LYMPHATIC DRAINAGE
MASSAGE
Within us all there is
a silent system working to keep us healthy- the lymph system. Without it our
bodies would swell up like balloons, swamping our cells with stagnant fluid.
The lymph system's impact is so far reaching that many don't even realize that
minor aches and pains, low energy or susceptibility to colds and flu may be due
to a sluggish lymph system and a compromised immune system. In this article
we’ll discuss the anatomy of the lymph system, what happens during edema and
how lymph drainage massage can help, as well as contraindications to lymphatic
massage.
LYMPH
VESSELS:
Lymph vessels make an intimate meshwork that covers every inch of your skin, and surrounds each organ in great detail. The lymph vessels start very small in what are called the initial lymphatic. Over 70% of the initial lymphatics are in and just under the skin. The initial lymphatic is a very delicate structure, one cell thick. Those cells are supported within the connective tissue by collagen and elastin fibers that help to anchor them in place. When the pressure within the interstitial space increases due to a buildup of fluid, or when the skin is slightly stretched, the filaments deform the wall of the initial lymphatic, opening it up. Then the interstitial fluid flows in and starts to move along the channel. At this point we start calling it lymph. Although only 2-3 liters of lymph is filtered through the lymph system per day, it is vital because it helps to remove proteins that that are too large to get back through the capillary wall. (Guyton and Hall, Human Physiology and Mechanisms of Disease, 6th edition, W.B Saunders Company, Philadelphia, 1997, page 139) The spaces that open in the initial lymphatic are 4 to 6 times bigger than the spaces in the capillaries. Removal of protein is essential because they draw water to themselves, so excess protein in the interstitial spaces causes swelling or edema. The lymph vessels also collect dead cells, waste products, bacteria, viruses, inorganic substances, water and fats.
Lymph vessels make an intimate meshwork that covers every inch of your skin, and surrounds each organ in great detail. The lymph vessels start very small in what are called the initial lymphatic. Over 70% of the initial lymphatics are in and just under the skin. The initial lymphatic is a very delicate structure, one cell thick. Those cells are supported within the connective tissue by collagen and elastin fibers that help to anchor them in place. When the pressure within the interstitial space increases due to a buildup of fluid, or when the skin is slightly stretched, the filaments deform the wall of the initial lymphatic, opening it up. Then the interstitial fluid flows in and starts to move along the channel. At this point we start calling it lymph. Although only 2-3 liters of lymph is filtered through the lymph system per day, it is vital because it helps to remove proteins that that are too large to get back through the capillary wall. (Guyton and Hall, Human Physiology and Mechanisms of Disease, 6th edition, W.B Saunders Company, Philadelphia, 1997, page 139) The spaces that open in the initial lymphatic are 4 to 6 times bigger than the spaces in the capillaries. Removal of protein is essential because they draw water to themselves, so excess protein in the interstitial spaces causes swelling or edema. The lymph vessels also collect dead cells, waste products, bacteria, viruses, inorganic substances, water and fats.
By performing
lymphatic drainage massage correctly, we can stimulate the opening of the
initial lymphatic and increase the volume of lymph flow by as much as 20 times.
But if we push too hard, we collapse the initial lymphatic, diminishing the
lymph flow. Excessive pressure can even break the filaments that hold the
initial lymphatic in place. This is one reason that deep styles of massage are
contraindicated in areas of edema. Luckily if deep pressure has broken any
filaments, they usually reform within 24 hours.
After the lymph has
entered the initial lymphatic, the lymph moves into a larger vessel called the
pre-collector, and then into even larger vessels called the collectors. The
collectors are 100-600 microns in diameter. These vessels have one way valves
every 6- 20 mm that only allow the lymph to move in one direction. When you’re
performing lymphatic drainage massage, you never have to worry that you are
damaging your clients by pushing the lymph in the wrong direction- because it literally
can’t flow backwards. Pushing in the wrong direction won’t be very effective,
but it won’t hurt your client unless you are using deep pressure- and in that
case, you are not doing lymphatic drainage massage.
From one one-way-valve
to the next is called a lymphangion. The lymphangions have a layer of smooth
muscle that spirals around them. Angion means heart- so this is really the pump
that pushes the lymph. Each lymphangion has an internal stretch sensor. The
walls of the lymphangion stretch when they fill up with lymph, and then the
stretch sensor tells the muscle to contract. This spiraling muscle contracts
squeezing the lymph into the next chamber. This swells the next lymphangion,
which then contracts, pushing the fluid down the line. At the same time the
lymphangion is pushing the lymph forward, it also is creating a vacuum behind
it. It is partly because of this vacuum effect that the lymph gets pulled into
the initial lymphatic in the first place. (Kasseroller, R., Compendium of Dr.
