Lymphatic drainage explained, and DIY lymphatic massage for beginners

The lymphatic system doesn't get talked about much, but it’s important in defending the body against infection because it helps to remove waste products from the tissues.

The lymphatic system works alongside the circulatory system, which uses our arteries and veins to move blood and deliver oxygen throughout our bodies. Blood is pumped out of the heart through arteries to exchange oxygen with tissues, then veins take oxygen-depleted blood back to the heart for reoxygenation.

However, there are bigger molecules that sit in tissues and can't get back into veins. That's where the lymphatic system comes in. It follows closely along the veins and works to collect fluid that will drain into the central circulatory system. These larger particles may be excreted through the kidneys or recirculated to get new oxygen and start the process again.

Why is lymphatic drainage so important for cancer patients?

For cancer patients, those larger particles may build up because the lymphatic system is unable to transport this fluid efficiently. The main reasons for this are the removal of lymph nodes or tissues that have undergone radiation treatment. This buildup can cause swelling, called lymphedema. The goal of treatment is to help move the particles into the lymphatic system and out of the congested areas.

What other patients might need lymphatic drainage?

Another common reason people may develop lymphedema in the United States is chronic venous insufficiency. The lymphatic structures may be working just fine but the venous system is unable to transport the fluid for which it’s responsible. This overloads the lymphatic system, and fluid accumulates in the tissue.

What are signs of lymphedema?

In recent years, we’ve developed the ability to monitor breast cancer patients for subclinical lymphedema. “Subclinical” means that the changes occurring in the tissue aren’t yet evident with a girth measurement nor can they be noted by feeling the tissue. But the fluid can be detected with a device that uses electric current to capture the amount of fluid between the cells. When we detect levels above normal, early intervention can address the issue before patients need more intensive treatment.

Other signs of lymphedema are aching and heaviness in the limb or area involved (especially when doing activity but possibly even at rest) and clothing fitting differently or tighter than previously. For example, a spring blouse that now is too tight on one side but fit last year can be a telling sign.

Lymphedema is typically not painful. However, that is not always the case. Lymphedema in the breast can be quite painful for many people.

Why is lymphatic drainage important?

The lymphatic fluid that can collect in the tissue contains a high concentration of protein. Protein can be a breeding ground for infections.

Cellulitis is a bacterial infection of the skin that causes inflammation, redness and pain. This type of infection can spread quickly in a limb that has lymphedema and will require medical attention for resolution.

Research studies have discovered that unaddressed lymphatic fluid buildup can lead to fibrosis, a hardening of the tissue, as well as a proliferation of adipose – fatty – tissue. Adipose tissue cannot be mobilized like fluid, causing the limb to feel heavy, making it more difficult to move. Finding clothing and shoes that fit can be difficult.

Does lymphatic drainage help with exercise recovery?

Yes, manual lymphatic drainage can be used for exercise recovery. If you have a normal lymphatic system, working with your central lymphatics through breathing can be impactful.

How does lymphatic drainage work?

The goal of manual lymphatic drainage is to mobilize fluid movement within the lymphatic system. In a normal lymphatic system, this is done by using the lymphatic structures to transport fluid more efficiently. In a compromised lymphatic system, the goal is to use lymphatic structures in other areas of the body to help with the work of transport. Lymphatic drainage, along with compression, exercise and skin care, comprise a Phase I treatment program.

Depending on needs, Phase I therapy could involve daily treatment, but typically a frequency of two or three visits per week is instituted. An episode of care could extend for several weeks. The goal of Phase I therapy is to optimize fluid reduction and move the patient to a maintenance program that can be carried out independently at home. A maintenance program could include self-massage, daytime compression in the form of a compression garment, nighttime compression (multi-layer wrapping or a specific nighttime garment), exercise and skin care.

Manual lymphatic drainage

A manual lymphatic drainage session takes about 45 minutes to complete, with the goal of facilitating the lymphatic system. The treatment begins with the central lymphatic structures, with the process working distally. For example, with upper extremity lymphedema, the sequence begins in the neck and with deep breathing followed by manual techniques from the shoulder to the hand.

Who should avoid lymphatic drainage?

Lymphatic drainage should be avoided if a person has a fever or active infection. Manual stress to the tissue should be avoided in an area undergoing radiation treatment or over a known cancer site.