Massage Therapy for Lymphedema

Massage therapy, especially lymphatic drainage massage, can help reduce swelling caused by lymphedema.

It encourages fluid movement and improves circulation. In this article, we’ll explore the benefits of massage therapy for lymphedema and introduce the lymphatic drainage technique for therapists. We will also cover important safety steps for an effective treatment. 

What is lymphedema? 

Lymphedema is a progressive disease, which occurs due to a blockage in the lymphatic system. The lymphatic system is a network of vessels and nodes that helps remove waste and excess fluid from tissues, returning it to the bloodstream. It can present with the following symptoms: 

• Swelling of the upper or/and lower limbs 
• Hardening and thickening of the skin of the affected body part 
• Heavy limbs 
• Impaired immune system 
• Wounds 
• The feeling of heaviness/achiness 
• Clothes/rings fit differently on each side of the body 
• Change in weight 
• Complaint of limited movement and/or strength in the involved limb 
• Symptom behavior of edema 

It's important to treat and detect lymphedema early. This helps prevent complications and worsening of symptoms. If the affected limb is less than 20% larger than normal, it's mild or moderate lymphedema. If it's more than 20% larger, it's considered severe. 

Professionals will tailor the treatment depending on the severity of the condition. Some may include gentle exercises to improve blood flow, compression, and medication. Additionally, skincare and self-management guidance are important.  

This is also where specialized massage techniques, like manual lymph drainage, become useful as a treatment. Below we detail the massage technique used to help individuals with lymphedema. 

Related course: Therapeutic Interventions for Lymphedema 

Massage therapy for lymphedema: Lymphatic drainage 

The most effective technique for lymphedema is manual lymphatic drainage (MLD). This massage technique improves the natural flow of lymph fluid in the body using gentle, slow, and rhythmic pumping techniques.  

The pressure is light. It shouldn’t cause redness on the skin. Therapists should apply just enough pressure to stretch the skin, without pressing deeply into the muscles. This should be performed on bare skin, without any moisturizing cream or oils. Some talcum powder could be used if the patient’s skin is sticky.  

Therapists start massaging and manually draining the affected area in the direction of the lymph flow, toward the heart. This opens capillaries, increases lymph uptake, and promotes fluid movement through the vessels, reducing swelling.  

IMPORTANT 

Massage therapists should monitor the patient during the massage for any adverse reactions, such as increased swelling or discomfort. Stop the massage immediately upon such occurrence. 

Steps for lymphatic drainage massage 

Lymphatic drainage massage involves two main steps: 

1. Filtration: Filtration is when water and nutrients leave the blood and move into the tissues to nourish them. This initial phase moves stagnant lymph fluid to areas with lymph nodes. This helps to "empty" congested regions and allows fluid to flow more freely. 
2. Reabsorption: After clearing, this phase helps fluid move into the lymphatic capillaries, where it re-enters the lymphatic system to be processed and filtered. About 80-90% of this fluid is reabsorbed back into the blood capillaries.  

Before proceeding with lymphatic drainage massage, therapists should perform a thorough physical examination. This can include assessing the range of motion, muscle strength, mobility, and sensation of the client. 

Therapists should review the client's medical history before massage. Be sure to customize the massage technique to the condition and needs of the patient. Look out for any signs of skin infection, wounds, or other conditions that can affect the treatment. Once the treatment is deemed safe, therapists should explain the treatment's purpose and benefits to the client. 

How to perform an effective lymphatic drainage massage 

Lymphatic drainage massage relies on understanding the lymphatic pathways and lymph nodes in the body. Treat each body part with care and informed understanding. Begin with the upper body before moving onto the legs. 

Here are a few simple tips for massage therapy for lymphedema. 

Upper body massage techniques 

• Neck: Massage therapists should gently massage the front of the neck to help move lymph fluid toward the chest. They should use short, downward strokes, starting from the area with swelling and moving toward the collarbone. 
• Armpit: Massage the area around the armpits using light pressure. Note that this area has many lymph nodes. Therapists can ask their clients to place their hands under the armpit against the ribcage. Then, they can gently stretch the skin towards the armpit. They should use circular strokes toward the nodes, which will push the lymph from your arms inward. 
• Arm: Therapists should perform lymphatic drainage massage on the arm by applying gentle, rhythmic strokes from the tips of the fingers upward toward the shoulder or axilla. This motion guides lymph fluid toward the armpits. 

Lower body massage techniques 

• Groin: Therapists should get approval from the client before proceeding with this sensitive area. Then they can place their hand on the top of the thigh, and use half-circle strokes, stretching the skin upward and outward towards the leg's side. Then they let it return to the starting position. Stimulating these nodes with light, gentle circular motions will lead to increased drainage from the legs. 
• Leg: Begin at the top of your leg, placing one hand on the inner side and the other on the back. Gently stretch the skin from the inner thigh up and out toward the hip, then move your hands lower and repeat. 

Massage therapists can also encourage clients to practice deep abdominal breathing. Guide them to inhale deeply, expand the belly, and exhale fully, drawing the belly button toward the spine. This technique enhances lymphatic drainage and can be practiced in various positions throughout the day. 

Safety measures during lymphatic drainage massage 

Massage therapy for lymphedema must be practiced with ample precautions. Therapists should know when to avoid massage or how to apply it safely. 

• History of blood clots or stroke. Lymphatic massage can mobilize any pre-existing blood clots. These may lead to serious complications, such as embolism or another stroke. 
• Current infection. In the case of acute infection, lymphatic massage therapy can stimulate faster distribution of pathogens of disease all over the body. 
• Open wounds. Massage in areas around open wounds can introduce bacteria and cause infection. Avoid areas with open wounds to prevent a possible infection. 
• Liver problems. The liver is responsible for detoxification. Lymphatic massage can overload it by increasing the toxins in circulation when the liver is not functioning properly. 
• Kidney problems. The kidneys filter waste from the blood. Lymphatic massage can add to this burden and may further complicate kidney complications. 

Which way do you massage for lymphatic drainage? 

Massage for lymphatic drainage is always directed toward the body's lymphatic pathways. The general direction is toward the heart, following the natural flow of lymphatic fluid.  

What is the difference between lymphatic drainage massage and regular massage? 

The major difference between lymphatic drainage massage and regular massage is the technique used and the intent of the treatment. Lymphatic drainage massage is a specialized technique directed toward the lymphatic system. This involves very light strokes and gentle stretching of the skin. It avoids deep pressure that would affect the muscles. 

On the other hand, regular massage, like Swedish or deep tissue massage applies pressure to the muscles. These modalities promote muscle relaxation, ease tension, and increase blood circulation within the tissue. 

How do massage therapists give a lymphatic massage? 

Trained massage therapists are known to use a gentle, sweeping motion on target areas with just enough pressure to shift the surface of the skin. They follow the right directions in the upper and lower body to ensure the flow and drainage of lymphatic fluid.