11 Benefits of Lymphatic Drainage: Does It Really Work?

Is drainage the same as lymphatic massage, lymphatic drainage massage, etc.?

In the field of lymphatic drainage, there are various distinct terms and expressions. To clarify the terminology, let’s start with a brief overview!

Drainage and lymphatic massage

The term “drainage” can refer to:

• A technique that aims to activate or facilitate the removal of excess fluid in a specific part of your body.
• The process of fluid evacuation itself.

So when we talk about “lymphatic drainage,” the term “lymphatic” specifies that the fluid in question passes through the lymphatic vessels.

As for the expression “lymphatic massage,” it solely refers to a group of techniques with the purpose of lymphatic stimulation. “Lymphatic drainage” is one possible technique within lymphatic massage.

Massage therapy and drainage

The term “massage therapy” encompasses various massage techniques. Lymphatic massage is a subset of massage therapy, and lymphatic drainage is a subset of lymphatic massage.

Drainage and lymphatic drainage

Drainage refers to the process of removing excess fluid from a specific part of the body. This fluid can be:

• 🩸 Blood (as in the case of a hematoma or bruising).
• 💧 Interstitial fluid: the fluid found in the space between capillaries (the microscopic terminations of blood vessels) and all cells in your body.
• 🧠 Cerebrospinal fluid, which surrounds your brain and spinal cord.

Similar to blood, there is circulation of interstitial fluid. This circulation occurs:

• Bidirectionally through the blood capillaries (fluid exits and enters the interstitial space through them).
• Unidirectionally through the lymphatic vessels, which form a parallel network to your blood vessels.

The term “lymph” is used to refer to the fluid contained within the lymphatic system. Hence, “lymphatic drainage” describes the circulation of fluid within this system.

Manual lymphatic drainage 💆🏻‍♀️ vs. non-manual

The term “lymphatic drainage” can refer to:

• The natural process of draining interstitial fluid through the lymphatic circulatory system.
• A group of massage techniques used by various professionals worldwide to stimulate and enhance the drainage process in the lymphatic system.

When we mention “manual lymphatic drainage,” we are referring to the group of massage techniques.

What is a lymphatic issue?

Wondering whether or not one is suffering from a lymphatic problem is never the first thought. First, we notice varying degrees of swelling in a part of the body (arm, hand, leg, foot, etc.). Only then does the question arise: is it a lymphatic problem?

The answer to this question is, of course, crucial in order to decide on the course of action. We speak of a lymphatic problem when the lymphatic circulatory system is dysfunctional.

A malfunction of your lymphatic system can result from:

• a congenital anomaly 🚼;
• a trauma 💥 (such as breast cancer surgery, a car accident, etc.).

When we are certain that the swelling of a limb results from a malfunction of the lymphatic system, we then refer to it as lymphedema.

⚠️ Attention: There are many cases of swelling in a body part that do not stem from a lymphatic problem! Chronic venous insufficiency is one example.

What are the indications & benefits of lymphatic drainage massage?

In this section, I review the common indications for lymphatic drainage.

Please note that by “indication,” I mean a clinical problem for which:

• physiotherapists sometimes use lymphatic drainage in their treatment;
• patients sometimes request physiotherapists to use lymphatic drainage;
• doctors sometimes prescribe physiotherapy for lymphatic drainage.

However, this does not necessarily mean that lymphatic drainage is truly effective for the specific clinical problem!

Throughout the section, I revisit the benefits of lymphatic drainage several times.

1. Postoperative lymphatic drainage

Regardless of the nature of your surgical operation, there is a high chance that swelling (edema) will occur in the operated area. This is a normal phenomenon that will gradually diminish over time ⏳.

Lymphatic Drainage & Postoperative Edema: Is it Useful?

Lymphatic drainage techniques are frequently used by physiotherapists to treat this type of postoperative edema.

Do these drainage techniques accelerate the reduction of swelling? It’s not so certain… Especially when considering the results of studies on the effectiveness of lymphatic drainage for its primary indication: post-surgical lymphedema in breast cancer.

Drawbacks of Lymphatic Drainage for Postoperative Edema

The use of lymphatic drainage for post-surgical edema presents the following drawbacks:

• Dependency on the therapist ☹️;
• The time dedicated to the technique is time that could be spent on another technique that is known to have a potent circulatory effect and additional benefits.

Example of Knee Replacement Surgery 🧎🏻‍♀️

Let’s take the example of a patient who underwent knee replacement surgery.

It is recommended that they start walking with a brace and crutches as soon as possible after the knee replacement surgery. Their knee will remain swollen for several months.

If they have 30 minutes to dedicate to their rehabilitation, is it better for them to spend it on lymphatic drainage or on walking (taking breaks if needed)?

