Manual Lymphatic Drainage (MLD) is a massage technique that involves encouraging the movement of lymph fluid within the body’s lymphatic system and may be used in the treatment of various conditions.

The Lymphatic System

Imagine the lymphatic system as your body’s plumbing: it is a network of vessels and organs that maintain fluid levels while also eliminating waste products. Excess fluid that is not absorbed by your tissues is picked up by lymphatic capillaries, now called lymph, and transported into lymphatic vessels which then terminate into the right lymphatic duct and the thoracic duct. They then merge into the subclavian veins and this is where the lymph is emptied before returning to the bloodstream.

Aside from plumbing, the lymphatic system is also in charge of immunity. The bone marrow creates white blood cells and helps your body ward off viruses. Lymph nodes, mostly found deep within joints, are glands that filter lymph. Bacteria, damaged cells, and cancer cells are kept and destroyed here by other immune cells. This is why you can feel swollen lymph nodes in your neck below your ears when you are suffering from the flu.

Any disruption of these functions within the lymphatic system can result in an accumulation of lymph in pockets within the body or on the extremities. This swelling is what lymphatic drainage techniques address.

MLD

The aim of Manual Lymphatic Drainage is to stimulate lymphatic flow and transport it from swollen to non-swollen areas. Often confused with traditional massage, MLD moves away from deep, kneading strokes and utilizes a lighter and softer approach. This is because lymphatic vessels are very delicate and lie just beneath the surface of the skin. Heavy pressure can cause these small pathways to flatten, which will block flow rather than aid in drainage. Techniques may vary but usually consist of slow, repetitive movements that are similar to light touch or pulling on the skin.

Diaphragmatic breathing is also a major aspect in MLD. Lymphatic fluid relies on the pulsation of arteries and contractions of muscles to keep itself flowing, as lymphatic vessels only contain one-way valves. It is also this mechanism that stops lymph from flowing backwards. Breathing stimulates blood flow and recruits muscle activity which all regulate lymphatic flow.

The combination of soft massage and breathing drains excessive lymphatic fluid from swollen areas of the body and returns them via circulatory system to the bloodstream where they can be re-absorbed.

Indications for MLD

• Swelling of the upper or lower extremities, as well as trunk and midline edema
• Lymphedema management, especially for post-operative cases, cancer treatments, or lymph node removal
• Assists in recovery by reducing localized swelling and bruising after cosmetic surgeries

Contraindications for MLD

• Deep vein thrombosis (DVT)
• Cellulitis
• Blood clots
• Fever
• Infections
• Congestive Heart Failure
• Acute Renal Failure
• Active cancer
• Unstable hypertension
• Hepatic cirrhosis with abdominal fluid (ascites)
• Thyroid conditions

References

1. https://lymphoma-action.org.uk/information-and-support/what-lymphoma/lymphatic-system
2. https://www.physio-pedia.com/Manual_Lymphatic_Drainage
3. https://my.clevelandclinic.org/health/treatments/21768-lymphatic-drainage-massage
4. https://www.cancerresearchuk.org/about-cancer/coping/physically/lymphoedema-and-cancer/treating/massage-manual-lymphatic-drainage
5. https://www.royalmarsden.nhs.uk/your-care/support-living-with-and-beyond-cancer/guidance-advice/lymphoedema-advice/drainage