How to Perform Lymphatic Drainage Massage

What is lymphatic drainage?

Your lymphatic system helps eliminate your body’s waste. A healthy, active lymphatic system uses the natural movements of smooth muscle tissue to do this.

However, surgery, medical conditions, or other damage can cause fluids to build up in your lymph system and your lymph nodes, a condition known as lymphedema.

If you’ve ever had a surgery on or involving your lymph nodes, your doctor may have suggested lymphatic drainage massage performed by a certified massage or physical therapist. However,

lymphatic massage is not recommended for people with the following conditions:

• congestive heart failure
• history of blood clots or stroke
• current infection
• liver problems
• kidney problems

Lymphedema

Procedures that affect or remove your lymph nodes can cause lymphedema as a side effect.

Lymphedema will only occur in the area near a surgical site.

For example, if you have lymph nodes removed as a part of cancer surgery to your left breast, only your left arm, not your right, might be affected with lymphedema.

Lymphedema can also occur as a result of an injury or medical conditions such as congestive heart failure (CHF) or blood clots in the body.

To move waste fluids away from the damaged area, lymphatic massage, which uses a gentle pressure, can help. It’s one technique used to reduce lymphedema.

Raakhee Patel, PT, DPT, CLT, is a physical therapist and certified lymphedema specialist who trains people to perform their own lymphatic massage after surgery.

“We don’t talk enough about lymphedema,” says Patel. Fluid build-up is uncomfortable and causes pain and heaviness in the affected area. And, according to Patel, “Stage 3 lymphedema can be devastating,” causing significant depression and lack of mobility that could complicate healing.

When performing a lymphatic massage, it’s important that the massage include more than just the affected area. The entire lymphatic system of the body, except the head, right side of the chest, and right arm, drains near the left shoulder. So, a massage should include all areas to drain properly.

Clearing and reabsorption

Patel teaches two stages of lymphatic massage: clearing and reabsorption. The purpose of clearing is to create a vacuum with gentle pressure so that the area is prepared to bring in more fluid, creating a flushing effect.

Clearing involves:

• supraclavicular lymph area: located directly under the collarbone
• axillary lymph area: located under the arms
• inside of the elbows

Clearing motions can be repeated as many as 10 times a day. Patel advises, “Always massage both sides of your body, not just the side with the lymphedema.”

A guide to clearing

There are three stages to clearing. Be sure to clear the supraclavicular area, axillary area, and inner-elbow area, in that order.

To clear the supraclavicular area:

• Begin by lying on a comfortable, flat surface.
• Cross your arms on your chest, with your hands resting just below the collarbones.
• Then lift your elbows slowly. The muscle action is as much pressure required to prepare the area to flush lymphatic fluid.

Next, clear the axillary area:

• Lay one hand above your head.
• Use your other hand to gently scoop the underarm area from top to bottom. The only pressure required is gentle enough to move the surface of the skin.

Finally, clear the area inside the elbows:

• Lay your arm straight at your side.
• Use the fingers of your opposite hand to gently pull the skin inside the elbow an inch at a time.

Only very gentle pressure is required. “In lymphatic massage, you’re only working the superficial skin structure,” says Patel. That’s where the fluid is trapped.

How to perform lymphatic massage on the legs

The goal of lymphatic massage on the legs is to open the lymphatic vessels to let excess fluid drain back up into the lymph nodes located in the groin.

There are different techniques used to perform lymphatic massage on the legs, but all have the same end goal: to release the fluid to go back up through the lymph nodes.

To perform a lymphatic massage on the legs, you can follow these steps:

• Perform lymphatic massage of the upper body before beginning with the legs. Follow the three stages of clearing in the supraclavicular area, the axillary area, and the inner-elbow area, in that order. This ensures that the system is clear to allow fluid to drain up.
• Use light pressure. If you can feel the muscles underneath your skin, you are pressing too hard.
• Begin the leg massage at the furthest point away from the injury or affected area and work your way down. For example, if your ankle has swelling, start the massage on the upper part of the leg.
• Starting at the top of the leg, put one hand on the inside of the leg and the other on the back of your leg.
• With gentle pressure, stretch the skin from the inside of your leg up and out, toward your hip.
• Continue this motion down the leg until you reach the knee.
• When you reach the knee, stretch the skin up, with alternating hands, toward your armpit.
• Repeat 10 to 15 times.

You have now completed the clearing step of the lymphatic massage.

A guide to reabsorption

The second part of lymphatic massage is reabsorption. To perform this stage of massage:

• Begin at the affected part of the body farthest from the core of the body. For example, begin at the tips of the fingers if you have lymphedema in your hand, arm, and shoulder.
• Using a gentle, sweeping motion with just enough pressure to shift the surface of the skin, massage from fingertip to hand, from hand to elbow, and from elbow to shoulder.

“Patient compliance is the hardest part of self-care, especially for women, who are so used to taking care of others,” says Patel.

She advises people to set aside at least 20 minutes a day for lymphatic drainage massage. “If you only have a brief amount of time, perform the clearing stage of massage.”

To begin reabsorption on the legs, you will use a pumping motion behind the knee:

• Place both hands behind your knees.
• Pump the back of the knee with a rolling, upward motion 10 to 15 times.

Your knee is now ready to take in fluid from the lower leg, so you can proceed to massaging the lower legs:

• Put one hand on the top of the shin and the other behind the leg.
• Stretch the skin in an upward motion, then release it.
• Continue down toward the ankle area.
• Repeat down through the ankle and feet, always stroking upward.
• End the massage by gently pushing fluid in the toes upward with your fingers.

Measuring effectiveness

How do you know if lymphatic drainage massage is effective? “This is a maintenance technique,” says Patel. “Your lymphedema should not get worse if you regularly practice lymphatic massage.”

Also, drink water. Well-hydrated tissue helps moves out waste materials.

Managing your lymphedema can also include:

• using a compression sleeve to prevent fluid buildup
• seeing a qualified therapist for in-office drainage massage

When choosing a therapist, learn as much about their education as possible. “Massage is very good for you, but deep tissue massage can be too heavy for someone with lymphedema, so don’t assume you can just go to a massage therapist.”

Look for someone who is a certified lymphedema therapist (CLT) and preferably a physical or massage therapist with oncology and pathology training.

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