Manual Lymphatic Drainage Massage
Manual Lymphatic Drainage (MLD) is the part of lymphedema treatment that patients usually refer to as "massage." Some therapists prefer to call it "manipulation," to distinguish it from the more usual sort of massage done to relieve muscle tightness, or simply for relaxation at a spa.
The manipulation involved in MLD uses very light pressure to stimulate the lymph vessels that lie just beneath the skin. Since these vessels are small and thin, firm pressure in any one area can actually shut them down momentarily, so the gentleness of the pressure is essential. Some therapists visualize this process as pushing the lymph fluid in the desired direction, while others see it as directing the flow by pulling the skin slightly ahead of the lymph flow. Either way, MLD is an important technique for moving lymph fluid out of the congested area and back into circulation in the center of the body.
The direction and order of MLD manipulation is as important as the gentle stroke. First the areas of the body where nodes are concentrated (neck, axilla, or groin) are stimulated in order to ready them to receive more fluid. Then the therapist begins, close to the nodes, moving fluid toward them with slow and rhythmic strokes. The massage continues with the therapist's hands moving farther away from the cleared nodes by degrees, but always directing the fluid back toward them.
What does MLD involve?
Preparing for MLD Treatment:
On days when you will be having MLD, avoid using lotions or other skin lubricants after your bath or shower, since friction on the skin is important to manipulating lymph flow. Wear comfortable, loose-fitting clothing that is easy to get on and off.
Your therapist will work hard to make you comfortable, as relaxation improves the effects of lymph manipulation. Dimming the lights is standard procedure, and some therapists add music or scented candles to enhance the mood of rest and quiet. Most patients find this helpful, but for others these mood-enhancers may create anxiety. If you are uncomfortable with these preparations, don't hesitate to let your therapist know.
For MLD therapy you will need to strip to the waist. Your therapist will provide a pillow, comfortable support for your knees, and a sheet or robe to drape your upper body. Throughout the massage you will remain modestly draped, with only those areas being worked on at the moment exposed. Again, if you become uncomfortable it's important to talk to your therapist about your feelings so she or he can make the necessary accommodations.
The MLD Massage:
Lymph fluid cannot move through hardened (fibrotic) areas, whether the fibrosis was caused by surgery, radiation, or the lymphedema itself. If you have areas of fibrosis blocking lymph flow, your therapist will begin with a deeper massage designed to break up the hardness over time.
Then the gentler MLD massage can begin, with some instruction in deep, abdominal breathing, followed by special motions to clear the nodes in your neck and axilla or groin (depending on where the therapist plans to move the lymph fluid.) Your therapist will then proceed with the massage pattern, moving to your chest, shoulder, arm, back and side. Your part in it all is to relax, breathe deeply – and don't worry if you fall asleep!
After MLD Treatment:
When you first begin MLD, you may find it hard to believe
that the kitten-petting gentle strokes of the massage can have any positive effect at all. In fact, it may seem like hocus-pocus and a waste of your time. But most patients are pleasantly surprised at the quick response of their body to this external means of moving the fluid trapped inside.
When stagnant lymph fluid is successfully moved back into circulation in your body, the result is that more fluid is available to be processed by your kidneys, so you may experience an urgent need to urinate following MLD. You'll want to be sure to use the bathroom before heading for home.
Occasionally, MLD that moves a lot of fluid can result in feelings of nausea or a deep aching. It is usually a passing effect and leaves no lasting problems, but do let your therapist know if you develop any unusual symptoms so your treatment can be adjusted.