Manual lymphatic drainage (MLD) is a therapeutic technique that guides lymphatic fluid to special lymphatic system organs that are equipped to remove toxins and reduce swelling in the limbs.

Lymphatic drainage techniques have been used for everything from surgery recovery to cosmetic treatments to post-injury care. Many people have experienced the healing benefits of manual lymphatic drainage and know it to be a great therapy to have access to. But what exactly is manual lymphatic drainage and how can you know if it’s the right treatment for you?

In this article, we will cover:

• What is Manual Lymphatic Drainage (MLD)?
• How does MLD work?
• Who can benefit from MLD?
• Who cannot receive MLD?
• What to expect from an MLD session

What is Manual Lymphatic Drainage (MLD)?

Manual lymphatic drainage – or MLD for short- is a gentle technique therapists use to guide your lymphatic fluid to the organs that filter and remove toxins. MLD is performed by a certified therapist by gently stretching the skin in the direction in which the lymph moves.

Lymph fluid consists of water, protein, cells, and long-chain fatty acids. It should be a watery consistency, but when it becomes stagnant it becomes thicker and has a more difficult time moving through the vessels. Drinking water is important to keep it at the right consistency. Diet, scar tissue, injuries, medication, how much you exercise, and different health conditions can affect the consistency of lymph fluid.

There are a few different forms of MLD. The most common are:

• The Vodder Technique
• Földi Technique
• Leduc Technique
• Casley-Smith Technique
• Brazillian Lymphatic Drainage Technique

Your lymphatic system consists of and works with:

• Lymph (the fluid that moves through the lymphatic structures)
• Lymphatic vessels
• Lymphatic capillaries
• Lymph nodes
• Anastomosis (these connect the lymphatic vessels with the blood vessels for cross-circulation)
• Cisterna chyli (only about 50% of people have a cisterna chyli)
• Spleen
• Thymus
• Bone marrow
• Tonsils
• Appendix
• Peyer’s Patches

The lymphatic vessels and capillaries run all throughout the body to help remove damaged cells and tissues, toxins, bacteria, and anything else that can contribute to inflammation in those areas. Certain vessels transport the lymph to the nodes to be filtered and other vessels that transport the filtered lymph away from the nodes to be recirculated.

Lymphatic circulation happens at a rate of 10-20 beats per minute. During an MLD session, this rate increases to 100-120 beats per minute. The therapist helps to stimulate the nodes to receive more lymph and then guides the lymph along the vessels and capillaries to be removed at a faster rate.

This is why after MLD sessions you’ll notice less puffiness and swelling in your face (normally you see it the most around your eyes and under your chin) and limbs.

Benefits of Manual Lymphatic Drainage

Originally, MLD was used in the clinical setting by orthopedic doctors. They used it to help reduce inflammation related to injuries or surgeries and for conditions like lymphedema. MLD is still used in these settings and can now be charged to some insurances.

MLD has now found its way into the spa industry because, in addition to health benefits, MLD is great for your appearance, too. Some sessions are targeted at facial puffiness given you that “I’ve just had a facelift” look. Others help flatten your tummy giving you a more contoured and flatter look.

Some of the conditions where MLD can help include:

• Fibromyalgia
• Chronic venous insufficiency (CVI)
• Lipedema
• Lymphedema
• Rheumatoid arthritis
• Autoimmune conditions
• Certain cancers
• Seasonal allergies
• Other inflammatory diseases or conditions
• Skin conditions like acne, eczema, dryness, or other rashes
• Chronic sinus infections (not during an infection)
• Chronic fatigue
• Chronic headaches/migraines
• Concussions
• Recently it’s been found to help with glaucoma and other inflammatory eye conditions
• Functional constipation
• Kidney disease (as long as it has not progressed to kidney failure
• Chronic or acute injuries
• Scar tissue build up

Those who suffer from bloating and brain fog can also benefit from MLD as both of these symptoms have been associated with inflammation and circulating cytokines.

Who cannot receive MLD?

While MLD sounds like it can fix most anything, there are some people who should not get MLD because it can cause more problems. If we look at how the lymph moves through the body and how the lymphatic system works with other organs and systems, you can see how moving the lymph at a faster rate can become dangerous.

