sand etchings

Manual Lymph Drainage/Lymphedema

sand etchingsA Massage-Like Technique for Lymphedema

Manual lymphatic drainage (MLD) is a type of gentle massage which is believed by proponents to encourage the natural circulation of the lymph through the body. The lymph system depends on peristalsis and the movement of skeletal muscles to squeeze fluid through lymph ducts and vessels.

Manual Lymphatic Drainage was pioneered by Dr. Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders, and is now recognized as a primary tool in Lymphedema management. Therapists can today receive certification through special classes conducted by various organizations specializing in MLD.

MLD consists of gentle, rhythmic massaging of the skin to stimulate the lymph nodes to open and drain. The treatment is very comfortable and non aggressive. A typical session will involve drainage of the neck, abdomen, trunk, and extremities and lasts approximately 40 to 60 minutes.  Treatment will include:

  • Compression Bandaging to reduce swelling. Fitting of custom compression stockings and sleeves help to maintain the reduction of swelling
  • Prevention education including diet and weight control
  • Remedial exercises to condition and strengthen muscles
  • Manual Lymphatic Drainage to increase lymph flow and redirect the lymph fluid
  • Topical skin care to promote healthy skin

Lymphedema Institute  

The Lymphatic System

Lymphedema – Supportive care from the National Institute of Health. Clear and concise article for patients, caregivers and massage therapists.

Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arm(s) and/or leg(s), and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary).

Lymphedema and exercise

Lymphedema & Exercise-another great article about when to exercise, how to get started, importance of going slow when you have lymphedema or at risk for lymphedema.

Lymphedema-Do’s and Don’ts

Are you at Risk for Lymphedema?

American Cancer Society and lymphedema

Lymph edema most often causes a feeling of heaviness, discomfort, cosmetic deformity, and repeated episodes of cellulites

Lympedema swelling may occur:

  • As a result of radiation or removal of lymph nodes

  • In breast, gynecological, testicular, bladder, colon, prostrate  or skin cancer

  • Immediately following surgery  or several years later

  • Damage to lymphatic vessels

  • As a result of cellulitius infection

  • Following orthopedic surgery such as hip and knee  replacements

  • Diabetes/Diabetic Ulcers

New Normal Massage With Lymphedema or At Risk for Lymphedema

Patients comment all the time that they believe that they can’t have a massage due to the diagnosis of lymphedema, or their fear of anyone touching their arm or leg keeps them from getting that much needed massage.  They have been instructed to not have blood pressures taken  or blood drawn from the affected arm.  So it makes sense to them that they can’t have a full body massage that might cause lymphedema or exacerbate their arm or leg that has lymphedema or is at risk for lymphedema.  Creating more confusion is that many times the patient’s physician or nurses are not aware that there are massage therapists with oncology massage training that have the ability to restore and renew a cancer survivor that either has lymphedema or is is at risk for lymphedema. 

Even with a diagnosis of lymphedema, it is possible to have a full body massage if the affected limb is treated appropriately.  Massage Therapists, with oncology massage training understand the correct massage adaptations  to ensure that your limb is not adversely affected. Position, site and pressure restrictions are utilized to ensure a safe and effective massage for a patient with lymphedema or a cancer patient at risk for lymphedema. 

Understanding the risk for lymphedema from an inappropriate massage, a Massage Therapist with oncology massage training can allow a patient to feel secure and comfortable during their new normal massage.  Offering tips and suggestions to prevent lymphedema helps a survivor maintain a great quality of life.  A sense of relief washes over a patient’s face when they realize their massage therapist has the training to modify a massage for their special needs due to cancer treatment.  Recently, a massage therapist, newly trained in oncology massage, informed her client that she would have to turn off the massage bed warmer due to her surgery that included nodal dissections.   The client immediately felt safe with the level of care she was about to receive. 

Once that confusion is cleared up with, the next question is usually, “What about lymphatic massage, can I have that during cancer treatment, isn’t it like manual lymphatic drainage?”  During chemotherapy your body is working hard to absorb the drugs.  If you were to have a lymphatic massage during chemotherapy treatment, it might possibly cause extreme fatigue or other symptoms.  A lymphatic massage might affect the efficacy of the chemotherapy treatment.  As one patient said to me years ago, “I am choosing chemotherapy, in no way do I want to decrease the benefits of the drug.”  The goal of a massage during cancer treatment is to calm, refresh, renew, not fatigue or cause flu-like symptoms.  The other situation with a lymphatic massage is due to nodal dissection, it is important not to over-tax the limb and possibly cause an episode of lymphedema due to the fact that the lymphatic pathways have been altered.  Directly lymph towards a compromised pathway due to nodal dissection, whether there is a diagnosis of lymph edema or not can cause adverse side effects to the at risk limb.

Sitting in on numerous conferences that are suppose to shed light on the management for lymphedema or risk prevention for lymphedema, I have listened to many opinions, that are not always based on credible research.  No wonder patients are confused.  First and foremost find a Massage Therapist that has been trained in Oncology Massage, confer with the National Lymphedema Network to clarify any confusion you might have  and discuss your concerns with your physician, physical or occupational therapist and self educate yourself.  

Recently I came across the article that said that Oncology Nurses were in the best postion to talk to patients about lymphedema.  In a perfect cancer center, where they have all the time in the world to educate each and every patient I would agree.  Most times they are so busy, that they are grateful that I am trained to educate the patients about lymphedema and answer all their questions.  In my opionion cancer centers need to learn to train and trust oncology trained Massage Therapists to be a much needed support staff.   Read article

What you should know about lymphedema

Breast Cancer-Self Management Strategies afer Mastectomy or Lumpectomy–  A wonderful article that has self help tips for patients.

Because a hug should never hurt

Easy Does It

The Incidence of Lymphedema

The experience of lower limb lymphedema

Lymphedema of the leg

Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma

Aerobic exercise for lymphedema

Even with a diagnosis of lymphedema, it is possible to have a  full body massage if the affected limb is treated appropriately.  An Oncology Massage Therapist will have the training to use techniques to ensure that your limb is not adversely affected. Position, site and pressure restrictions are utilized to ensure a safe and effective massage.

Exercises for Lymphedema– Simple to follow exercises to help manage lymphedema.