Lymphatic drainage for lymphoedema
Lymphatic drainage is a type of specialised massage that encourages lymph fluid to drain away from the swollen area.
Lymphatic drainage is a specialised, gentle type of medical massage. It may be used as part of your lymphoedema treatment. The aim is to encourage the lymph fluid to move away from the swollen area, so it can drain normally. It also helps lymph fluid drain through the healthy lymph vessels. This helps control swelling.
There are 2 main types of lymphatic drainage:
- manual lymphatic drainage (MLD)
- simple lymphatic drainage (SLD).
You should only have MLD from a trained lymphatic drainage therapist. It is a short course of treatment.
SLD is something you can be shown how to do yourself. You can continue with this long term.
You should not have other types of massage on the affected area.
There are several different techniques for MLD. They are all similar but use different massage movements. Your therapist can tell you more about the method they use and what it involves. Breathing techniques are also an important part of MLD.
You usually have MLD along with compression garments or bandaging to keep the swelling down. But MLD can be particularly useful in areas where it is difficult to use compression therapy. For example, MLD can be used if you have head and neck or genital lymphoedema.
NHS lymphoedema treatment clinics often give short courses of MLD. However, it is not available at all centres. If you have difficulty finding a qualified MLD therapist, contact Manual Lymphatic Drainage UK. Or the British Lymphology Society has a directory on its website that you may find helpful.
Your therapist will tell you how often you will have MLD. The length of the course may vary, and it is sometimes combined with other treatments. Before and after MLD, your therapist will do some breathing exercises with you.
You will usually lie down. You may need to remove some of your clothing. Your therapist will begin by treating unaffected lymph nodes. This frees up space for fluid from the affected area to drain into. They will use some pressure and slow, regular movements. Your therapist may ask you to do some simple movements during the treatment to help the lymph to drain.
To help keep the swelling down between treatments, your therapist will show you how to do a simple version of MLD yourself at home. It is a type of self-massage called simple lymphatic drainage (SLD).
You will not have MLD if you have an infection called cellulitis in the swollen area. You also cannot have it if you have certain medical conditions, such as heart problems.
Your lymphoedema specialist may suggest simple lymphatic drainage (SLD) as part of your lymphoedema treatment. This is a simplified version of manual lymphatic drainage (MLD). It is sometimes called self-lymphatic drainage.
It is important that you learn these techniques from a lymphoedema specialist before you start. They will show you how to massage the area where you do not have lymphoedema. This helps to make some space for the fluid to drain into from the swollen area. They can also show a friend or relative how to do it.
Usually, you do not massage the swollen area.
Your lymphoedema specialist will explain how to do the massage and show you the right amount of pressure to use. This will depend on your situation.
The aim of this massage is to improve the flow of lymph fluid in the healthy lymph vessels. Once the vessels have cleared, the excess fluid from the swollen area can drain away more easily.
It is best to choose a time and a place where you can do SLD in a relaxed way. This could be somewhere nothing will interrupt or distract you. Make sure you have everything you need before you start, and get into a comfortable position.
Remember to do your deep breathing exercises first.
You do not use any oils or creams for the massage. You use your hand to very gently move the skin in a particular direction. You always move the skin in the direction away from the swelling. You could use a little talcum powder if your skin is sticky. If your skin is red when you have finished, then the movement is too much.
The Lymphoedema Support Network has information on the self-management of lymphoedema and SLD.
Hand held massagers
Hand-held massagers may be useful for people who have less movement in their hands. Some people find it helpful to use a soft baby brush or shower puff as a massager. You should talk to your lymphoedema specialist before buying any hand-held massagers.
Before and after MLD and SLD massage, breathing exercises can help lymphatic drainage. Use the following simple exercise:
- Sit upright in a comfortable chair or lie on your bed with your knees slightly bent.
- Rest your hands on your ribs.
- Take slow, deep breaths to relax.
- As you breathe in, move the air down to your tummy (abdomen). You will feel your tummy rising under your hands.
- Breathe out slowly by sighing the air out. While breathing out, let your abdomen relax inwards again.
- Do the deep breathing exercise five times.
- Have a short rest before getting up, to avoid feeling dizzy.
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Below is a sample of the sources used in our lymphoedema information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Skin care for people with lymphoedema. British Lymphology Society 2022.
Guidelines on the management of cellulitis in lymphoedema. Lymphoedema Support Network and British Lymphology Society.
O’Donnell TF et al. Systematic review of guidelines for lymphedema and the need for contemporary intersocietal guidelines for the management of lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2020.
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