Originally published in Massage & Bodywork magazine, June/July 2006. Copyright 2006. Associated Bodywork and Massage Professionals. All rights reserved.
These days, the manual acceleration of lymph drainage is mainly used by practitioners to reduce the size of lymphedemas, even though the main function of the lymphatic system is detoxification and disposal of metabolic waste. The compromised quality of the air, water, food, etc., causes significant accumulations of metabolic waste products in our body, some of which are toxic. In many cases, this accumulation of toxins causes us to feel low energy levels, fatigue, mood swings (the clinical symptoms of which are often confused with depression by physicians) fatigue, etc. There is no doubt that lymph drainage is a powerful method for lymphedema reduction, but I also believe we should offer lymph drainage to our clients as a detoxification program. Clients who receive full-body medical massage regularly (for example, on a weekly basis) should be getting a lymph drainage session every fifth treatment. I do not advise therapists to incorporate techniques of full-body massage with lymph drainage techniques, as this can cause severe reactions such as headache, dizziness, nausea, etc. Detoxification causes a significant improvement in the power and function of the immune system. I personally see regular lymph drainage sessions incorporated with full-body stress management massage as no less important than immunization against the flu virus and other infections. Immunizations sometimes do not protect people from contracting the flu, for example. A consistent detoxification program has proven very effective in protecting humans from infections.Introduction
The main function of the lymphatic system is detoxification, but it also plays an important role in immunity. Lymph is an extracellular fluid that enters the lymphatic vessels and is mixed with cellular elements. The lymphatic system starts at the lymphatic sacs in the extracellular spaces. These sacs have pores, allowing the passage of large proteins and other metabolic waste products. When the lymphatic sacs are filled, lymph enters the lymphatic vessels. These vessels also have large pores and carry a small quantity of smooth muscles. The walls of lymphatic vessels contain valves, directing the flow of lymph one way only (toward the heart). Along the path of the lymphatic vessels are lymphatic nodes. When the fluid reaches these nodes, infections, alien proteins, and other foreign materials are destroyed. The drained lymph then continues its flow. Most of the lymphatic fluid reenters the circulation via the thoracic duct (a common drainage duct). Through this duct the lymph enters the brachiocephalic vein. The right lymphatic duct drains lymph only from the right upper extremity and half of the face and head.The Nature of Lymphatic Flow
During inspiration, the diaphragm muscle contracts, creating negative intrapleural pressure. This is when both the thoracic and right lymphatic ducts release the largest amount of lymph into the circulatory system.
It's important to remember these points:
-Gravity is the main opposition to lymph flow. Most of the
lymphatic vessels are between skeletal muscles. When muscles contract (during movement), a pumping action is created, thereby pushing the lymph along.
-Pulsations of large vessels (arteries and veins) also help the lymph to flow.
-The peristaltic contractions produced by the walls of lymphatic vessels, however weak, contribute somewhat to the flow of lymph (though not
When we perform manual acceleration of lymph drainage we actually use the knowledge of the nature of lymph drainage and apply special techniques to accelerate lymphatic drainage. The WorkStep 1.
The client lies on her back. Place your hands on the upper part of the rib cage (mainly on the sternum). Ask your client to inhale and exhale. In the next inhalation, resist the expansion of the rib cage with moderate pressure. Release the pressure upon exhalation. With resistance of rib cage expansion, we cause the diaphragm muscles to work harder. The degree of the diaphragm muscle contractions projects the level of negativity of intrapleural pressure. The more negative intrapleural pressure we create, the bigger the volume of lymph that drains into the circulatory system. Repeat the rib cage expansion 5-6 times.Step 2.
Ask your client to turn her head to the right. Place your hand on the junction area of the thoracic duct and the brachiocephalic vein. Apply pressure (pumping action) upon exhalation. Repeat these techniques 5-6 times.Step 3.
Ask your client to turn her head to the left. Place your hand on the junction area of the right lymphatic duct and the superior vena cava. Apply pressure (pumping action) upon exhalation. Repeat these techniques 5-6 times.Step 4.
