Manual Lymphatic Drainage Massage (MLD)

Manual Lymphatic Drainage Massage (Vodder Method)

What is Manual Lymphatic Drainage Massage? 

A gentle, rhythmic form of massage designed to increase the movement of lymph in the body.  This technique was developed by Dr. Emil and Estrid Vodder in 1932.  It is the most well-known manual technique for aiding lymphatic drainage. 

The Lymphatic System consists of lymph vessels and several organs, all of which contain lymphatic tissue.  It is part of the immune system; it also helps to eliminate toxic or waste material from the body.  Some key functions of the lymphatic system are:

• Returns protein and water to the cardiovascular system and helps maintain fluid balance in the body
• Absorbs protein, fat and fat soluble vitamins
• It is part of the body’s immune system and responds to foreign cells, microbes and cancer cells
  • The lymphatic system produces white blood cells which are activated by contact with viruses and bacteria, and foreign particles in the lymph fluid. Once activated, they form antibodies and start to defend the body.

The lymphatic system relies on lymphatic vessels to collect and transport lymph fluid to the bloodstream.  These vessels are distributed throughout our body even in the brain, as was discovered in a recent study by the National Institutes of Health (NIH) in 2015.  Lymph fluid is directed to the lymph nodes where they are filtered.  Lymph nodes are found primarily in the neck, the armpits, the abdomen, the groin area, and behind the knees.

General Effects of Manual Lymph Drainage:

• Soothing effect – the light pressure of the strokes promotes a parasympathetic response i.e., takes you out of the fight or flight mode
• Analgesic effect – helps to reduce pain by closing the “gates” which normally allow pain signals to reach the brain
• Decongests the tissues and restores them to normal tissue condition
• It helps accelerate the transportation of bacteria and allergens to the lymph nodes where white blood cells can destroy them and protect the body
• Increase of lymphatic drainage of fluids

 

Technique:

Manual Lymphatic Drainage Massage encompasses 4 basic techniques with the key technique or stroke being predominantly a circular stretching of the skin.  The pressure is generally very light and gentle but can vary depending on the types of tissue being worked on.  These techniques are designed to increase the movement of lymph and interstitial fluid and mimic the movement or flow of the lymph.  They are performed directly over the skin.  The lymphatic system relies on the pumping of the heart and activities such as walking (exercises) to help move lymph.  Manual lymph drainage massage creates a pumping effect to help move or direct lymph towards the lymph nodes.

 

Contraindications:

Despite the many benefits of this modality, there are certain conditions that would not be indicated for receiving this treatment.  General contraindications (concerning the entire body) are:

• Acute cellulitis – inflammation of the skin
• Untreated congestive heart failure (cardiac edema)
• Acute untreated deep venous thrombosis (DVT)
• Fever
• Metastatic or malignant disease (Therapist would need to work with treating physician)

 

Neck Treatments (all general contraindications plus):

• Cardiac arrhythmia (ex. A-V block, a vagal stimulus may cause cardiac arrest)
• Hyperthyroidism (risk of additional thyroid hormones could be introduced into blood circulation)
• Patients with a history of or risk of Arteriosclerosis and clients over 60 (risk of embolism caused by arteriosclerotic plaque)

 

Abdominal Treatments (All general contraindications plus):

• If trying to get pregnant
• Radiation fibrosis, R. colitis, R. cystitis (R = radiation)
• Crohn’s disease
• Diverticulitis and diverticulosis (small and large intestines)
• Liver cirrhosis (portal venous hypertension)
• Abdominal aortic aneurysm (even following surgical repair)
• Unexplained Pain (because we do not know what the underlying problem is)
• Implanted devices (e.g., drains, feeding tubes, colostomy bags, morphine pumps any implanted device, mesh implants, etc.)
• Others (hernias, cysts, inflammation “itis”, etc.)

 

More precautions are required for the following:

• Renal Dysfunction (kidney disease) – a doctor’s note would be required for MLD treatment
• Chronic inflammation
• Bronchial asthma
• Hypotension
• Diabetes

 

Consideration for clients with post deep venous thrombosis (DVT):

Clients with a history of DVT and those at risk for an episode will be treated with extra caution.  The location and length of time will impact the treatment approach for each client.  A physician referral and/or verbal ok should always be obtained and presented to the Massage Therapist prior to the lymphatic massage.  If approved by the treating doctor, it is generally safe for a client to receive MLD 6 months after the last acute episode if the DVT was in the lower extremities (i.e., the legs).  

If the DVT was in the abdomen, pelvic area, or if an inferior vena cava filter was inserted to trap blood clots, the therapist will avoid deep pressure to the abdomen during MLD.

 *No deep pressure will be given to clients receiving anticoagulant drugs such as Warfarin (COUMADIN)