Lymphatic Drainage

Manual Lymphatic Drainage

Barbara G. White, LMT, MTI, BCTMB, CLT is a Certified Manual Lymphatic Drainage (MLD) and Complete Decongestive Therapist (CDT). I have been practicing Lymphatic drainage since 1999 and teaching since 2004. Training includes both Vodder and Chickly techniques.

“Healing is a Process, not an Event!”

  • 30 minute session $45

  • 60 minute session $80

  • 90 minute session $115

  • 120 minute session $155

  • Ultrasound/Cavitation added to any service is $15
  • Lymphatic K-Tapping for skin retraction or for increased lymphatic flow and fluid reduction is $20 fee added to service
  • K-Tapping30 min stand-alone service for $65.

Manual Lymphatic Drainage (MLD) may be recommended in a variety of situations including full body detoxification and immune system boost, post-surgical swelling and scar tissue reduction. MLD speeds recovery time for overall health and injury recovery. Cancer and post-cancer treatment plans frequently include MLD and Complete Decongestive Therapy in recovery from lymph node dissection, radiation and chemotherapy. Mastectomy and other supporting medical interventions is the most common cause of lymphedema in the United States. Axillary Web Syndrome or “cording” occurs in a segment of this population. Complete Decongestive Therapy (CDT) is frequently needed. Other forms of cancer have similar effects. Please visit with your therapist regarding treatment options.

What is lymphadema?Lymphedema [lim-fa-dee-mah] is a chronic condition where a protein rich fluid called lymph or lymphatic fluid collects in the tissues just below the skin causing swelling. Your lymphatic system runs throughout your body and is like a plumbing system for your lymph fluid.

When this system does not work properly, whether it was poorly developed from birth, or damaged from surgery, radiation, or a trauma, your body cannot effectively transport lymph fluid. When transport is interrupted and lymph fluid cannot drain properly, it causes swelling where the drainage is disrupted. This swelling can be in any part of the body, most often in the arms and legs, but also the breast or chest wall, abdomen, head and neck, or genitals.

When the fluid remains stagnant in the tissue, the body recognizes this excess protein as “foreign” and wants to “wall off” this area to protect it. This can cause a state of inflammation, which then causes fibrosis (scar tissue). That fibrosis can feel hard and tight, and makes it more difficult for the fluid to move out of the area. It also puts patients at higher risk of wounds healing slowly and infections called cellulitis or lymphangitis.

Lymphedema may present following the above listed treatments or any other injury to the lymphatic system. Lymphedema may also be present as a result of untreated or advanced stage CVI or congenital malformation of the lymphatic system. MLD and CDT may be used to remove the swelling and maintain the reduction. Compressive garments and home exercises are needed in conjunction with MLD and as always, staying in compliance is key. Please keep your physician in the loop with any treatment plan you are pursuing.

What is the lymphatic System?

The lymphatic system is a part of the circulatory system. Most people are aware of their cardiovascular system but less commonly aware that the cardiovascular system is only a part of their overall circulatory system.

The Cardiovascular system, with the help of red blood cells (RBC), carries and distributes nutrients, oxygen, neurotransmitters, chemicals and hormones to distal parts of the body through arteries and arterioles. The RBCs and their cargo are dropped off in the tissues for cell use.

The target cells use these substances and create waste products in return. The Capillaries pick up these RBCs and wastes and carries them in veins to filter the blood through the kidneys and liver before returning to the heart and lungs to do it all over again.

The Lymphatics are a series of veins that run from distal parts of the body toward the heart but don’t have a set of arteries leaving the heart. It is a one-way system. The Lymphatic system houses a high concentration of white blood cells and T-cells that are responsible for our immune response. When wastes such as large proteins, fat cells and pathogens are unable to move back into the smaller capillaries of the cardiovascular system the lymphatic system picks them up and moves them through progressively larger lymphatic vessels to lymph nodes. The human body has between 700-1000 lymph nodes depending on the person. The lymph nodes are the functional part of the lymphatic system where the wastes are churned up inside the nodes and attacked with the WBCs. Phagocytosis (cell eating) takes place and the large wastes products and pathogens are disarmed and crushed up before being returned to the blood stream for disposal.

