Manual lymphatic drainage is a form of physical therapy and is mainly used for oedema and decongestion therapy, which can occur after operations or trauma. This therapy is particularly often used after tumor treatment or removal of lymph nodes. Since 1960, the therapy of manual lymph drainage, developed mainly by Emil Vodder, has become established.
Since then it has been taught in German massage and physiotherapy schools. The persons performing the therapy are mainly masseurs and physiotherapists. Since the therapy of manual lymphatic drainage requires practice and special training, the therapy is only allowed to trained personnel. The training is a 4-week-long additional training and is defined in the guidelines of the IKK. While lymphatic drainage is very widespread in Austria and Germany, it is used much less in the USA.
Application Engineering
Emil Vodder describes four basic terms in his technique of lymphatic drainage: These different grips are adapted to the corresponding body regions. This is intended to activate the lymphatic system, which in particular improves the pumping capacity of the lymph vessels. The frequency of this pumping action is 10 to 12 contractions per minute under resting conditions.
This can be increased to up to 20 contractions. Through the grips and the changing pressure, the therapist creates a stimulus for the tissue. The smooth muscle cells of the lymph vessels respond to this stimulus with an increased pumping frequency.
By repeating these grips many times, an increased flow rate is achieved. The direction of pressure is adapted to the lymph vessels that can be reached and must always be in the direction of the root of the limb (arms, legs), or to the end point of a lymph vessel. The lymphatic vessels unite in two large veins, the subclavian and internal jugular veins, which are located in the area of the heart and under the clavicle.
In this way, the lymph is directed towards the large lymphatic trunks. Furthermore, the therapist can move protein-rich lymph from the superficial lymphatic system, which covers the entire body like a net, via the so-called watersheds into a healthy area. There the accumulated lymph can then be removed.
With all these applications, the lymph drainage, in contrast to the classical massage, does not cause any increased blood circulation of the tissue. If the congestion is very severe, manual lymph drainage can be combined with compression bandages, exercise therapy and skin care.
- Standing circle
- Pump handle
- Scoop handle
- Rotary handle
Manual lymphatic drainage is mainly used to treat lymphostatic edema.
These occur due to an insufficient transport capacity of the lymph vessels when the lymph is normal. This includes primary and secondary lymphedema. A typical secondary lymphedema would be the edema of the arm after breast cancer surgery with removal of the axillary lymph nodes.
In addition to this decongestant effect, lymphatic drainage also has a pain-relieving and sympathicolytic effect. Patients become calmer, the gastrointestinal tract is stimulated and skeletal muscle tone decreases. By decongestion before and after operations, the pain can be relieved and in some cases the need for painkillers can be significantly reduced.
In addition, the healing process can be faster. Further indications are all orthopedic and traumatological diseases that are accompanied by swelling. Lymphatic drainage is also often used for burns, migraines or whiplash injuries.
In scar treatment, lymph drainage is used to improve the mobility of the scar and the formation of new lymph vessels after the vessels have been cut. Nowadays, the skin is exposed to particular stress. No matter whether environmental factors or stress in everyday life, the skin, as the largest organ of the human body, is heavily stressed and therefore requires special care.
This is especially true for facial skin, which often appears dull and tired. The reason for this is often an insufficient removal of harmful environmental substances via the lymph. This leads to a congestion of secretions, which can become noticeable by a swelling of the lymph nodes and which makes the skin look dull and lackluster, often also reddened.
Lymph drainage can be used to try to improve this skin condition. The effect of lymph drainage on the face is based on the method of massage. Through gentle pressure and stroking movements on the skin, the lymphatic system is stimulated and an existing lymph congestion can be released.The purpose of lymphatic drainage in the face is to stimulate the transport of harmful substances to the nearest lymph nodes and to improve blood circulation in the massaged area by stimulating the surrounding connective tissue and muscles.
Lymph drainage should always be performed by a trained therapist. You can also try out simple procedures yourself. However, this is always at your own risk.
Instructions for lymphatic drainage in the face: First stroke your fingers along one side of the neck (left or right) and then move your fingers from the middle to the other side of the neck. The massage direction is always from the collarbone to the chin. Then you move with your index fingers below the nostrils and the middle fingers below the lower lip on both sides simultaneously from the middle towards the ear.
Now place the ring finger on the nostrils and move them with a gentle stroking motion towards the ear. In the fourth step, the index finger is placed on the eyebrows and then, with a little pressure, is led to the ears and from there below the eyes to the nose. In the last step, the palms of the hands are placed on the face, leaving only the nose free.
Now apply strong pressure on the face for about 5 seconds. If the lymph drainage is repeated regularly on the face, a fresher and more even complexion can be achieved. Many people know the problem that after long standing/sitting or in hot weather the legs are swollen in the evening.
This is mainly due to the fact that people no longer walk on all fours but in an upright position. The water collects in the deeper parts of the body and can cause swelling there. In most cases, this condition returns to normal overnight.
If the lymphatic system is malfunctioning, the water is no longer completely transported towards the heart. The cause for this can be too many substances that have to be transported, which leads to an overstraining of the system or even a destruction of the lymphatic system through e.g. operations. This leads to swellings, which often occur on the legs for the reasons mentioned above.
Through the lymphatic drainage on the leg, the lymph vessel system is stimulated to absorb and transport the tissue fluid again with slight pressure, which is always exerted in the same direction. The leg is first massaged from the ankle upwards with stroking movements. Then circular movements are made on the thigh from the knee upwards towards the groin.
