Lymphatic massage is gentle and subtle work, yet its effects are potent on physical and emotional levels.

It is effective for many conditions; for example, it helps reduce inflammation and swelling, relieve acute and chronic pain, and detoxify the inflammatory effects of stress, surgery or trauma from a motor vehicle accident. In addition, healthy lymph drainage promotes sleep, and improves both blood and lymph circulation. These actions will help refresh and rejuvenate your clients.

What is Lymph?

Lymph is a clear or milky-colored fluid that can be thinner or thicker depending on how much soluble material it carries. Interstitial (extracellular) fluid enters into the lymphatic system via open-ended lymph capillaries and becomes lymph; the exact mechanism of this transition is unknown.

Lymph then travels through progressively larger vessels, moving toward the heart and into the bloodstream at the lymph terminus (subclavian vein) located at the medial end of the clavicles (Fig. A).

Figure A: The lymph terminus (subclavian vein) located at the medial end of the clavicles

Since interstitial fluid is cleansed by lymphatic flow, the quality of lymph circulation determines the environment that supports and nourishes every cell in the body.

This process is described in much more detail in Bruno Chikly’s textbook Silent Waves: Theory and Practice of Lymph Drainage Therapy (2001).

Components of lymph, notes Chikly, include water (about 96%), as well as lipids, carbohydrates and proteins (big molecules that cannot be absorbed directly into the blood). Lymph also carries cells — primarily lymphocytes (white blood cells), cell fragments and debris. These are processed and removed so that adverse effects of excess medications, urea, body waste, environmental pollutants, and calcium deposits from trigger points are neutralized.

Healthy Lymph Flow

Lymph that circulates freely will provide a healthy environment for every cell. Greater lymph flow brings noxious substances in contact with a larger number of white blood cells, which helps neutralize them and defend the body from disease.

Lymph nodes interspersed throughout the lymphatic vessels are like washing machines, where even more processing of the lymph can occur. Maximizing the volume of lymph flowing through the system optimizes the cleansing action.

Breathing and exercise are normal bodily functions that promote lymph circulation. Clients recovering from surgery or injury tend to limit or guard their activity; in these cases, manually stimulating lymph flow can clean out extracellular debris and reduce swelling and subsequent pain to speed recovery.

The rate of lymph flow is determined by two factors:

  • Lymphangions (coiled muscle tissue lining larger lymphatic vessel walls) that contract and relax to push lymph along; and
  • External mechanical forces (breathing, skeletal or intestinal muscle contractions, artery pulsation and manual lymph strokes).

Mechanism of Lymphatic Massage

Lymph vessels are mostly superficial — 70% superficial in the limbs — lying just under the dermo-epithelial junction. They are connected to the skin by anchoring filaments.

When a massage therapist applies manual pressure to move skin over underlying tissues (Figs. B1 and B2), that skin friction pulls on the anchoring filaments to widen lymph vessel openings. Lymph capillaries are open-ended tubes; hence, the entrance can be widened. This manual stimulation also stimulates lymphangions to contract and release, propelling lymphatic flow.

Figure B1: Application of skin friction
Figure B2: Release of skin friction

Chikly explains that manual lymph facilitation is important to maintain healthy circulation. Superficial lymph circulation is not stimulated by exercise but is stimulated by the rhythmic application of skin friction and release. Deep lymphatics, which can be stimulated by muscle contractions, run below fascia and within viscera. When deeper fascia is immobile and stuck with scar tissue or organs lack a healthy motility, manual lymph facilitation can help restore lymph flow.

Benefits of Lymphatic Therapies

Manual lymph bodywork has many benefits, including:

  • Reducing inflammation by bringing excess fluid and waste from the extracellular space into lymph circulation;
  • Increasing blood and lymph circulation. Lymph returns to the bloodstream and heart at the subclavian vein, thereby increasing nutrition and excretion of harmful wastes;
  • Stimulating tissue regeneration via that cleaner environment;
  • Stimulating immune responses by bringing substances into contact with more white blood cells;
  • Stimulating the parasympathetic nervous system (rest and repose) to counter the effects of trauma with slow, rhythmic lymphatic strokes at the pace of natural lymph flow;
  • Improving mood via processing hormones, neuropeptides or medications that may alter the emotional state;
  • Reducing pain through reducing inflammation. Also, slow, rhythmic lymphatic strokes provide intermittent pressure stimulus to override pain signals (the gate effect); and
  • Increasing peristalsis, thereby reducing the discomfort of irritable bowel syndrome.

Precautions & Contraindications for Lymphatic Massage

Based on the intake information the client gives, you should ask yourself, “Would increasing lymph flow help what the body is doing to heal?”

