During manual lymphatic drainage you lie relaxed on a treatment table while the therapist moves the skin with slow, circular strokes and very light pressure. Treatment almost always starts at the neck or trunk, far from the swelling, and only then works towards the swollen arm or leg. On prescription in Germany a session lasts 30, 45 or 60 minutes. For lymphoedema it is usually followed by compression, because without it the effect hardly lasts.
What manual lymphatic drainage is
Manual lymphatic drainage is a decongestive therapy. Its aim is to support the drainage of tissue fluid through the lymphatic vessels. It was developed by the Danish physiotherapist Emil Vodder in the 1930s together with his wife Estrid. Most techniques used in German practices still go back to him.
It has little in common with massage in the usual sense. There is no kneading, no friction and no tapping. The muscles are not the target at all. The work happens in the skin and the tissue directly beneath it, where the fine lymphatic vessels run. Oil is usually not used, because the hands are meant to move the skin rather than glide over it. For comparison, how a classic massage works is described in Classic massage: how a treatment works and the techniques used.
When it is prescribed
In Germany manual lymphatic drainage is a prescribed therapy. A doctor orders it, for example for lymphoedema after breast cancer surgery or radiotherapy, for swelling after operations and injuries, or for lipoedema. It may be performed by physiotherapists and massage therapists with a specific additional qualification.
The German catalogue of prescribable therapies lists three levels, named after treatment time: MLD-30 for a single body part, MLD-45 for a larger region and MLD-60 as a full treatment, for example when both legs are affected. Applying a compression bandage can be prescribed in addition. Lymphatic drainage is also offered as a wellness treatment without prescription, in that case without a medical diagnosis and usually without compression afterwards.
How a treatment works
- Assessment: At the first appointment the therapist asks about diagnosis, operations and medication. They look at the swelling, feel the tissue and often measure the circumference of the arm or leg at fixed points.
- Positioning: You usually lie on your back with the affected arm or leg slightly raised. Only the area being treated is uncovered.
- Neck and collarbone: Almost every treatment starts here, even when the leg is swollen. Above the collarbone the lymph flows into the venous blood. This region is stimulated first.
- Trunk and lymph nodes: Next come the lymph nodes close to the swelling: the armpit for a swollen arm, the groin and abdomen for a swollen leg. Calm abdominal breathing is sometimes part of it.
- The swollen limb: Only now does the therapist work on the arm or leg, moving away from the body towards the hand or foot, while each stroke itself always pushes towards the trunk. The idea: first clear the outflow, then move the fluid along.
- Compression: For lymphoedema a bandage or compression garment follows straight afterwards. Without it, fluid can quickly build up again.
The treatment is quiet and slow. Each stroke is repeated several times at the same spot before the hands move on a little. Some people fall asleep. Pain or reddened skin is not a sign that it is working but a sign of too much pressure.
The four basic techniques
Stationary circles
The flat fingers or the whole hand rest on the skin and move it in small circles without sliding over it. This technique is used mainly on the neck, the face and the lymph nodes.
Pump technique
The hand encloses the arm or leg between thumb and fingers and moves forward in a wave-like motion. It suits long body parts such as the thigh and lower leg.
Scoop technique
A turning motion from the wrist, reminiscent of scooping water. It is used mainly on the forearm and lower leg.
Rotary technique
The flat hand turns across larger surfaces such as the back or abdomen. Pressure and release alternate at a calm pace.
What studies show about the benefit
The best studied area is lymphoedema of the arm after breast cancer. A Cochrane review analysed six small trials with 24 to 45 participants each. Lymphatic drainage was safe and well tolerated in all of them. Added to compression bandaging, it reduced swelling slightly more than bandaging alone. Most of the effect, however, came from the bandaging. Women with mild to moderate lymphoedema appeared more likely to benefit. Pain and heaviness improved in six to eight out of ten participants, whichever treatment they received.
A larger Belgian trial at five hospitals with 194 women with chronic arm lymphoedema is clearer still. All of them received skin care, compression, exercises and education. On top of that, one third received traditional lymphatic drainage, one third drainage guided by imaging of the lymphatic vessels and one third a sham drainage. After three weeks and 14 sessions, swelling had gone down by roughly the same amount in all three groups. The authors conclude that, in chronic lymphoedema, lymphatic drainage added to the other components gave no clinically important extra benefit.
Whether lymphatic drainage after surgery can prevent lymphoedema is unclear. A second Cochrane review of ten trials with 1,205 participants found no firm answer. The honest conclusion: lymphatic drainage is a safe component of decongestive therapy. In these trials, however, compression carried most of the effect. One-year follow-up also suggests that results are more likely to last when the made-to-measure garment continues to be worn.
Massagers and massage chairs are no substitute
Lymphoedema belongs in medical hands. It needs a diagnosis, a therapy made up of several components and regular check-ups. No massager and no massage chair can replace that. Medical devices for pneumatic compression are available only on prescription, and they are something quite different from a wellness device.
What a device can offer is comfort after a long day. Many people find air compression on the feet and calves pleasant when their legs feel heavy in the evening. Suitable devices are in Foot massagers with calf cuffs, all others in Massagers. What they can and cannot do for swollen legs is explained in Leg massager for swollen legs. What lies behind a lymphatic drainage programme in a chair is covered in the guide to massage chairs with lymphatic drainage. You can try the chairs at the NAIPO Relax Lounge in Hamburg.
Contraindications and warning signs
Drainage is not performed during acute inflammation, such as cellulitis with redness, warmth and fever. The same applies to a recent thrombosis and to severe heart failure, where fluid in the legs and lungs comes from the heart. With an overactive thyroid or heart rhythm disorders, the therapist often leaves out the neck or treats it only gently.
See a doctor promptly if a leg swells suddenly on one side and hurts, if a swelling becomes hot and red or fever develops, and immediately if you become short of breath. If you have varicose veins, read Is massage safe with varicose veins? first.
Frequently asked questions
How many sessions are usual?
That depends on the diagnosis and the prescription. In the decongestion phase of lymphoedema several sessions a week are usual, followed by less frequent maintenance sessions while the compression garment is worn every day.
Can I do lymphatic drainage myself at home?
Simple techniques, yes, provided you have learned them from a therapist. In the Belgian trial, self-management on days without a session was a fixed part of the programme. It complements therapy but does not replace it.
Is lymphatic drainage the same as a gentle massage?
No. A massage works on the muscle, lymphatic drainage on the skin and the tissue beneath it. For an overview of the other types, see Types of massage at a glance.
Sources
- Ezzo J, Manheimer E, McNeely ML et al. (2015): Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003475.pub2
- De Vrieze T, Gebruers N, Nevelsteen I et al. (2022): Manual lymphatic drainage with or without fluoroscopy guidance did not substantially improve the effect of decongestive lymphatic therapy in people with breast cancer-related lymphoedema (EFforT-BCRL trial): a multicentre randomised trial. Journal of Physiotherapy. doi:10.1016/j.jphys.2022.03.010
- Stuiver MM, ten Tusscher MR, Agasi-Idenburg CS et al. (2015): Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD009765.pub2
This article does not replace medical advice.
Written by NAIPO Editorial Team · Massage & Product Experts from Hamburg
Product experts, service technicians, and massage enthusiasts at Alsterwell GmbH — specializing in massage technology for over a decade, with our own workshop and showrooms for test sitting.
Fact-checked by David Eberst · Co-founder of NAIPO
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