The different grips can be applied in different numbers and locations. Here too, you should never feel pain during the treatment, as the sensitive lymphatic channels will then be subjected to too much pressure. In most cases, however, the treatment is perceived as extremely pleasant.
You can also have your doctor prescribe lymph drainage on the leg. Several sessions at regular intervals are usually necessary to completely remove the swelling. Especially after injuries or operations in the knee region, the sensitive lymph channels can be damaged.
The lymph is then no longer completely removed and accumulates in the knee, thigh and lower leg region. Lymph drainage can help here. At the beginning, it should be carried out by a physiotherapist, but after some time and appropriate instructions, the patient can also carry it out independently.
The lymphatic drainage at the knee is always based on the anatomical course of the lymph vessels and is always carried out in the direction of flow. Excessive pressure should be avoided, as the lymph vessels are very thin and have already been damaged by the operation/injury. Instructions for lymphatic drainage of the knee: First place both hands on top of each other and massage the swelling and surrounding area in a circular motion with gentle pressure.
Now, from the knee upwards towards the groin, pull the hands with little pressure and repeat the whole procedure about five to ten times. For lymphatic drainage of the lower leg, start at ankle level and first embrace the entire lower leg with both hands for a few seconds. Then the grip is loosened again and the lower leg is enclosed again.
After squeezing the lower leg firmly about three times, start a little further up in the same way. Continue doing this until you have reached knee level. The lymphatic drainage in its own way has the goal of setting the tissue water in motion and transporting it in the direction of the lymph nodes.
However, it is never a substitute for qualified treatment by a physiotherapist. If you experience any discomfort during lymph drainage of the knee, you should consult your doctor immediately.Just like the legs, the feet are considered a predisposed site for lymphatic congestion. This is due to the fact that the lymph, following gravity, accumulates at the lowest point of the body, i.e. the feet.
With the help of manual lymph drainage, effective decongestion therapy can reduce the local symptoms, so that painful swellings on the foot due to lymphatic drainage disorders are reduced. Incidentally, lymphedema of the foot is relatively easy to diagnose clinically and can be distinguished from edema of a different origin. For example, in contrast to venous edema, the toes are also swollen and are called “box toes”.
The name is explained by the fact that when pressure is applied to the toes, they take on a box or rectangular shape. The Stemmer sign is also positive. Here one checks the liftability of the skin over the second toe by a slight pinching movement.
In case of lymphedema, the skin cannot be lifted, so the sign is positive. To treat lymphedema of the foot, the typical grip techniques of manual lymph drainage can be used. Basically, it is important to ensure that the pressure on the tissue is effective but not painful and that the lymph fluid can be transported to the next lymph node region by correctly performing the grips.
The two dynamic grips, the scoop and pump handle, are particularly suitable, since they are used in all peripheral parts of the extremities (i.e. hands and feet or forearm and lower leg). The pressure massage is usually performed from the periphery, i.e. from the toes towards the ankle. If the foot is extremely swollen, the twist grip can also be used to decongestion of the lymph vessels.
It is important that other areas of the body are also treated, despite the localization of complaints in the foot. The order and selection of the body parts to be included varies according to the strength of the symptoms and clinical picture. Finally, it is advisable to wear compression stockings in addition to lymphatic drainage and to ensure sufficient movement.
Lymphedema of the arm is manifested by swelling of the arm. The arm sometimes feels heavy and tingling sensations may occur. As with lymph drainage in the trunk area, the position of the arm in relation to the heart means that any contraindications must be explicitly noted.
These so-called contraindications include, for example, advanced heart failure, active cancers, thromboses and infections. The exact indication should always be determined in consultation with the patient’s treating physician. The treatment procedure for lymphatic drainage is basically based on the same criteria as those for lymphatic drainage of the foot, since the arm is also an extremity.
It is therefore important to ensure that the pressure massage is performed from the hands in the direction of the shoulder, i.e. from the periphery towards the middle of the body. The lymph drainage is stimulated with gentle stroking movements. The therapist usually starts at the forearm and slowly strokes and kneads in the direction of the upper arm up to the lymph nodes of the armpits.
Here the lymph is then transported into the lymphatic system. Before treating the edematous swollen region, however, more centrally located and symptom-free body regions should be included in the decongestive massage. These include the neck, chest and trunk areas.
Depending on the intensity of the symptoms, dynamic hand movements of the lymphatic drainage techniques can be applied. This includes the scoop and pumping handle. As in the case of the foot, the rotating handle can also be used in the case of extreme swelling, which is actually more suitable for lymph drainage of the trunk.
On the arms, in addition to primary lymphedema, secondary edema formation or flow obstruction after trauma with surgical or conservative treatment is often indicative of lymph drainage. Lymphedema on the arm, for example, is evident after surgery. Patients who have had to undergo surgery for breast cancer (breast cancer) and whose lymph nodes in the armpit area have had to be removed are particularly affected by such edema.
The duration of the lymph drainage on the arm is determined by the treating therapist and the prescribing physician; it usually takes 30 to 60 minutes. The frequency of lymphatic drainage also depends on the disease, it can be done once or several times a week. For certain diseases, lymphatic drainage of the arm may not be performed.
There are various reasons why manual lymph drainage should not be used. A distinction is made between absolute and relative contraindications.Absolute contraindications include untreated skin tumors (malignancies), thrombosis or thromboembolism, acute septic inflammation and decompensated heart failure (NYHA III or IV). Relative contraindications are chronic inflammation, thrombosis, hypotension, thyroid dysfunction or bronchial asthma. In these cases manual lymphatic drainage may be used, but should be adapted to the previous illnesses and certain precautions should be taken.