Specific contraindications include:

  • Acute infection or fever. When the client is running a fever of 101 or higher, their body is already working hard enough to get rid of the problem.
  • Systemic inflammation such as colds or flu. First, the client is contagious; second, the whole body is already coping with processing inflammation.
  • Serious circulation problems. You could possibly dislodge a clot and have it become a dangerous embolus in the heart or lungs.
  • Serious heart problems. Increased lymph flow will increase the load on an already-burdened heart.
  • Anuresis, or a low volume of urine produced in the kidneys. Increased lymph circulation will increase the load on overworked kidneys.
  • Removal of or radiation to lymph nodes as a result of cancer treatment. Lymphatic massage could deliver more lymph to nodes that are not available for processing the increased load.
  • Removal of the spleen. Lymphatic massage is not completely contraindicated — but because the spleen assists in cleaning lymph, it is best to limit sessions to under an hour or to client tolerance, whichever is less.
  • Any situation where your intuition does not feel comfortable. It is always best to get a doctor’s opinion about a potentially questionable treatment.

Benefits of Specializing in Lymphatic Massage

Lymphatic facilitation is an invaluable tool in my clinical practice, which focuses on people with medically complex conditions, such as people who have been in motor vehicle accidents, have sports injuries, or are preparing for or recovering from surgery.

For recent trauma and acute inflammation, such as a sprained ankle or strained shoulder, where the localized area is red, hot, swollen and painful, lymphatic facilitation strokes applied proximal to the area help drain away excess fluid and debris from the injury site. For auto accident clients, lymphatic drainage will remove inflammatory products and the resultant pain, and calm the heightened sympathetic response of fight, flight or freeze that can result from the trauma of a crash.

Lymphatic work can be used to clean out pre-surgery sites so they are prepped for rapid healing. After surgery, lymphatic work will help clear out the inflammatory response to the operation, along with any adverse effects of lingering medications and anesthesia.

Lymphatic facilitation can be used alongside other massage techniques to reduce inflammation and pain. For example, when a client complains of tendonitis in the wrist, lymphatic strokes focused proximal to the injury are effective. When the primary focus is on or around the head and neck, gravity can assist lymphatic flow, so a seated position can be helpful.

Lymphatic techniques can also take up a full session; full-body sessions last about an hour to an hour and a half. Clients are advised that the strokes are like very gentle skin friction that is more effective over bare skin. It is not unusual for clients to fall asleep during the session because of lymphatic drainage’s powerful effect on the autonomic nervous system.

In full-body treatments, the client lies comfortably on a massage table, usually supine, as most lymph nodes are on the front of the body. After a session, a client may feel wonderfully refreshed, or it may take a few days to feel this vitality after feeling sluggish at first. I advise clients to drink lots of fluids and get more rest in order to maximize rapid healing.

Training in Lymphatic Massage

This article discusses lymphatic massage in general — but there are actually several types of lymphatic work a therapist can learn. All focus on optimizing the body’s lymph flow, using different methods.

Types of lymphatic work include Complete Decongestive Therapy (CDT), which includes Manual Lymph Drainage (MLD), bandaging and other modalities.

MLD, named by Emil Vodder, is used to reduce lymphedema or the stagnation of protein-rich fluid. MLD can reroute lymph fluid by stimulating healthy, more centrally located vessels and nodes to drain into the venous system instead of pathways that no longer function.

Lymphatic Drainage Therapy (LDT), developed by Bruno Chikly, MD, focuses on feeling lymphatic flow.

My lymph detox classes at the Oregon School of Massage in Portland, Oregon, cover lymphatic facilitation for the face and whole body, which stimulates lymphangions to process more lymph than breathing and natural movements normally move on their own. 

About the Author

Marian Wolfe Dixon, LMT

Marian Wolfe Dixon, LMT, completed master’s degrees in psychology and health education and a post-doctoral fellowship in Complementary and Alternative Medicine from the National Institutes of Health. Working professionally as a massage therapist since 1992, she is the author of Myofascial Massage, Body Mechanics and Self-Care Manual and Bodylessons, and is an NCBTMB-approved Continuing Education Provider.

References and Further Reading on Lymphatic Massage

A. Aspelund et al., “A Dural Lymphatic Vascular System that Drains Brain Interstitial Fluid and Macromolecules”, Journal of Experimental Medicine 212, no.7 (June 2015):991-9.

A. Louveau et al., “Structural and Functional Features of Central Nervous System Lymphatic Vessels,” Nature 523, no. 7560 (July 2015):337-41.

Chikly, B. Silent Waves: Theory and Practice of Lymph Drainage Therapy, International Health and Healing Inc. Publishing, Scottsdale, AZ. 2001, 419 pgs. ISBN:0-9700530-5-3.

Chikly, B. and Chikly, A., “Lymph in the Brain – New Scientific Paradigms About the Brain, Cerebrospinal Fluid Dynamics, Lymph and Their Applications for Manual Therapy”, Massage & Bodywork, (January – February 2016): 46-53.

Chikly, B. and Chikly, A., “Manual Therapy for the Lymphatic System – Pathways to Detoxification and Immune Surveillance”, MASSAGE Magazine (August 2016):38-42.

Schechter, C. “Bodywork for the Lymphatic System – A Comparison of Popular Techniques”, MASSAGE Magazine (August 2016):32-35.

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