Vodder's Manual Lymph Drainage, Haug, Heidelberg, 1998)
Once the lymphangions
begin contracting, they cause a chain reaction, or a wave of contractions that
start to push and pull the lymph through the body. In this way stimulating
lymph flow in one area can increase lymph flow in another. Other factors that
can assist the movement of the lymph are skeletal muscle contractions,
breathing, the pulsing of arteries, as well the ability of the angions to
contract independently of the stretch receptors. Lymphatic Drainage Massage’s
effectiveness lies in its ability to activate the stretch response, which
significantly increases the pulsation rate of the lymphangions, increasing
lymph flow through the vessels.
LYMPH
NODES:
Eventually, all lymph vessels lead to lymph nodes. Lymph nodes can be as small as the head of a pin, or as big as an olive. There are 400-700 lymph nodes in the body, half of which are located in the abdomen, and many are in the neck.
Eventually, all lymph vessels lead to lymph nodes. Lymph nodes can be as small as the head of a pin, or as big as an olive. There are 400-700 lymph nodes in the body, half of which are located in the abdomen, and many are in the neck.
The primary function
of lymph nodes is to filter and purify the lymph. The lymph nodes produce
various types of lymphocytes. Lymphocytes destroy harmful substances within the
body, and are a big part of the immune system. The lymph nodes reabsorb about
40% of the liquid content of the lymph. This makes the lymph much thicker.
Because of this thickening and the filtering process, the lymph nodes offer the
greatest resistance to the flow of lymph. In fact the lymph nodes offer about
15 times more resistance than the vessels themselves. Lymphatic drainage can
help overcome this resistance and get the lymph flowing.
EDEMA:
Each cell is nourished by the nutrients, oxygen and proteins that flow across the walls of capillaries into the interstitial fluid. There is a dynamic balance between the forces that help those nutrients to first exit the capillaries, and then get reabsorbed back into the blood stream. Proteins play a big part in this transfer because they have a tendency to draw water to themselves. This means that the proper amounts of protein on both sides of the capillary wall are vital to keep the tissues balanced. If there are too many proteins within the interstitial spaces, fluid will start to accumulate, causing edema. The lymph system’s role of removing proteins is vital to keeping edema down. If the lymph system becomes sluggish, or is damaged by surgical removal of lymph nodes, edema can develop. This type of edema is called lymphostatic edema- or a high protein edema. Lymphatic drainage can be helpful in reducing this type of edema because the cause is a reduced functioning of the lymph system.
Each cell is nourished by the nutrients, oxygen and proteins that flow across the walls of capillaries into the interstitial fluid. There is a dynamic balance between the forces that help those nutrients to first exit the capillaries, and then get reabsorbed back into the blood stream. Proteins play a big part in this transfer because they have a tendency to draw water to themselves. This means that the proper amounts of protein on both sides of the capillary wall are vital to keep the tissues balanced. If there are too many proteins within the interstitial spaces, fluid will start to accumulate, causing edema. The lymph system’s role of removing proteins is vital to keeping edema down. If the lymph system becomes sluggish, or is damaged by surgical removal of lymph nodes, edema can develop. This type of edema is called lymphostatic edema- or a high protein edema. Lymphatic drainage can be helpful in reducing this type of edema because the cause is a reduced functioning of the lymph system.
Other causes of edema
can be a chemical imbalance in the body caused by liver disease, diabetes, or a
variety of other ailments. This type of edema is called lymphodynamic edema,
and requires other forms of therapy due to the fact that it is a chemical
imbalance. (Kasseroller, R., Compendium of Dr. Vodder's Manual Lymph Drainage,
Haug, Heidelberg, 1998)
INDICATIONS:
Lymphatic drainage massage is a profound technique to help increase lymph flow. With an increase of lymph flow immune function is increased. Harmful substances are removed from the tissues and neutralized in the nodes. It has also been shown that an increase in lymph flow stimulates an increased production of lymphocytes- enhancing immune function.
Lymphatic drainage massage is a profound technique to help increase lymph flow. With an increase of lymph flow immune function is increased. Harmful substances are removed from the tissues and neutralized in the nodes. It has also been shown that an increase in lymph flow stimulates an increased production of lymphocytes- enhancing immune function.
Patients that have extreme
amounts of edema should work with a group of healthcare practitioner trained in
lymph drainage, bandaging and other modalities. However, with a proper
understanding of contraindications and some basic training, massage therapists
can enhance the health of their clients and reduce minor cases of edema.
Lymphatic drainage in
this arena can be applied to clients who are suffering from a lack of energy,
or a sluggish immune system.
Lymphatic drainage
massage is also useful when working with clients who have sports injuries.
After the initial inflammatory stage has passed, lymphatic work can be applied
after Sports or Neuromuscular massage has been completed. This will help to
clear the tissue of debris, and help to reduce the minor edema that sometimes occurs
after deep massage. Continued applications of lymphatic drainage while the
client is healing can help to enhance the tissue regeneration process by keep
the tissue as healthy as possible.