The veins pick up 80-90% of the fluids that leak from the arteries and there in only a percentage of the cellular waste products from the area. Imagine a bath tub with a drain that will pass 90 gallons in a day and a faucet that lets in 100 gallons in a day. Without an over flow drain, that tub will spill over onto the floor by the end of the day. The spill over of fluids in our hands or feet is exactly like that bath tub. Edemas can form anywhere in the body but are most common in the limbs.

In addition to edemas, cancers form where cells are forced to mutate to survive in toxic environments. Remember, our cells are eating and excreting in the same pool of fluids. Too many toxins surrounding a cell prevent nutrients from moving in and toxins from moving out. Cells reprogram and mutate to survive. Our bodies are designed to fight off these cancer cells but sometimes lose that fight.

With less emphasis on life threatening pathologies, the most common illnesses that we face daily are also combated by the lymphatic system. Opportunistic pathogens can over grow in our bodies if our immune systems are unable to mount an appropriate defense. The outcome could be the common cold, yeast infections, sinus infections, urinary tract infections, infectious skin infections, staph infections and more. The list is endless.

The lymphatic system has the task of picking up the left over 10 – 20% of fluids preventing edemas and illness. If 10 – 20% doesn’t sound like much, know that a cup of coffee is only 4% coffee and 96% water. There’s a big difference between a cup of coffee and a glass of water. In fact, without our lymphatic system, we wouldn’t survive more than 2-3 days.

Since the Lymphatic system is only a one-way system moving toward the heart, it doesn’t have the muscular contractions of the heart to propel the fluids and wastes forward. It relies on the rhythmic pressures created from body movement. 70% of the lymphatics are superficial and moveable through manual lymphatic drainage techniques. 30% of the body’s lymphatics are deep and only moveable through kinesthetic movements of the body. If the lymphatic system is overloaded or sluggish from a lack of movement (as common in bed ridden patients) the body’s ability to fight off these common pathogens is reduced.

FAQ’s

What is Manual Lymphatic Drainage (MLD)?

Manual Lymphatic Drainage (MLD) techniques closely mimic the body’s natural rhythms. The lymphangions (lymphatic vessels) are anchored to the body’s soft tissues. The body’s movements pull on these anchoring filaments opening the lyphangions to suck in fluids from their environment. Once in th show more e lymphatic vessels, the system can do it’s job. The light touch and rhythmic movements of Manual Lymphatic Drainage pull the skin and associated anchoring filaments to increase the fluids moved into the vessels.

The ordering of MLD stokes is as important as the quality in the technique touch. It is a very specialized hand technique beginning at the clavicle where the lymph moves into the cardiovascular system and the moving to the more distal chains. Lymph nodes are located all over the body but most concentrated in the neck and behind the ears (cervical nodes), under the chin (sub-mandibular), under the arms (axillary), deep in the abdomen and at the inguinal region where the legs meet the trunk.

Who needs MLD?

MLD is safe and indicated for most people with a few notable exceptions. For the most part, if you are frequently ill or just sluggish, MLD can help overcome this burden if the primary cause is an overtaxed lymphatic system. Minor edemas can be helped with basic lymphatic techniques. More extreme ed show more emas need specialized care and additional training. Check with your MLD care provider for credentials and training levels if you are post-cancer, post-surgical or lymphodemas are present. Lymphatic Drainage is a specialty service and requires specialized training. Many therapists attempt to pass themselves off as qualified after an online class or a simplified weekend class. Certification is a bigger critter and requires a minimum of 135 hours of consecutive study and multiple exams, written, verbal and practical. Without proper training even well intentioned therapists can unknowingly cause harm. Please ask and be aware of credentials.

