Manual lymphatic drainage (ML; MLD) is a therapeutic procedure of physical applications. It is a special form of massage that can be used to treat lymphedema. Although manual lymphatic drainage is a form of massage, it is not based on improved perfusion of the tissues (improved blood flow) like other forms of therapy of this type. Through various massage and grasping techniques that are tailored to the anatomy and physiology of the lymphatic vascular system, as well as to the fluids in the interstitium (interstitial space; interstitial tissue), the lymphatic system can be effectively activated, resulting in improved drainage (drainage promotion; drainage) of the lymphatic vessels.
Indications (areas of application)
- Postoperative and post-traumatic swelling – manual lymphatic drainage has a particularly high value in the treatment of swelling of an area of the body caused by surgery or trauma. If possible, manual lymphatic drainage should be applied at an early stage, as this can significantly improve wound healing. Furthermore, additional treatment measures are positively influenced by lymphatic drainage. Studies have shown that lymphatic drainage can also relieve postoperative pain.
- Acute inflammatory edema – in the context of rheumatic swelling, manual lymphatic drainage is considered effective and recommended.
- Irritant effusion – an irritant effusion, which can occur, for example, as a result of activated osteoarthritis, can be treated effectively with manual lymphatic drainage only to a limited extent. As an adjunct therapy, however, drainage can be useful.
- Chronic lymphedema – chronic lymphedema represents one of the most important indications for the use of the procedure. Both primary forms (unrelated to existing diseases) and secondary edema (caused by a disease process) can be effectively treated with lymphatic drainage.
- Post-apoplexy edema – after an insult (stroke), lymphedema can complicate the already complicated rehabilitation and put a lot of stress on the patient. Drainage can be optimally integrated into the neurophysiological treatment concept.
- Edema caused by hypoproteinemia – hypoproteinemia (protein deficiency) can be caused by various triggers. In addition to a renal (kidney) cause, liver damage can also cause hypoproteinemia. Enteral (intestinal) causes also often lead to a loss of protein.
- Chronic venous insufficiency (CVI) – venous insufficiency can cause edema, but drainage can effectively treat it. Although the primary cause can be found in damage to the venous vascular system, the procedure is a treatment option of choice. Due to the venous insufficiency, there is an extension of the vascular deficit to the lymphatic vascular system, which can be positively influenced by drainage.
- Pregnancy edema – pregnancy-associated edema can be treated by drainage.
- Lipedema – fat deposits significantly stress the vascular system; secondary edema (water retention) often occurs. Manual lymphatic drainage, of course, does not affect the fat distribution, but can reduce complications resulting from this and contributes to pain relief.
Contraindications
- Malignant tumors – lymphatic drainage is used in the rehabilitation of tumor surgery. However, it is not a treatment option for a tumor. Whether massage can cause tumor cells to spread is still unclear, but is considered unlikely.
- Acute infections – in the case of skin and subcutaneous infections, manual lymphatic drainage should be avoided, as there is a risk of spreading the bacterial or viral pathogens systemically.
- Decompensated heart failure – lymphatic drainage could cause an overload of the heart, which in the worst case can lead to cardiac arrest.
- Cardiac arrhythmias – by manual lymphatic drainage can be strengthened existing cardiac arrhythmias.
- Hypotension – through the drainage can further reduce blood pressure.
- Acute deep vein thrombosis – in an immobilized patient, drainage should be refrained from, because there is an acute risk of embolism, as mechanical entrainment of the thrombus (blood clot) is possible.
Before therapy
Before implementation, possible contraindications (contraindications) and, if necessary, therapy restrictions must be precisely checked.
The procedure
Manual lymphatic drainage is based on the manual circular stimulation of the patient’s skin, which can affect deeper tissue layers. Unlike traditional massage, pressure is not sufficient to elicit a vascular response or increased blood flow. In addition, no nociceptors (pain receptors) are activated, so that no pain reaction can be evoked. By applying stretching stimuli in the transverse and longitudinal directions, it is possible to mobilize a large volume of interstitial fluid toward the nearest groups of lymph nodes. However, the movement of the lymph is not based solely on the direct displacement of the fluid, but primarily on the stimulus-dependent contraction of the lymphatic vessels. Basic grips of manual lymphatic drainage:
- Standing circle – standing circles are important in cases of lymph node accumulation, as the application of this basic grip improves perfusion through these physiological flow obstacles.
- Pump grip – this dynamic grip is usually performed on the extremities from the periphery to central to reduce fluid there. The pump grip can be performed one-handed or two-handed alternately.
- Scoop grip – this grip is used on the lower legs and forearms. Crucial in the application of the grip is that the pressure sequence leads to a skin deformation directed diagonally to the limb axis.
- Twist grip – the dynamic twist grip is particularly suitable for use on large areas of the body. In manual lymphatic drainage, this is therefore mainly used for the trunk of the body.
After therapy
After the therapeutic measure has been carried out, the success of the therapy must be reviewed. If necessary, other measures must still be used to achieve a satisfactory result.
Possible complications
When used correctly by well-trained therapists, complications such as painful tension or low blood pressure occur very rarely. With less experienced therapists, therapeutic measures may be performed incorrectly, if necessary, so that complications may occur more frequently. For example, sometimes only the swollen leg is massaged first instead of preparing the healthy tissue above the swelling for drainage. In addition, complications can occur if contraindications are not followed.
