Every week, I have new patients for lymphatic drainage, and the reasons they come are many & varied. It’s worth taking a moment to lay out when are the best times to seek it, and when it’s probably not.
First, I’ll briefly describe what the lymphatic system is, and what it does. That should give you some idea of the kinds of things lymphatic drainage massage can help. Then, I’ll describe some of the best reasons, then some of the ‘maybes’, and finally some of the ‘yeah…. nah’s.
What is the lymphatic system
I love talking about the lymphatic system because it’s kind of an un-sung hero system of the body. It does a bunch of awesome stuff for us, yet hardly anyone knows what it is. We all kinda know about the blood system, and the nervous system, but not many of us know about the lymphatic system.
Let’s change that, shall we?
Heads-up: to really get a good understanding, we have to get into quite an amount of detail. The lymphatic system can affect, and is affected by, a wide range of things, which means we have a lot of ground to cover for it all to make sense.
Stay with me, now! I promise I’ll make it easy to understand.
Let’s do this.
In this VERY simplified picture, we see that the lymphatic system is made up of vessels and nodes. The vessels are similar in structure to your blood vessels, because they are also for transporting fluid. The nodes have special immune system functions that we’ll get to shortly.
The nodes are collected in areas where there is a lot of movement: the armpits, the groin, behind the knees, etc. There are also a bunch of them around the head and neck.
The largest proportion of lymphatic structures, though—about 70%—are around your intestines. This is because they serve both a digestive function (which we’ll also get to), as well as an immune function.
This immune function makes more sense when we consider that a huge amount of lymphatic structures are located in places where there is a thinner barrier between the inside of the body and the outside world: the mucous membranes of the face, eyes, and throat, and the stomach and gut, which receive the food and drink that comes from the outside world and is, unavoidably, covered in numerous fungi, bacteria, and particles of dust & dirt. Never fear, though, for a well-functioning lymphatic & immune system are very well adapted, and more than capable, of dealing with it all! And that is precisely because of the lymphatic system and its parts. 😉
So: we have an immune function, a digestive function, and a fluid-transport function.
Fluid balance
In extreme conditions, poor lymphatic drainage can look like this:
The fluid inside the lymphatic system has originally come from the blood. For whatever reason, the science nerds have decided to call the fluid different things depending on where it is located at the time. Confusing, but whatever.
In the blood, it’s called ‘plasma.’ It’s that clear, yellow fluid you sometimes see around some wounds, and its role is to suspend everything else in your blood – the blood cells, and all the nutrients, waste products, immune cells, etc.
When the blood reaches the capillaries (the smallest blood vessels), it travels out of the blood vessels into the spaces between the cells. Here, it is called ‘interstitial fluid’ (try saying that three times fast). It carries the nutrients with it, and then the cells can take up what they need, do their processing, and spit out what they don’t need any more into that space between the cells and blood vessels. Some of that fluid then gets back up by the veins and back into the blood system.
However, a majority of it (roughly 60%-plus) doesn’t go back into your blood system. This is where the lymphatic system comes in. It takes up the rest of that fluid, and when the fluid enters the lymphatic vessels, it is then called ‘lymph.’
This means that if your body contains 8 liters of blood, the lymphatic system will move around about 4 and a half to five liters of that fluid on a regular basis. So, you can imagine that if something is wrong, a lot of fluid goes nowhere, and hangs around in that space between the cells. This is where the puffiness and swelling associated with lymphatic dysfunction comes from. This swelling or puffiness is called lymphoedema or, simple, oedema.
The fluid then travels up through the lymphatics, through multiple nodes, into larger and larger vessels, until it reaches two portal ducts in the large veins just under your collarbones. There, it re-enters the blood system, and it all starts again.
If it can’t do that very well, you get pooling of fluid (lymphoedema) in the affected areas.