Place your fist on the client's navel area. When the client exhales, perform pumping techniques under moderate pressure. Given the fact that the biggest lymphatic vessels including the cisterna chyli are on this level, this pumping effort is extremely important for acceleration of lymphatic fluid progression to the thoracic duct. Repeat this technique 5-6 times.
Lymphatic nodes are mechanical and chemical filters. After massive acceleration of lymph drainage through lymphatic nodes, connective tissue within them often becomes tense, which in turn reduces their drainage and filtering capability. Therefore, it is very important to massage all lymphatic nodes in a gentle manner in order to release this connective tissue tension.
If you palpate any swellings, enlargements, or tenderness in
the lymphatic nodes, do not massage those nodes. You should recommend the client to see her physician.Step 5.
Place the tips of the fingers on the submandibular lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).Step 6.
Place the tips of the fingers on the submental lymph nodes, and under moderate pressure, massage the nodes in a circular motion (5-6 times).Step 7.
Place the tips of the fingers on the cervical lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).Step 8.
Place the tips of the fingers on the axillary lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).Step 9.
Place the tips of the fingers on the cubital lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).Step 10.
Place the tips of the fingers on the inguinal lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).Step 11.
Place the tips of the fingers on the popliteal lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).Step 12.
Place the tips of the fingers on the malleolar lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5-6 times).
As stated previously, the pores of lymphatic vessels are large. Therefore, the proposed steps of pumping and direction of lymphatic fluid to the lymphatic nodes must be performed gently and with a lot of sense. If kneading techniques are performed instead of pumping, lymphatic fluid will be removed from the lymphatic vessels to the extracellular space instead of being directed to the nodes, thoracic duct, and right lymphatic duct.Step 13.
With both hands, perform pumping techniques on the lateral sides of the lower leg with a combination of light strokes directed toward the lymph nodes. Proceed with the same technique on the front thighs.Step 14.
With the client lying in an anatomical position, perform pumping techniques on the forearm and arm, accompanied with light strokes directed toward the lymph nodes.Step 15.
Ask your client to lie on her stomach. Perform pumping techniques on the lower leg and back thigh, accompanied by strokes directed toward the lymph nodes.Step 16.
Place both hands on the lumbar region. Move your strokes toward the lateral part of the lower back and proceed in the direction of the axillary lymph nodes. Repeat 5-6 times.
The total time of the session is approximately forty-five minutes. Usually the proposed protocol on the anterior and posterior are completed in 20-25 minutes. Repeat the proposed protocol twice. Boosting Immunity
Dear practitioners, please understand that lymph drainage techniques are not massage techniques at all. There is no doubt that usual massage therapy techniques can contribute somewhat to the acceleration of lymph drainage, but not significantly. The large pores of lymphatic vessels, under application of pressure, allow the lymph to move back into the extracellular spaces instead of proceeding through the lymphatic vessels to the lymphatic nodes and ducts. Its simplicity and contribution to well-being puts the discipline of lymphatic drainage for detoxification in a unique position of value. For example, a person receives vaccination against the flu that initiates antibody production in the body. Existence of flu antibodies (the immune system warriors) means that this person has acquired resistance to the flu virus. But this person has a considerable accumulation of toxins in her body. This means that her acquired immune system is significantly depressed, and that her body has a lowered ability to defend against infection. This depression of immune system function can easily be restored by detoxifying this person's body. Disciplined lymphatic drainage can cause significant detoxification, which in turn boosts the function of the already acquired immune capabilities.Boris Prilutsky, MA, is the founding director and senior instructor at the Institute of Professional Practical Therapy in California. Prilutsky graduated from the Pedagogic Institute of Higher Education in Vinnitsa, Ukraine, with a degree in physical education, and from Medical College in Ramat-Gan, Israel, with a major in chiropractic medicine. He has been practicing and teaching medical massage for more than thirty years. Contact him at email@example.com.