The bigger question is who doesn’t need MLD. Your practitioner should screen your health history (if he/she doesn’t, look for another practitioner). Do not receive Lymphatic Drainage if you are currently running a fever over 100°F. Cardiovascular and Kidney disorders are high on the list of concerns because MLD increases the flow of fluids 30-60 times normal movement if properly applied. Also, anyone who has or recently has had an active cancer needs to be considered carefully before treatment. This doesn’t mean that MLD cannot be preformed on this population, but rather special considerations need to be weighed including a recommendation from their treating physician. The same pathology in different people produces different responses and carries a variety of different secondary disorders.

How should I prepare?

Eat light and healthy for a few days before and after a lymphatic drainage session. Drinking plenty of water and limiting waste and fatty intake will help your body to heal itself. You will be less likely to feel ill due to a healing crisis if you treat your body with respect as a matter of habit bu show more t especially when you are knowingly going in for a detoxification style treatment.

What should I wear?

Dress comfortably for your session. You will be asked to disrobe and lay face up under a sheet. You will be covered at all times so your warmth and modesty will not be compromised. No lotions or oils are used during this session so stickiness during redressing after the session is not a concern. show more

What should I expect from a MLD session?

MLD is not a massage but it is very relaxing. The touch is extremely gentle and rhythmic so most clients fall asleep during the session. We recommend no conversation or questions limited to the treatment only if necessary. Questions can be asked in advance but feel free to ask your question at any p show more oint during the session. The quiet time enhances relaxation and healing but your knowledge in the process also offers a necessary comfort. Your therapist will begin with an gentle cervical pull and Myofascial compression over the sternum while she/he asks you to take a few cleansing breaths. Once you’ve begun to relax your practitioner will begin rhythmic movements behind your clavicle and then up your neck. This stroke will not glide over the skin but rather move the superficial layers a short distance under her/his hands. This begins the movement of lymph. This process will cover the full front side of the body and occasionally parts of the posterior torso depending on the goals of the session.

I’ve heard I might get sick from a MLD session, is this true?

If your system is highly toxic or you are fighting a rather nasty batch of pathogens, it is possible for you to feel ill following a lymphatic drainage session or possibly during the session. This process is known as a healing crisis. The healing crisis response does not happen often but don’t be show more alarmed if it happens to you. You have not been injured. It is your body’s natural and necessary response to the pathogens that were laying wait in your body. MLD speeds up lymphatic re-absorption and makes your body process higher concentrations of pathogens more rapidly. The good news is that it will pass more quickly as well, frequently in a matter of hours. Resist treating the symptoms with fever reducers or other medications unless necessary. Your body burns a fever to increase acidity of the system to kill pathogens. Bringing the fever down or suppressing the mucus doesn’t make the cause of the fever or mucus go away, rather it drives it back into your system. Be patient and let your immune system do its job. You will be healthier for it. Use your best judgment. If the symptoms are extreme or do not subside in a reasonable manner you may want to see a health care physician as more deeply rooted problems may be present. Also be aware that your body may be more ill than you are aware.

Less common but also possible, emotional injury or illnesses can surface during a healing crisis as well. Emotions need to be recognized, honored and allowed to run a natural course as they can be just as responsible for disease as more commonly recognized pathogens. Wellness is much more than just the absence of physical disease. Health involves the union of body, mind and spirit. If you display an emotional trauma as a part of lymphatic drainage we also recommend Myofascial Release as an adjunct therapy.

Now that I’ve told you about the feel bad stuff, let me comfort you by saying that you should feel better than you have in a long time following your first lymphatic session and even better with subsequent sessions. Typically you will experience a greater level of energy and endurance and a clear sense of self being.

How often should I get Lymphatic drainage?