The Immune Connection
Your lymph nodes and lymphoid tissues are like army barracks for your powerful defense forces. They are PACKED with amazing cells with badass names like Natural Killer cells (NK cells), B-cells (memory cells that remember the things that have tried – and failed – to attack you before), macrophages (which literally eat invaders and then digest them with concentrated bleach) and T-cells (which get activated by B cells to take out invading organisms). Anything that tries to come through the nodes that doesn’t identify itself as a part of you is in big, big trouble.
Your tonsils are part of your lymphatic system, too. They try to catch anything coming through your mouth. Then, all along your intestines, areas called Peyer’s patches, which are kind of like tonsils in your guts, seek and destroy anything in your food before it can get through your gut lining and into your bloodstream. You have some amazing defenses, and your lymphatic system is a big part of this.
Digestive Role
The huge amount of lymphatics around your intestines also serve the purpose of absorbing and transporting ALL of the dietary fats you eat, from the healthiest to the least healthy ones. This is because fat doesn’t dissolve in water, so if it went straight into the bloodstream, it would separate and get all gunked-up. As it travels through the lymphatic system, it gets packaged up into packets that will dissolve in blood, so that by the time it gets to the portal veins and re-enters the bloodstream, it can be easily transported to the liver for metabolism.
What does this mean?
If your lymphatic system is moving more slowly than optimal, any or all of those three functions (digestive, immune, fluid balance) could be impacted. It could be a local problem where a small part of your body is affected, or it could be systemic, where the whole body is affected.
How does manual lymphatic drainage massage help?
To answer this, we need to understand how your lymph would normally move, and why it might not be moving as well as it should.
There are two main ways that lymph moves normally, known as the muscle pump and the breath pump. Keep in mind, the lymphatic vessels have valves in them that stop the fluid from going backwards. It can only move forwards, or stop.
The Muscle Pump
This one is easier to understand. Where there are muscles on either side of a lymphatic vessel and the muscles contract, it pumps the tubes with the fluid inside them. Since the vessels are valved, the fluid can only get pumped up towards the portal ducts. So, the more exercise you do, the better your lymphatic function works. The less moving you do, the opposite happens. So this is yet another reason for us to stay active.
In hospitals, where patients may be laying in bed for long periods of time, there are specially-trained physical therapists who go around the wards performing lymphatic drainage massage to support those patients who can’t move very much for themselves.
However, just under the skin, there are only muscles on one side, and they don’t have much to push against. This means a majority of pooling lymphatic fluid happens just under skin, giving it that puffy, swollen appearance.
Helpfully, this means manual lymphatic drainage massage can help, since we can’t really reach inside and between your muscles! But we can apply pressure to the skin, and provide that opposing force.
It’s also important for clearing fluid from your lower legs, where the fluid is furthest away and also it has to fight gravity the hardest. Get those calf muscles working!
The Breath Pump
This is essentially a pressure differential pump. When you breath in, the pressure inside your thoracic cavity goes down, and the pressure inside your abdominal cavity goes up. This helps to pump the fluid up from your abdomen, where some of the largest vessels are located, and effectively ‘sucks’ the fluid the last part of the way to the top of your thoracic cavity, where those portal ducts are. Clever, hey?
This means that, once again, exercise is important. Exercise gets you breathing harder, which works this breath pump as well as the muscle pump. It doesn’t have to be a huge 45 minute HIIT session, either. Anything that gets you breathing just that little bit harder, like a brisk walk, is enough to get this fluid pumping system working.
Things that negatively affect your lymphatic function
As you can see, the lymphatics are affected by, and affect, a number of different functions. Here are some of the main things that can slow down the lymphatic system’s optimal work:
- Lack of movement/exercise
- Certain dietary or immune factors that irritate lymphoid structures in the gut
- Damage to lymphatic structures through injury, surgery, or infection
- Chronic high stress, where the body prioritises the stress response (fight, flight, or freeze) and inhibit various functions such as digestive and lymphatic
- Long periods of poor quality sleep, which leads to chronic high stress
- Various infections, for example in the sinuses, mouth, throat, or infections of the soft tissues such as cellulitis or myositis
- Large bruises and the swelling that goes with them
- Certain hormonal issues where the fluid balance is affected
- Problems with salt balance, which affects overall fluid balance
- Congestive heart or lung disease
- and others. This is a non-exhaustive list.