Regular walking offers numerous advantages in terms of🚶🏻‍♂️:

Maintaining joint mobility🧘🏻;
Promoting circulation activation;
Preserving muscle strength 💪;
Engaging in cardiovascular exercise 🫀;
Regulating body weight ⚖️;
Being cost-effective and independent!

It is free, and often you won’t need anyone’s assistance 🆓.

Personally, as a professional, I consistently prefer to prioritize active approaches like walking over passive ones like lymphatic drainage.

2. Lymphatic drainage of the arms

Swelling in an arm can be related to a lymphatic problem or not. If that’s the case, it’s referred to as lymphedema of the upper limb.

The occurrence of lymphedema in the upper limb is typical after breast cancer surgery. It’s then called secondary lymphedema of the upper limb (in contrast to primary lymphedema, which is when there is a congenital abnormality of the lymphatic system).

Secondary lymphedema of the upper limb is the most common form of lymphedema.

Potential negative consequences of arm lymphedema

Potential negative consequences of arm lymphedema include:

• Aesthetic discomfort 🪞
• Functional impairment, meaning a reduced ability to use the arm in daily life due to its weight
• Shoulder pain due to the increased weight of the arm
• Development of erysipelas (or cellulitis), a bacterial infection of the skin 🦠. The skin is under constant tension due to the swelling, which tends to weaken it.

Management of arm lymphedema

Management of arm lymphedema involves:

• Implementing a specific system of compressive bandages
• Regular exercises for the upper limbs 🤸
• Regular and thorough skincare of the arm (to prevent the risk of erysipelas) 🚿
• Manual lymphatic drainage, usually performed before the application of bandages.

Does manual lymphatic drainage really provide added value compared to other measures? I address this point in a specific section on the benefits effectiveness of lymphatic drainage (later in the article).

3. Lymphatic drainage of the legs

If you have swelling in one or both legs, it is essential to determine the underlying cause of the problem. At a basic level, you should ask yourself:

• Is it a lymphatic problem? In other words, is the swelling a result of a failure in my lymphatic system?
• Is it a venous problem? Is my venous system compromised?

Being clear about these questions is crucial because the management approach differs depending on whether the underlying problem is lymphatic or venous.

In practice, I am frequently approached by people seeking lymphatic drainage for venous issues (usually in both legs). However, two issues arise in such cases:

1. The effectiveness of manual lymphatic drainage is uncertain for lymphatic edema, and even more so for venous edema (as seen in chronic venous insufficiency, for example).
2. The management of lymphatic edema is much more involved than simply performing occasional drainage (which, incidentally, takes about 30 to 45 minutes per limb):
   • It requires regularity.
   • It must be accompanied by a specific system of compressive bandages.
   • It should involve regular active engagement of the limb(s), with walking being a preferred activity for the legs.

That’s why it is important to think twice before embarking on this demanding and uncertain adventure. 🤔

4. Restless legs

Restless Legs Syndrome is a neurological condition characterized by an irresistible urge to move the legs. This condition can significantly disrupt the sleep of those who suffer from it. 🥱

To my knowledge, there are unfortunately no good reasons to believe that manual lymphatic drainage can be beneficial for this syndrome. At best, it may have a transient effect at the time of application and shortly afterward. However, it is unlikely that the effect would last long enough to improve the sleep quality of patients.

In 2022, the therapeutic approach for Restless Legs Syndrome is primarily pharmacological [1]. 💊

Among the non-pharmacological approaches mentioned in the medical literature [1] are:

• Avoiding psychoactive substances such as alcohol, tobacco, and caffeine 🍷🚬☕ >>> 🚮
• Engaging in moderate-level exercise 🚲
• Maintaining healthy sleep habits (e.g., regular bedtime and wake-up time) 😴
• Learning relaxation and meditation techniques that can be used during the night 🧘🏻
• Avoiding the pressure to sleep at all costs
• Engaging in motivational coaching or cognitive-behavioral therapy.

5. Varicose veins

Varicose veins are permanently enlarged and distorted veins. This condition results from hereditary factors and is associated with specific life situations such as pregnancy, obesity, menopause, and advancing age, among others.

In 2022, the curative approach for varicose veins is exclusively surgical [2].

To my knowledge, there is unfortunately no good reason to believe that lymphatic drainage can be useful for this condition.

6. Heavy legs

The sensation of heavy legs is a typical symptom of venous insufficiency, although it can also be associated with other diseases.

It is plausible that manual lymphatic drainage may provide short-term relief from the sensation of heavy legs. This may also be true for other massage techniques.

7. Venous insufficiency

Chronic venous insufficiency can lead to swelling (edema) in both legs. This condition is typically found in individuals who are:

• elderly,
• female,
• obese,
• pregnant,
• have a history of deep vein thrombosis,
• have experienced trauma to one or both legs,
• or have a family history of varicose veins.

