Lymphatic drainage

Lymphatic drainage is an important part of lympdoedema treatment. It’s a form of massage that helps stimulate the lymphatic system and encourages the flow of lymph fluid. Manual lymphatic drainage (MLD) is a specialised massage technique that should only be practised by trained therapists. Manual Lymphatic Drainage UK holds a list of qualified MLD specialists. A course of MLD may last a few weeks and can be repeated again in the future.

You can also learn to do a simplified version of MLD at home yourself, called simple lymphatic drainage (SLD). It’s important that you’re taught this by a specialist. SLD helps stimulate the lymph channels and drain excess fluid.

Lymphatic drainage should be used in combination with deep breathing exercises before and after the massage.

What is lymphatic drainage?

Lymphatic drainage is a special massage technique that encourages lymph to drain out of a limb with lymphoedema into an area that drains normally. It’s an important treatment for lymphoedema. There are two main types of lymphatic drainage: manual lymphatic drainage (MLD) and simple lymphatic drainage (SLD).


Manual lymphatic drainage (MLD)

Manual lymphatic drainage (MLD) is a specialised, gentle type of skin massage and an important part of lymphoedema treatment. The aim is to encourage the extra lymph fluid to move away from the swollen area so it can drain normally. MLD also encourages and improves lymph drainage in the healthy lymph vessels, which helps keep fluid away from swollen areas. Breathing techniques are an important part of this treatment.

MLD should only be given by a trained and experienced therapist. There are a number of different techniques for MLD including the Vodder, Földi, Leduc or Casley-Smith methods. A therapist should be trained in at least one of these.

MLD is usually combined with compression garments or bandaging to maintain its effects. But it can be particularly useful in areas where it’s difficult to use compression therapy, such as in the head and neck area.

NHS lymphoedema treatment clinics often provide MLD. However, it’s not available at all centres. If you’re having difficulty finding a qualified MLD therapist, contact Manual Lymphatic Drainage UK, who keep a register of their members.

Having MLD

MLD can be done for up to an hour a day or three times a week. A course may last for three or more weeks and can be repeated every three months or every year. Before and after MLD, your therapist will do some breathing exercises with you.

You’ll usually be lying down and may have to remove some of your clothing, unless you have lymphoedema of the head and neck area. Your therapist will begin by treating unaffected lymph nodes using very gentle pressure, and slow, rhythmical movements. MLD isn’t used if you have an infection (cellulitis) in the swollen area or if you have certain medical conditions, such as heart problems.

You can be taught how to do a simplified version of MLD yourself at home. It’s a type of self-massage called simple lymphatic drainage (SLD).


Simple lymphatic drainage (SLD)

This is a simplified version of MLD, which you can be taught to do yourself at home. It’s carried out in combination with breathing exercises.

Doing SLD

Choose a time and place where you can do SLD in a relaxed way and won’t be interrupted or distracted. Make sure you have everything you need before you start and get yourself into a comfortable position. Don’t forget to do your deep breathing exercises first.

We have diagrams and explanations on this page to help you, but these are only a guide. It’s important that you’re taught these techniques by a specialist before you start. You might want to ask a relative or friend to go to your appointment with you so they can learn the techniques and help you at home. The LSN (Lymphoedema Support Network) has DVDs on the self-management of lymphoedema that show how to do SLD.

The massage is done without any oils or creams, using your hand very gently to move the skin in a particular direction. A little talcum powder may be helpful if your skin is sticky and your hand doesn’t move freely. If your skin is red when you’ve finished, then the movement is too hard.

Hand-held massagers

Hand-held massagers may be useful for people who have restricted movement of their hands. However, it’s a good idea to talk to your lymphoedema specialist before buying one. Some people find it helpful to use a soft baby brush as a massager.


SLD massage 1 – for arm and leg swelling

Front view of a torso
Front view of a torso

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This massage aims to stimulate the flow of lymph in the body generally.

  • Place your fingers, relaxed, on either side of your neck at position 1 (shown in the diagram above).
  • Gently move the skin in a downwards direction, towards the back of your neck.
  • Repeat 10 times at position 1, 2 and 3.
  • At position 4 (on the top of your shoulder) use a gentle movement around the front of your neck in towards the top of your breastbone (where the collarbones meet).
  • Repeat five times.

If you have a short neck, you may not be able to massage the neck in four places. If this is the case, miss out position 3.


SLD massage 2 – for swelling of one arm

Front view of swelling of the arm
Front view of swelling of the arm

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The aim of this massage is to stimulate the lymph channels on the body (trunk) to clear the way ahead so excess fluid can drain away.

The skin is always moved away from the swollen side. You’ll find it easier to start with one hand, and then swap to the other as you move across the body.

  • Starting in the armpit on the non-swollen side (position 1), use light pressure to gently stretch the skin up into the armpit. Your hand should be flat and not slide over the skin. Repeat five times.
  • Next, at position 2, use a light, gentle movement with the whole of the hand to slowly stretch the skin towards the non-swollen side, with a slow rhythm. Repeat in the same area five times.
  • Repeat the same movements at position 3.
  • Swap hands, and repeat the movements five more times at position 3 with your other hand, as this position is very important for lymphatic drainage. This time, the movement with your fingers is a slight pull to move the skin towards the non-swollen armpit.
  • Repeat movements five times at position 4, then 5.

If you have the help of a relative or friend, the massage can be repeated across the back, starting again from the non-swollen side (position 1).

Swelling-arm-back-labelled
Swelling-arm-back-labelled

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SLD massage 3 – for swelling of one leg

Swelling of a leg
Swelling of a leg

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The aim of this massage is to clear a path ahead of the affected leg to allow excess fluid to drain away.

Starting at the armpit on the same side as your affected leg (position 1), use light pressure to stretch the skin up gently into the armpit. Your hand should be flat and gently resting on the skin, not sliding over it. Repeat five times.

Repeat five times each at chest level (position 2), waist level (position 3), then at your lower abdomen (position 4). Each time you will be gently pushing the skin up towards the armpit on the same side as the swelling.