Manual Lymphatic Drainage (MLD) Massage to the Rescue
So, no you know more about the lymphatic system and how it serves you than most people in the world. Nice work staying with me, here!
As you can probably tell, MLD is most useful for people who:
- Have had damage to their lymphatic structures, such as post-surgery recovery, or those who have had lymph nodes removed (for example after breast cancer)
- Have had certain infections and can’t move the fluid fast enough
- Get several sinus or respiratory infections per year
- Have hormonal conditions that affect fluid balance
- Have conditions that limit their physical movement
It’s worth noting that MLD is not a cure for anything—it is only ever symptomatic care.
The first appointment with me is always a longer one, 90 minutes, so that we can go through in detail everything that might be feeding into your condition. This helps me not only to be able to tailor and target my MLD treatment for you, it also allows us to get a really good broad overview snapshot of your current health status. This will help us to see any flags go up that can tell us who you need to see to resolve the underlying cause of the issue.
I have a growing range of referral partners who are more than capable of helping you.
How often should I get lymphatic drainage massage?
This is entirely individual. As we’ve seen, there are many, many different reasons that underlie people’s situations, which means there is no one-size-fits-all recommendation.
But to give you some idea, here are a few different examples.
One of my breast cancer survivor patients came every week for about four or five months through her post-surgical period, and still comes back every three to six months for some additional support, especially if she’s gone through something that has affected her stress or ability to exercise.
Another breast cancer survivor, who had a larger number of lymph nodes removed, comes every three weeks like clockwork for a 45-minute management treatment. Her arm is swollen pretty much the whole time, and she needs to wear a compression sleeve constantly.
One of my first MLD clients was a super-duper-stressed-out 27 year old woman who had developed a rash on her abdomen with bloating and constipatation. Alongside her naturopath, and some lifestyle changes, we managed to resolve the condition and she only comes back for relaxation massage every now and then.
Another patient has a well-managed yet sometimes serious anxiety condition and sees me every now and then when her face puffs up and she develops dark rings around her eyes. She comes roughly every six months for some extra support when her lymphatics get sluggish.
Then there’s another who recently had a tummy tuck surgery which (necessarily) cut through a large number of lymphatic vessels. I assist with fluid movement by re-routing the interstitial fluid and lymph to areas where it can drain better, as well as helping her extensive abdominal scar tissue to heal into functional tissue.
Finally, another young client had sinus reconstruction surgery and I assisted her with fluid movement in her face during her post-op period. I haven’t seen her since then.
If you didn’t know, now you know.
And finally, to close out, here are a few fast facts about the lymphatic system that I think are fascinating.
DID YOU KNOW:
Your body can re-grow new lymphatic vessels, but it can’t re-grow new nodes. This is relevant to my post-surgery clients – the tummy tuck lady will regrow new abdominal vessels. The breast cancer survivors won’t re-grow their missing nodes.
The lymphatic system wasn’t even properly described in medical textbooks until around the 1960s. Before that, there was just too much other important stuff to cover. So, we’re still researching it and learning new things about it. For example, we only just discovered how the brain itself drains, lymphatically, in 2015.
Lymphatic vessels get tiny. They find their way into every little nook and cranny, between nearly every cell you have in your body. The openings where the fluid enters are not circular holes, they’re more like flaps, like the shingle tiles on a roof. This means if we press too hard, it closes the openings and the fluid can’t get in. This is why MLD massage is so gentle—if we press too hard, it closes the doors. It must be gentle, like a firm patting or squeezing, in order to work.
Cool, hey??