Lymphatic drainage is not part of the modern management strategy for edema in venous insufficiency [3].

The current management approach for chronic venous insufficiency includes [3]:

• Wearing appropriate compression stockings
• Avoiding certain postures (e.g., crossing legs for prolonged periods)
• Regularly elevating the legs
• Modifying lifestyle habits, such as:
  • Considering quitting smoking 🚬 >>> 🚮
  • Increasing walking volume 🚶🏻‍♂️
  • Engaging in more physical activity
  • Considering weight loss ⚖️
• Regularly performing specific ankle movements to promote blood circulation even while sitting or lying down 🦶

Medication and surgical approaches may also be considered on a case-by-case basis.

In general, an active management approach is preferred over a passive one. This principle applies to the management of chronic pain as well. Massage or manual drainage falls under passive management approaches.

8. Lymphatic drainage and breast cancer

The aftermath of breast cancer surgery is the typical situation where the question of the usefulness of lymphatic drainage arises. Depending on the surgery performed, lymph nodes may be removed in the armpit region.

The removal of lymph nodes constitutes a genuine injury to the lymphatic system. This injury can disrupt local lymphatic circulation, resulting in lymphatic arm swelling (“lymphedema”).

In these circumstances, lymphatic drainage of the arms is part of the standard management approach. In this regard, I invite you to read the section of this article specifically dedicated to arm lymphatic drainage.

10. Lymphatic drainage of the hand 👋

The management of secondary lymphedema in the hand is similar to that of the arm. Therefore, I invite you to refer to the specific section of this article dedicated to arm lymphatic drainage.

11. Lymphatic drainage for post-traumatic edema

The question of lymphatic drainage for post-traumatic swelling (such as an ankle sprain) is similar to that of post-surgical swelling. That’s why I invite you to read the specific subsection of this article titled “Lymphatic Drainage in Postoperative Care.“

In the meantime, I’ll summarize the key points here:

• Post-traumatic swelling resolves on its own over time, regardless of any interventions.⏳
• There is no good reason to believe that manual lymphatic drainage accelerates the healing process.
• The time spent on receiving lymphatic drainage could be better utilized for other truly beneficial activities.

12. Lymphatic drainage and weight loss

The lymphatic system plays a role in maintaining fluid balance and removing waste from the body.

When it comes to weight loss, lymphatic drainage alone is unlikely to be a significant factor. While the technique may temporarily reduce localized swelling or bloating, it does not directly cause fat loss or lead to substantial and sustainable weight reduction.

Lymphatic drainage techniques may offer certain benefits related to water retention, relaxation, and overall well-being. But they are not a direct solution for weight loss.

To achieve sustainable weight loss, there is no choice but to have a diet that aligns with one’s physical activity and basal metabolism, along with lifestyle modifications!

What are the different methods of lymphatic drainage?

The method of manual lymphatic drainage was invented by Emil Vodder in the 1930s. It is based on the following general principles [4]:

• The person is in a lying position; 🛏️
• Ventilatory exercises are performed at the beginning of the session; 🫁
• During the session, the following are systematically performed:
  • Manual pumping of certain lymph nodes;
  • Application of a specific massage technique (slow, rhythmic, and relatively superficial).

Variations in the implementation of these general principles have led to variations in the original method, such as [4]:

• The Földi method;
• The Casley-Smith method;
• The Leduc method.

There are likely several other variations. (Some therapists appreciate being able to give their name to a technique or method 🐓.)

Regardless of the method or variation, an important question for patients is: Is it effective? Does it work? Whats are benefits?

Let’s explore that now.

What are benefits of lymphatic drainage massage?

Throughout this article, we have unfortunately seen no good reasons to believe that lymphatic drainage is effective for:

• Post-operative edema, such as after knee replacement surgery (excluding breast cancer surgery)
• Post-traumatic edema, for example, after an ankle sprain
• Venous edema
• Restless legs
• Varicose veins
• Pain related to diabetic neuropathy
• Edema related to chronic venous insufficiency

However, it is plausible that manual lymphatic drainage may provide short-term improvement in the sensation of heavy legs.

But what about the main condition for which manual lymphatic drainage is generally indicated? What about secondary lymphedema of the upper limb after breast cancer surgery?

Let’s examine the recent scientific literature on this subject. But before we do, let’s briefly discuss the stakes.

The 2015 Cochrane review on manual lymphatic drainage for lymphedema following breast cancer

Cochrane is a nonprofit international organization that aims to provide systematic reviews of healthcare treatments’ effectiveness 📚. In 2015, they conducted a review on manual lymphatic drainage for lymphedema following breast cancer treatment [5]. Here’s an excerpt from their conclusion:

Manual lymphatic drainage is safe and might provide additional benefit when used with compression bandaging to reduce swelling. However, this result needs to be confirmed with randomized data. Results were contradictory for function (range of motion) and inconclusive for quality of life.”

