Lymphatic drainage

Lymphatic drainage is an important part of lymphoedema treatment. It is a specialised, gentle type of massage. It helps lymph fluid to move away from the swollen area into an area that drains normally.

There are two main types of lymphatic drainage. These are manual lymphatic drainage (MLD) and simple lymphatic drainage (SLD).

Manual lymphatic drainage is a specialised massage technique that should only be done by trained therapists. The length of the course may vary and it is sometimes combined with other treatments.

Simple lymphatic drainage is a simplified version of MLD. You can be shown how to do this yourself at home. It is important that you are taught this by a specialist. Sometimes hand-held massagers can be used by people who have less movement in their hands.

Deep breathing exercises should be done before and after the massage. This helps the fluid to drain.

What is lymphatic drainage?

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 two 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.

I see my wonderful lymphoedema nurse Judy every few months. She gave me massage instructions and advice on support garments. I try to do the massage most days.


Manual lymphatic drainage (MLD)

You should only have MLD by a trained therapist. There are several different techniques. They are all similar, but use different massage movements.

The different methods are:

  • Casley-Smith
  • FG-MLD
  • Földi
  • Leduc
  • Vodder.

Your therapist can tell you more about the method they use and what it involves.

You usually have MLD along with compression garments or bandaging to keep the swelling down. But it can be particularly useful in areas where it is difficult to use compression therapy. Breathing techniques are also an important part of this treatment.

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. They keep a register of their members. Or the British Lymphology Society has a directory on its website that you may find helpful.

Having MLD

When you start, you will usually have MLD daily, then it will reduce to 2 or 3 times a week. 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. 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 (cellulitis) in the swollen area. You also cannot have it if you have certain medical conditions, such as heart problems.

Simple lymphatic drainage (SLD)

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’s important that you’re taught these techniques by a lymphoedema specialist before you start. They will teach you to massage the area where you don’t have lymphoedema. This helps to make some space for the fluid to drain into from the swollen area. You do not massage the swollen area. They can also teach a friend or relative to do it.

Doing SLD

Your lymphoedema specialist will explain how to do the massage and show you the right amount of pressure to apply. This will depend on your individual situation.

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. Once these channels have been cleared, the excess lymph from the swollen side will be able to drain away more easily.

It is best to choose a time and a 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. Remember to do your deep breathing exercises first (see below).

The massage is done without any oils or creams, using your hand very gently to move the skin in a particular direction. The skin is always moved in the direction away from the swollen side. 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.

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 restricted movement of their hands. You should talk to your lymphoedema specialist before buying one. Some people find it helpful to use a soft baby brush as a massager.

Deep breathing exercises

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.

You might find it helpful to listen to our CD Relax and breathe, which can help with deep breathing. You can also contact our cancer support specialists for more information.

Back to Lymphoedema

What is lymphoedema?

Lymphoedema is a chronic condition that causes swelling when the lymphatic system is not able to drain fluid properly.

Skin care for lymphoedema

If you have lymphoedema, good skin care is essential. Looking after your skin is an important way of preventing infection.