Not only is lymphatic
drainage useful for sports injuries, but it can also help scars. (Godart, S.,
"Lymphatic regeneration after second degree burn," Progress in
Lymphology, 1975/ Hutzshenreuter, P.O. and Brummer, H., "Manual Lymph
Drainage used for Scar Healing," University of Ulm). Lymph work has been
shown to help the scarring process by enhancing circulation and immunity. As
the lymph flow around the scar is increased, lymph vessels that have been
damaged are stimulated to heal, and the increased lymph flow also draws away
toxins, improving the health of the tissues.
When attempting to
assist healthy scar formation, it is important not to push the lymph into the
scar, which can cause the formation of keloids (a buildup of collagen fibers).
All scar work should be done without deforming a newly forming scar- so as to
not rip the tissue. One way is to work above the scar (closer to the node that
drains the area). For example, a lymph therapist could work in the axilla and
upper arm to help increase the lymph flow around a scar in the forearm.
Beyond its application
for injuries, Estheticians have been using lymph drainage massage for years to
enhance the quality of the skin, especially on the face. When the lymph is
flowing, the cells are being bathed in fresh fluid, causing the skin to look
fresh and alive. We have all experienced having minor edema in our faces- that
puffy feeling and baggy eyes when we first wake in the morning after a long
night. Usually after a few minutes of being vertical the lymph system starts to
drain the face. A great way to see the power of lymph drainage is to apply a
few strokes on one of those mornings, and watch in just a few minutes the
tissues drain right before your eyes- leaving you looking vibrant and healthy.
Another common use for
lymph drainage massage is with women who have had breast cancer and had some
axillary lymph nodes removed. Sometimes these people develop edema in their
arm. If there is a great deal of swelling, then this is out of the scope of
practice for a most massage therapists due to the need for bandaging. If the swelling
is minor however, then a fully trained lymphatic drainage therapist working in
conjunction with medical supervision can do a great amount of good.
CONTRAINDICATIONS:
For the most part lymphatic drainage massage is safe. With such a light touch, the danger of causing damage to the tissue is slim. However, there are a few conditions that are contraindicated, and these happen when an increase of lymph flow would be detrimental. It is a good idea to get clearance from their doctor if you ever feel uncertain about working on someone. Acute inflammation, Malignant tumors, Thrombosis and major heart problems are all contraindications to lymphatic drainage massage. Lets look at these one at a time.
For the most part lymphatic drainage massage is safe. With such a light touch, the danger of causing damage to the tissue is slim. However, there are a few conditions that are contraindicated, and these happen when an increase of lymph flow would be detrimental. It is a good idea to get clearance from their doctor if you ever feel uncertain about working on someone. Acute inflammation, Malignant tumors, Thrombosis and major heart problems are all contraindications to lymphatic drainage massage. Lets look at these one at a time.
Acute inflammation
caused by bacteria, viruses, poisons or allergens is contraindicated. You can
tell if this is the case because the tissues will be hot, red and painful, with
congestion accompanied by fever. Lymphatic drainage massage will push these
substances into the lymph channels before the body has a chance to eliminate
them through phagocytosis in the interstitial spaces. If you perform lymphatic
drainage you can spread the toxic substances throughout the body. Wait a few
days until the condition is not acute, and the body has had a chance to clean
up the area.
Malignant tumors are a
contraindication for lymphatic drainage massage because of the fear of
spreading the cancer. Wait until after the malignancy is treated to perform
lymphatic drainage massage.
Thrombosis and
phlebitis are two conditions that can lead to free floating blood clots.
Usually people with these conditions will be in a hospital on blood thinners.
If you are working in a hospital setting, do not work on these patients. In
your practice, one indication of a possible femoral thrombosis is when the
client has pain in one leg and a sudden swelling and bluish discoloration of
the skin. People who are bedridden have a greater likelihood of developing
thrombosis in the legs.
Major heart problems.
If the heart is not fully functioning the edema can be lymphodynamic, due to
lack of venous return. Putting more fluid into the heart would only stress it
more, worsening the condition.
After reading the
contraindications for a modality, many therapists experience fear of working on
anyone. The most appropriate response to this list is to add it to your client
intake questionnaire. It should also make you take pause to reflect on the
power of this type of work- to do harm as well as good.
Lymphatic drainage
massage is a great ally in any massage therapist's tool kit. By being able to
address the lymph system directly, client's immune system function can be
significantly increased. When we have a strong immune system, we are happy,
balanced and whole. Lymphatic drainage massage can go where Deep Tissue and Swedish
cannot- into swollen areas. The paradox is that such a superficial technique
has such a deep impact.
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