Lymphatic Drainage is most productive in a series of treatment, usually 3 sessions for detoxification. A session usually lasts between 45 – 60 minutes. The first session begins the movement and is much like a squeegee pushing mud slug down a drain. The second session picks up show more the remaining debris after the initial draining has occurred and should follow the initial session within 3 days. Three or four days later another session should be received to make sure the new momentum is maintained. Occasionally the practitioner may find that additional sessions are necessary or that after the first or second session there is no need to return immediately. Once you have completed the first series of sessions you should return to maintain as you feel necessary. If you wait until you feel positively horrible before you return you’ll have to start all over again. It is easier to maintain health than it is to regain it. If you are receiving MLD for Lymphedema or post-surgical healing more frequent sessions may be needed. Complete Decongestive Therapy in the case of Lymphedema requires a minimum of 3 times per week for several weeks depending upon which limb or trunkal region is involved and which stage of lymphedema you are presenting. This will require evaluation by your therapist. Expect 3 weeks of therapy, compressive bandaging, exercises and home compliance for effective results. Lymphedema is a life long condition and must be treated and maintained to avoid greater complications down the road. Typically compression garments are required life long for maintenance.

Post-surgical MLD usually requires 2-3 times per week in the beginning and tappers off as the body begins to heal. It is not uncommon for the surgeon to recommend 5 times a week. The more frequent the sessions, the faster healing occurs. Each person heals differently. Standard medical recommendations are 10-15 sessions beginning the day after surgery or 2 weeks post-op depending on the doctor and the surgical procedure(s). My experience shows that need to vary from 5 to 30 depending on each individual case and the extent of surgical procedure. Complications from surgery also alters these numbers. Everyone heals at a different pace. Compression garments play an important role in recovery and are commonly required by the surgeon. Compliance with your doctors orders are a must including our lymphatic sessions. It is Important to note that many untrained or improperly trained therapists may attempt to “rub” the tissues or “squish out” the fluid. These techniques are dangerous for the tissues that are trying to heal. Your lymphatics are very superficial and more than a VERY light touch will compress the vessels and they begin to spasm much like the heart when it goes into fibrillation. When this happens, the vessels can no longer move fluid out. In fact, the damage caused to delicate tissues that are trying to heal causes increased inflammation and the extra fluid brings with it high protein content and fibrosis begins to set in; that’s scar tissue and lumps and skin “glued” to the tissues below. If your therapist insists on this method or attempts to reopen drain holes or needle aspirate, you should know that unless they are a nurse or doctor, this is out of scope of practice and dangerous to your body and healing process. Frequently you’ll hear these methods referred to as Brazilian or Colombian methods. They damage tissues. Be aware and if you do chose these styles of therapy keep an eye on our results. You may change your therapy style at any point if you feel it is necessary. Be in control of your own health, it’s your body.

Other Common recommendations:

Drink plenty of water (your body weight divided in half is normal recommended water intake). Reducing water will not reduce swelling. Infact it keeps your body from flushing out the swelling and increases risks of lumpy fibrosis and increases discomfort following surgery.

Many Surgeons recommend drinking 100% Pineapple Juice. Bromelain is naturally found in Pineapples and is great in speeding recovery and reducing swelling. The one downfall is that pineapple juice is high in fructose (sugar). If you are diabetic or borderline this could cause a blood sugar issue. Bromelain Capsules are available to avoid that issue as well as for convenience. Be sure you are visiting with you physician to make the best decisions for you.

Before you have your cosmetic surgery, consider asking your surgeon about the “cell saver”. A great amount of blood is lost during surgery and the cell saver cleanses and recycles your own blood limiting those losses. Sometimes this is required if your hemoglobin count is borderline or low but even if it isn’t, my experience has been that my patients that use the cell saver recover faster.

Flying…So many of us fly to meet the perfect surgeon. This is not necessarily wrong but there is a consideration to make that most people don’t think about until it’s already done. When you fly, the atmospheric pressure changes on our body change and suddenly the damaged tissues that are already swelling pop like a can of biscuits. This slows your recovery and increases your pain for the first 2-4 weeks. It’s not a deal changer but it is a consideration you should be aware of in advance.

Remember that healing is a process not an event. You begin peeling the layers of dysfunction away like the layers of an onion. Be committed to health and a clear simple path. Healing doesn’t always feel good but health does once you’ve arrived.