Lymphatic Drainage – Information About Lymphatic Massage

The most effective treatment for lymphedema is massage. You will learn about three well-known forms in this article: lymphatic drainage performed by a trained lymphatic therapist, self-lymphatic massage which imitates this therapy and can be done by the patient, and the latest device-assisted compression therapy.

Lymphatic massage, also known as lymphatic drainage, is a special massage technique that supports the function of the lymphatic system. The goal of this massage is to stimulate the flow of lymph fluid throughout the body, thereby promoting the removal of toxins, reducing swelling, and improving immune system function.

Effects of lymphatic drainage (compression therapy)

Lymphatic massage has numerous positive effects:

1. Reduction of swelling. It effectively reduces swelling, such as lymphedema or edema due to venous insufficiency.
2. Detoxification. It aids the body's detoxification by facilitating the removal of metabolic waste products.
3. Supporting immune system function, since better lymph circulation helps fight pathogens.
4. Pain relief effect, especially in joints and muscles.
5. Improvement of skin condition. Improved lymph circulation supports skin health maintenance.
6. Relaxation. Gentle, repetitive pressure helps relax the body and mind, reducing stress and anxiety.

Applications of lymphatic massage

• Treatment of lymphatic circulation diseases (lymphedema). Lymphedema usually affects the limbs. Accumulation of lymph fluid between cells causes swelling and aching pain. This is particularly common after surgical or radiation treatment for cancer.
• Treatment of lipedema. This condition is a disorder of fat metabolism, involving abnormal enlargement of fat cells.
• Post-mastectomy conditions treatment. After breast removal due to tumor, most cases develop edema on the affected arm side. After abdominal-pelvic surgery, edema often affects the lower limbs.
• Varicose veins. The treatment effectively eliminates the painful swelling and heavy legs sensation caused by varicose veins. It can be safely used in pregnancy-related varicose veins.
• Post-thrombotic syndrome (PTS). Deep vein thrombosis always heals with a residual condition that may include leg swelling.
• Peripheral artery disease (arterial narrowing). Only advanced devices with a "top-down" program, pushing pressure from the thigh to the toes, are used to treat arterial narrowing. This therapy effectively improves limb blood circulation and wound healing.
• Paralysis of limbs. Blood circulation in immobile, paralyzed limbs slows, increasing risk of thrombosis and/or pressure ulcers. Device-assisted lymphatic massage "replaces" muscle movements and maintains lymphatic and blood flow.
• Prevention. After surgery, circulation slows due to inactivity, increasing risk of thrombosis (blood clot formation within vessels). Device-assisted lymphatic massage helps prevent this. It also reduces post-operative hematoma and limb swelling.
• Cellulite. Regular device massage "breaks up" cellulite nodules in the skin and helps eliminate them. It also enhances the effect of cavitation fat reduction treatments.
• Wellness relaxation. Provides a pleasant massage for a tired body. Refreshes, calms, relieves stress.

Contraindications of lymphatic massage

Although lymphatic drainage is generally safe, it is not advised in certain conditions, for example:

• Acute infections. Since pathogens and immune defense cells circulate in the lymph system, massage during infection may spread the infection and impede immune function.
• Severe heart problems. While not outright excluded, treatment must be cautious in cases of cardiomyopathy, heart failure, or uncontrolled hypertension despite medication. Massage also "presses" blood out from veins, increasing heart load. If you experience pulsations in your temples, rapid heartbeat, or worsening headache during massage, it means the therapy is too strong! Notify your therapist!
• Malignant tumors. After total removal of uterus and pelvic lymph nodes (e.g., Wertheim operation), lymphatic drainage by device should be used cautiously under professional supervision, especially in lymphedema cases. The same applies to edema from prostate cancer. If the tumor was completely removed, the risk of therapy is low; if active, pressure treatment may cause tumor spread. Careful assessment and individual decision are needed.
• Acute deep vein thrombosis. Massage is contraindicated within 90-120 days after onset, but can be used in residual condition treatment after 4 months.

Consult your doctor or a qualified therapist before undergoing lymphatic massage to ensure this treatment is suitable for you.

Lymphatic drainage by a trained therapist

Hand-performed lymphatic massage by a trained lympho-therapist (also called lymphatic drainage) takes place in a lymphatic therapy clinic or hospital department.

Important! This is not comparable to sports massage; deep, strong muscle kneading movements are not used here. If you experience strong pressure and near-pain sensations, you are not getting lymphatic massage!

The therapist uses gentle, almost stroking movements. There is a definite sequence starting with the lymphatic centers of the region (e.g., neck, underarm, groin, knee crease, etc.), gently massaging the lymph nodes. This is called "opening the lymph gates", softening lymph nodes to facilitate lymph flow during subsequent movements. Massage strokes are directed toward the regional lymph gates.

Effectiveness of manual lymphatic drainage

According to the latest physical therapy handbook (Evidence-based Physiotherapy, Tamás Bender, Medicina, 2017), there is no evidence for the effectiveness of manual lymphatic drainage itself, let alone for "opening lymph gates". It is used because "it has always been done". The method was "invented" in 1903 and has been practiced since despite the lack of measurable results in medical studies.

My related opinion is that manual lymphatic drainage can indeed be effective if performed with adequate frequency. The need varies among patients, but even mild lymphedema would require several treatments a week, and severe cases need at least daily treatment. However, insurance typically covers only 5 or at most 10 treatments annually. Obviously, insufficient frequency leads to unnoticeable effect.

Most patients simply cannot afford the necessary number of manual lymphatic drainage sessions.

