Chronic fatigue syndrome 
• Migraine and headache – but not while the person has a migraine or headache
• High blood pressure – helps to reduce this
• Recurring colds, flu, ear and chest infections – improves breathing
• Scar tissue – improves lymph flow, softens and improves tissue elasticity
• Constipation and digestive problems – increases bowel or bladder movements
• Arthritis and rheumatism – decreases pain
• Hormonal imbalances / PMS / menopause / regulation of menstruation
• Hay Fever and blocked sinus
• After a bout of glandular fever
• Acne reduction following a detox (although initially this may become worse)
• Post root canal surgery or tooth extraction
• Stress and fatigue – induces restful sleep and relaxation
• General health and wellbeing – stimulates and improves the immune system.
Contra-indications can be either Absolute (strictly prohibited) or Relative (requires the physician’s approval. Again, this is not a full list. If you have any concerns you must ask your client to consult their doctor/specialist and ensure you receive a written clearance from the client’s doctor and/or specialist before MLD treatment commences.
• Cancer – during any period of current active cancer or post-cancer conditions
• Sarcoma, malignant growths, leukaemia
• Acute inflammatory illness
• Major cardiac problems
• Post and recent thrombosis
• Varicose and spider veins
• During menstruation – do not include the abdomen
• After surgery – get clearance from the doctor before commencing
• Asthma – do not carry out massage during the acute phase. Also be aware that you can bring on an attack if you overstimulate a client who suffers from asthma.
• Low blood pressure – reduce the time overall. If there is no problem in the first session then slowly increase the time of each additional massage, carefully monitoring your client’s responses
• Thyroid – must not be used on hyper or hypothyroidism unless medication is being taken for its regulation
• Moles, beauty spots, burns, fresh scars and bruises, open wounds and sprains – do not include these areas in your massage
• Renal insufficiency or clients receiving haemodialysis – they bruise and tire easily
• Infected sinusitis
• Gynaecological infections – including cysts, uterus conditions etc
• Sports injuries with oedema or inflammation
• Pregnancy – not allowed on the abdomen
• Where diverticulitis and pancreatitis is indicated
Massage procedure
First of all, it is important to take a full client medical history as this type of massage is not appropriate for all conditions. You will need to know any past and current illnesses, surgery and current medications. This sets up perimeters for contra-indications. If in doubt before massaging ask the client to get a written clearance from their doctor or specialist. If pain is present, discontinue treatment until the cause is known. If a sudden increase of swelling occurs, discontinue treatment. The client should go to their doctor for a check-up. Discontinue treatment until the infection has completely gone. For best results the whole body must be massaged, not just the affected part. Always start with clearing the terminus, clavicle, axilla, cisternal chyli, iliac and inguinal node groups and reverse this at the end of the treatment. Always treat the distal area first before the proximal e.g. Upper arm before forearm, thigh before lower leg or abdomen before leg. Pressure should be gentle and light, and contact superficial, remembering the lymph is just under the skin and contact is with the skin not the muscle. Lymphatic drainage massage should not cause pain. Each stroke or movement is very specific. Each should have a pressure and a relaxation phase (to allow lymph vessels to refill after the pressure phase). The gentle pressure improves the activity of the lymph vessels and gently clears congestive of the node. Clients will feel rhythmic pumping, pushing and sweeping scooping hand movements with the palms and pads of fingers. Treatment time depends on age, health, any ailments, physical health and the reason for the massage. But once you have established that your client’s health is normal and healthy, a general overall full body lymphatic drainage massage will take approximately and hour to complete. It is important not to rush the massage and try to feel through your hands and fingers the movement of the lymph along the limbs and the gentle stimulation and clearance of the node groups. Be sure to advise your client that because the main groups of nodes are located under the armpits, between the top of the thigh and groin, stomach and chest areas, you may have to work near or on these areas. This may cause distress or seem odd to some clients so assure them it is an important part of the massage. If they look, say or feel at all embarrassed, let them know you can use a towel or light sheet over those areas or ask them to wear something light next time so you can treat over it, but of course it is better to work directly on the skin. Advise your client that they may feel tingling on other parts of the limb or body or need to swallow. This is a natural part of the massage and shows it is working. As you start to move the lymph and clear node groups, lymph in other areas will start to move. Be aware some clients’ blood pressure may fall during the massage and they may experience light headedness or dizziness on getting off the table. Let them take a few minutes sitting up before stepping off the table.
It is important to advise your clients to take the following steps after the massage:
• Drink lots of water over the next 24 hours
• Go for a short walk (10 mins) as this will assist the lymph to keep moving through the body and assist the massage procedure
• Do 10 minutes of slow abdominal breathing twice a day
• Advise your client that they may sleep better, feel more relaxed and less stressed, that there may be an increase in bowel and bladder movements, a decrease in pain involving joint inflammation, and an improvement in sinus problems etc After the first treatment, it is a good idea to contact your client the next day for feedback. If they at all felt nauseous in the first few hours after treatment you may need to reduce the length of the next massage and/or ask them not to eat for a couple of hours prior to their next appointment.
Examples of treatments for common ailments
Be aware that each of these ailments will have a myriad of causes which can sometimes be difficult to determine. Migraine: Lymphatic massage should not be used during a migraine attack. Treatment is usually between episodes and given once per week for three weeks of 30-40 minutes per session. Constipation: Waste material remaining in the bowel becomes dry and difficult to expel. Give a 30 minute remedial massage before a 30 minute targeted area lymphatic drainage massage. This gives a decongestive effect on the large efferent lymph pathways in the abdominal area. Cellulite: The first two stages are reversible but the last two are irreversible. It is difficult to treat and can require many sessions, and then only partial success may only be achieved. IMPORTANT NOTE: To ensure that the highest standards are maintained, and for the safety of clients, practice should be confined to those who have undertaken formal training through a recognised college or school.


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