To complement “Lymphatic Drainage for Geriatric Clients” in the August 2015 issue of MASSAGE Magazine. Summary: You can help clients experiencing lymphedema, or chronic tissue swelling, by training in the gentle, noninvasive modality of manual lymphatic drainage. Certification in this area can allow you to work with geriatric clients, postoperative cancer patients and other specialized populations who may have this condition.
For a massage therapist, navigating a patient’s medical history can sometimes be overwhelming. When looking at past medical history, we need to decide what is most relevant to our current practice with the client.
When patients have a history of a past cancer diagnosis, this navigation becomes even more complex.
Any type of chronic swelling in the tissue is referred to as lymphedema. Oftentimes, patients will experience postoperative lymphedema following a mastectomy or other oncology-related surgical procedure.
It can be difficult to distinguish if the swelling is the body’s normal healing response; a residual side effect of chemotherapy (or other) medications used in cancer treatment; or a true oncology-related lymphedema caused by lymph node removal.
Manual lymphatic drainage (MLD) is often implemented to help alleviate excess fluid and help the healing process by decreasing bruising and swelling, increasing comfort. A properly trained therapist uses MLD or compression bandaging to alleviate lymphedema related to lymph removal.
Lymph nodes serve as filters to purify the interstitial fluid sent to them via the lymphatic vessels. Their second function is to work like small bulb syringes—tiny little vacuums that draw in interstitial fluid. They absorb fluid, detoxify the body, and prevent and resolve congestion in the tissues.
When lymph nodes are removed in order to stage or treat cancer, the corresponding limb or quadrant of the body loses some of its suction ability, or ability to pull lymphatic fluid from the affected body part. This can lead to congestion in the tissues and uncomfortable and debilitating edema that decreases mobility and function.
Lymphatic fluid is made up of water, protein and cellular debris—viruses, bacteria and other pollutants that are drained by the tissues of the body. In oncology cases, full-body MLD can be used following active chemotherapy treatment to speed detoxification, cleanse and purify the tissues, and decrease some of the byproducts of the chemotherapy; although it is important to first get clearance from the client’s oncologist.
Gentle and noninvasive
Manual lymphatic drainage uses a light, repetitive skin stretching movement that is very specific: the skin is stretched in a specific direction and sequence to help speed the rate at which the lymphatic fluid reaches the appropriate lymph node groups for filtration and decongestion of the tissues.
The massage therapist’s role in oncology care is to help speed the decrease of lymphatic congestion that often occurs after treatment. In addition, full-body MLD stimulates the entire lymphatic system, which is highly beneficial to the immune system.
Manual lymphatic drainage is both gentle and noninvasive, and as long as major contraindications have been ruled out, can often be administered without needing to identify the cause of the swelling.
For example, a patient may come in with a very swollen arm following rotator cuff surgery. Her past history may show lymph node removal due to breast cancer on the same side. A properly trained Certified Lymphatic Therapist (CLT) can treat the edema with the appropriate MLD protocol without needing to pinpoint the cause, as long as contraindications are not present. The same is true for lower extremity edemas, even if it is unclear whether the cause is past oncology care or general venous aging and venous stasis.
The major contraindications to manual lymphatic drainage are acute congestive heart failure, acute renal failure, active blood clots, active infection, active bleeding and undiagnosed cancer. If none of these are present, MLD is a safe and gentle modality appropriate for many indications, and is the best option for moving fluid from one body part to another.
The key to resolving oncology-related edema, postoperative edema, or venous stasis edema is to work within the lymph system instead of going too deeply into the muscular-skeletal system.
The repetitive skin stretch technique encourages fluid into the lymphatics for absorption and removal in a way that does not occur while pressing too deeply.
Beyond Oncology Care
Manual lymphatic drainage can be successfully employed for aesthetic and dermatological indications, in wound healing and sports medicine, and to treat a variety of conditions such as pain, arthritis, bursitis, tendonitis, chronic head and neck tension, migraines, edema due to pregnancy, and dependent edema (hemiplegia, paraplegia). Perhaps most importantly, it is highly effective in treating autoimmune conditions such as fibromyalgia, chronic fatigue, rheumatoid arthritis, lupus and more.
In addition to transferring fluid from one body part to another, research shows that manual lymphatic drainage speeds the interstitial fluid’s filtering process through the lymph nodes, increasing detoxification rates by up to 30 percent.
Training in Lymphedema Care
Until a therapist is fully trained in manual lymphatic drainage or compression bandaging, his or her primary role is to serve as an advocate, educate patients on appropriate care, and help them locate an MLD or certified lymphedema therapist in their area. Certified therapists can be found at monarchce.com, lymphnet.org and CLT-LANA.org.
About the Author
Carmen Thompson, L.P.T.A., C.M.T., C.L.T., provides lymphatic therapy to clients through her practice, Lymphatic Care Specialists LLC. Thompson’s program, Monarch Continuing Education, is one of seven programs in the U.S. meeting training guidelines for the certification of lymphedema therapists set forth by the National Lymphedema Network and the Lymphology Association of North America. She wrote “Lymphatic Drainage for Geriatric Clients” for the August 2015 issue of MASSAGE Magazine.