Overall, lymphedema afflicts patients every day of the year (365 days), so 5-10 manual treatments yearly are certainly insufficient. Rare massages have no meaningful effect on lymphedema. The effect lasts only a few hours before swelling returns. Weekly 1-2 manual sessions, in my view, are just a waste of money. Most patients need daily or multiple daily treatments. This aligns with the treatment recommendations of the International Lymphedema Framework consensus document. This, however, is unrealistic since one limb massage costs 5,000–10,000 HUF and full-body massage 10,000–15,000 HUF nowadays. Appropriate number of treatments could cost hundreds of thousands per month.

Self-lymphatic drainage

Techniques of lymphatic edema-reducing massage can be learned. It is a simple, risk-free method to treat a limb in 8-10 minutes.

You should learn and understand some basics before starting self-treatment.

• Perform massage with clean, dry hands without using cream or oil. The essence of self-massage is to place your hand on the skin with slight pressure and move it upward 2–3 cm. Oily hands slide, which reduces effect.
• Massage should be done with mild pressure — just slightly more than the weight of your hand. Avoid strong, painful movements.
• Massage should be gentle enough to avoid skin redness during treatment.

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Phases of self-massage

• Preparation phase, where you gently massage and soften the lymph gates of the affected side (for arm edema: neck, underarm, chest; for leg edema: groin, knee crease) to facilitate lymph flow through the tissues.
• Treatment of the affected limb, starting from the top (less edematous area), progressing downward. This is necessary because starting from the toes would mean pushing the entire lymph column upward from the bottom, which is very inefficient.
• On the leg, start pulling-pushing movements at the upper thigh, whereas on the arm start at the underarm level. This creates space for pulling lymph from lower areas in the next step, so each step creates room for lymph moved by the following action.

The essence of the movement is to move lymph upward a few centimeters by the hand's pushing motion. If you perform too long a stroke, lymph won't move properly. The correct stroke is short (about 2-3 cm). Perform a stroke every ~2-3 seconds. Repeat 15 times on each area, then repeat once over the entire limb (if you have time, even up to 3 times).

Even a single self-massage may bring noticeable relief. More likely changes appear after 10–15 days of regular use, after which maintenance treatments are necessary. With lymphedema, you must continue this lifelong; accept it as part of your life and take care of yourself, otherwise it will affect your daily life adversely.

The following video demonstrates the self-lymphatic drainage technique step-by-step. The exercises are from a patient information film from MD Anderson Cancer Clinic, a university hospital in Texas.

Click the play button!

Device-assisted compression therapy

Device-assisted compression therapy is the latest treatment method developed because qualified therapists are scarce, and most patients cannot access them. Therefore, patients only get treatment when they find a therapist, not necessarily when they need it.

During device-assisted compression therapy, the device simulates the lymphatic therapist by sequentially inflating and deflating the air chambers of connected cuffs like boots, gloves, pants, or waist belts.

It applies pressure to tissues, moves swelling similar to manual drainage, reduces edema, eases acute and chronic limb tightness, improves circulation, and alleviates pain.

Treatment is done with a compression therapy unit. In Hungary, these are also called pressure-wave or compression therapy devices, but these terms denote the same equipment.

Advantages of device-assisted compression therapy

• Price. The device and accessories cost about the price of one month of manual lymphatic drainage and can be used for 8-10 years.
• Time-saving. No need to travel to distant clinics for treatment, no waiting or queuing.
• When needed. You can use your device whenever necessary without scheduling.
• As often as needed. Use it as frequently as your condition requires, not limited by prescriptions or affordability.
• Effective. Device-assisted treatment provides thorough, circumferential limb therapy, often more effective than manual massage.
• Portable. Take your device on vacations or trips to maintain treatments wherever you go.

I wrote about compression therapy units and what to consider when choosing one in this article: Compression Therapy Unit – What It’s For, How to Choose? (click the link to read).

Summary

There are three main types of lymphatic massage for treating lymphedema: therapist-performed massage, home self-massage, and device-assisted compression therapy. Therapist-performed massage is the most professional and effective, especially in severe cases, but can be costly long-term. Home self-massage is cost-efficient and suitable for milder cases but requires technical knowledge and consistency. Device-assisted compression therapy is more effective than self-massage due to its consistent and even pressure, and despite initial investment, it offers better long-term value than regular therapist visits, making it an ideal choice to balance cost-effectiveness and treatment efficiency.

Frequently Asked Questions

Is lymphatic massage painful?

Lymphatic massage generally does not cause pain and often provides a pleasant, relaxing experience. Its purpose is not deep muscle kneading but to stimulate the lymphatic system. However, in some cases, such as when lymph nodes are swollen or inflamed, or in the presence of chronic diseases, you might feel mild discomfort or pain during treatment.

Is lymphatic massage the same as traditional massage?

Many myths surround lymphatic massage, often misleading people. Many believe it serves the same purpose as traditional massages, primarily muscle relaxation and stress relief. However, lymphatic massage uses special techniques aimed at stimulating the lymphatic system and enhancing lymph fluid flow using a very gentle technique based on mild pressure. Thus, lymphatic massage fundamentally differs from traditional massage in both objectives and methods.

Can manual lymphatic drainage or compression therapy units be prescribed by the National Health Insurance?

Currently, manual lymphatic drainage cannot be prescribed by doctors for reimbursement by Hungary’s National Health Insurance (NBT). NBT coverage usually applies only to health care services and medications, excluding alternative or supplementary therapies. As for compression therapy units, these cannot be prescribed by NBT either. These devices are typically for personal use and are not classified as medical devices covered by health insurance. Overall, although lymphatic massage can effectively treat some health issues, currently it is not reimbursable, and such treatments must be paid out-of-pocket.