Cochrane

In other words, the results at that time were not particularly promising. Now let’s see what has been found since 2015.

Since 2015, at least two new studies [6,7] cast doubt on the usefulness of manual lymphatic drainage after breast cancer surgery.

The first study, published in 2018, concludes as follows:

Manual lymphatic drainage does not provide additional benefit in terms of volume reduction in patients with breast cancer.

The second study, published in 2021, concludes as follows:

The results of the study indicated that both therapeutic approaches were effective for patients with breast cancer-related lymphedema. However, no additional effect of manual lymphatic drainage was found regarding the percentage of arm volume reduction in the intensive treatment phase.

The treatment protocol was equally effective with and without manual lymphatic drainage. In other words, manual lymphatic drainage appears to have been ineffective.

Conclusion: no benefit of manual lymphatic drainage against lymphedema

As a reminder, the main aspects of post-surgery breast cancer lymphedema management include:

• Applying appropriate compression bandages
• Regularly performing exercises for the upper limbs 🤸
• Conducting regular and thorough skincare (to prevent the risk of infection) 🚿
• Manual lymphatic drainage

If we trust the results of the studies, manual lymphatic drainage may be unnecessary against lymphedema of the upper limb after breast cancer surgery. The good news is that everything else seems to be effective! 🎉

Can you perform lymphatic drainage on yourself?

Yes, it is possible to perform lymphatic drainage on yourself! The complexity may vary depending on the body part being treated, but it can be done.

There are numerous online resources available that explain how to perform self-lymphatic drainage.

Here are some of this videos.

• Self manual lymphatic drainage massage for arm swelling and lymphedema

• Self manual lymphatic drainage massage for leg swelling and lymphedema

• Self manual lymphatic massage for face

How to find a physiotherapist specialized in lymphatic drainage?

There is no directory that lists all physiotherapists using this technique.

Here are some tips to find a physical therapist in your area who offers this type of treatment:

• Search “physiotherapist lymphatic drainage” or “physical therapy lymphatic drainage” on Google Maps or your search engine, along with the name of your city. You may come across physiotherapists who mention lymphatic drainage on their website.
• Contact physiotherapists in your area individually by phone. It may be time-consuming, but it often yields the best results. If you leave a voicemail and don’t receive a callback, you can try calling at different times.
• If you’re looking for a physiotherapist for lymphatic drainage after breast cancer, ask the healthcare service that treated your cancer. They usually have a list of physiotherapists offering this treatment.

Lymphatic drainage is not strictly a specialty in physiotherapy. Physiotherapists receive training in manual lymphatic drainage as part of their initial education.

***

Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like:

• Revitive Medic Review

 📚 SOURCES

[1] Vlasie, A., Trifu, S.C., Lupuleac, C., Kohn, B., & Cristea, M.B. (2022). Restless legs syndrome: An overview of pathophysiology, comorbidities and therapeutic approaches (Review). Experimental and Therapeutic Medicine, 23, 185.

[2] Ricardo de Ávila Oliveira, Andréa Castro Porto Mazzucca, Daniela Vianna Pachito, Rachel Riera, José Carlos da Costa Baptista-Silva (2018) Evidence for varicose vein treatment: an overview of systematic reviews. Sao Paulo Medical Journal 136 (04).

[3] Berti-Hearn, Linda MSN, RN, CWOCN; Elliott, Brenda PhD, RN, CNE Chronic venous insufficiency, Nursing: December 2019 – Volume 49 – Issue 12 – p 24-30.

[4] https://www.physio-pedia.com/Manual_Lymphatic_Drainage

[5] Ezzo, J., Manheimer, E., McNeely, M. L., Howell, D. M., Weiss, R., Johansson, K. I., Bao, T., Bily, L., Tuppo, C. M., Williams, A. F., & Karadibak, D. (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. The Cochrane database of systematic reviews, (5), CD003475.

[6] Tambour, M., Holt, M., Speyer, A. et al. Manual lymphatic drainage adds no further volume reduction to Complete Decongestive Therapy on breast cancer-related lymphoedema: a multicentre, randomised, single-blind trial. Br J Cancer 119, 1215–1222 (2018).

[7] Sen, E. I., Arman, S., Zure, M., Yavuz, H., Sindel, D., & Oral, A. (2021). Manual Lymphatic Drainage May Not Have an Additional Effect on the Intensive Phase of Breast Cancer-Related Lymphedema: A Randomized Controlled Trial. Lymphatic research and biology, 19(2), 141–150.