Since the lymphatic vessels work closely with the veins, conditions affecting the cardiovascular system are the most affected by the increased amount of lymph flow. People with the following conditions should not receive MLD:

• Congestive heart failure
• Blood clots (let your therapist know if you’ve had a history of blood clots, if you currently don’t have any they should be okay to work on you, but to be on the safe side check with your doctor and get them to send a note that you’re cleared for treatment)
• Certain cancers
• Kidney failure (kidney disease can receive and benefit from MLD but once it crosses over into failure you can no longer receive sessions)
• Deep vein thrombosis (DVT)
• Cellulitis
• Stroke
• Fever of any kind
• Current infection
• Are currently taking an antibiotic or other medications that need specific time release
• Certain cancers
• Uncontrolled medical or mental conditions

Please let your therapist know about any medications or conditions that you have that may prevent you from being able to receive treatment. If it is a rare condition or it is uncontrolled, get a note from your doctor saying that it is okay for you to receive treatment.

What to expect from your manual lymphatic drainage session

Now keep in mind this can differ depending on the type of MLD you receive. For the sake of this article we will be talking more about the Vodder technique than anything else.

You can receive this treatment with or without clothing on. It does make it easier for the therapist to get your skin to stretch without clothing on but in some settings this wouldn’t be appropriate so your therapist will know how to adjust for this.

Your therapist may or may not take measurements of your limbs to see what your initial measurements are especially if they will be billing insurance and are in a physical therapy setting. Massage therapists in some states (like PA where I live) are not able to bill insurance so they may not take measurements unless it’s for lymphedema and that is part of your goals.

Your therapist may use water or hand sanitizer to get a better “grip”. The stickiness between your skin and theirs allows for lighter pressure and more of a stretch for better drainage results.

Your therapist will begin the session by making small circular motions where your lymph nodes are located. The circles will be done before guiding lymph to those areas. The circular motions will be done in the following areas, in this order:

• Collar bone – supraclavicular
• Neck -cervical
• Under the jaw -submaxillary
• In front of and behind your ears
• Armpit areas (both sides) -axillary
• Top of your legs (both sides) -inguinal

Once these main circular motions are done they will either make small circles (typically done on the face) or use long stretching motions (on the extremities) towards these areas. The therapist will also address the anastomosis which are like highways going across your body to guide the lymph that is in the trunk of your body.

This is typically done with circular motions that will go from one side to the other and then repeated going the opposite direction. This will be done:

• Across your chest (at the armpit line)
• Across the top of your back (also at the armpit line)
• Across the bottom of your back (in line with your sacrum)
• Diagonally on your abdomen from under your arm to your belly button area

These areas can be sensitive or triggering for some people. Keep in mind that your therapist will drape you so that you remain covered throughout the process.

If you’ve experienced trauma in your past these areas can make you feel vulnerable to have worked on. Please let your therapist know if you’ve experienced trauma of any kind prior to the session so they can work on releasing emotional, physical, or mental trauma alongside the therapy. Not all therapists are equipped to work with these special populations of people so ask ahead of time if your therapist is to make sure you can work well together.

Your therapist will end the session by stimulating the nodes again and then your session is up. The session will last anywhere from 30-60 minutes depending on your specific situation. Typically they last around 45 minutes for the average person.

The touch during MLD is very light. Using deep pressure pushes the vessels down too much and does not help the lymph circulate better. For certain areas and treatment types, your therapist may stimulate the deeper structures of your lymphatic system this is often done in the abdomen.

After your session, you will likely have to use the bathroom more frequently and you’ll feel more thirsty throughout the day. Make sure to drink a lot of water to help your body remove the toxins and keep up with your faster-moving lymph.

Make sure you get a quality therapist to perform your lymphatic drainage session. Make sure they’ve taken an accredited course on it and can show you a stamp of approval that they passed. If you’re in the northeastern Pennsylvania area, I can travel to you to provide MLD sessions. Book your appointment here.

If you have any questions about MLD, drop them in the comments and I’ll get back to you ASAP.