Manual lymphatic drainage is a therapeutic massage designed to decongest the lymphatic system. It is mainly used for swollen legs and arms. We explain how lymphatic drainage works, what needs to be considered, and what you can do yourself for a healthy lymphatic system.

Manual lymphatic drainage supports the lymphatic system

Manual lymphatic drainage is a gentle massage to improve lymphatic flow. Like classical massage and connective tissue massage, it is one of the manual forms of therapy.

In manual lymphatic drainage, the lymphatic vessels are stimulated by a therapist through certain hand movements and gentle pressure, which helps to remove the lymphatic fluid.

Lymphatic drainage can help with almost all types of swelling: it is used, for example, for primary and secondary lymphedema or lipedema. It doesn’t matter where on the body the swelling is located: lymphatic drainage can help with swelling of the fingers, hands, arms, legs, feet, neck or knee, chest, and even swelling around the eyes (1).

The difference between lymphedema and lipedema

Lymphedema is swelling that occurs due to lymphatic stasis in the lymphatic vessels. A distinction is made between primary lymphedema – a congenital malformation – and secondary lymphedema, which only develops in the course of life (for example, after lymph node removal or when a tumor obstructs lymph flow). If the leg is affected by lymphedema, it is colloquially referred to as “water in the leg”.

A distinction must be made between this and lipedema. These painful fat deposits can occur on the buttocks, legs or arms, always affecting both arms or legs at the same time, while lymphedema can also occur only on one side. Lipedema, like primary lymphedema, is congenital, but usually occurs in the course of life. All information about lipedema can be found at the link above.

Lymphatic drainage dismissed as charlatanry

Manual lymphatic drainage was developed in the 1930s by the Danish physiotherapist Emil Vodder. At that time, doctors believed that lymph nodes should not be touched under any circumstances – especially not swollen ones. Knowledge about the lymphatic system was still very limited at that time.

Vodder and his wife Estrid, who was a naturopath, violated this taboo. They suspected that the lymph nodes play a role in many ailments. Finally, they found that congestion in the swollen lymph nodes can be relieved by a gentle massage (2).

At the time, her method met with a lot of opposition, was dismissed as mere stroking and called charlatanry – because in medical circles no one could imagine that a manual method could actually influence the lymphatic system. It was not until 40 years later that science confirmed the effect of lymphatic drainage.

Lymph: an important means of transport in the body

The lymphatic system is an important part of the immune system – it is there to “declutter” the body. Lymph (also called lymphatic fluid) is a yellowish body fluid that is responsible for the removal of metabolic products, waste products, cell debris, toxins, pathogens, excess tissue fluid, etc.

The lymph flows in the lymphatic vessels. These fine channels form a transport system that spans the entire body and connects the approximately 600 lymph nodes. Most lymph nodes are located on the neck, armpits and groin.

The lymph nodes filter out the above-mentioned pollutants and pathogens from the lymphatic fluid and render it harmless. Only then is the detoxified and thus harmless lymphatic fluid released into the blood, transported with it to the kidneys and excreted from the body with the urine.

The so-called superficial lymphatic system runs largely parallel to the superficial veins and cleanses the skin and tissues. The deep lymphatic system, on the other hand, cleanses the muscles, bones and joints and runs parallel to the deeper veins and arteries.

The body pumps around two liters of lymphatic fluid through the lymphatic vessels per day – driven by the pulsation of the blood vessels, muscle movements and the movement of the diaphragm when breathing (4).

The goal of lymphatic drainage

If the lymphatic system is disturbed in its function – for example, due to too little exercise, accidents or infections – the lymph accumulates. It flows slowly and slowly and finally leads to swelling – the so-called edema. So, edema is caused by fluid accumulation in the tissues.

Lymphatic drainage drives the lymphatic flow again. The congested lymphatic fluid is distributed and the flow of the lymphatic vessels is improved. The aim of lymphatic drainage is therefore to increase the performance of the lymphatic system so that congested lymphatic fluid can be removed.

Lymphatic drainage contributes to edema reduction and pain relief, leads to faster wound healing and better mobility of the affected region. Lymphatic drainage can also support physical therapy by reducing swelling and promoting mobility (5)(6).

Lymphatic drainage can be used for these complaints

Manual lymphatic drainage can be used, for example, for swollen hands, legs, feet or arms. It is used successfully for the following problems (7) (8):

• Lymphedema due to rheumatic diseases
• Lymphedema after injuries and accidents (bruises, broken bones, sprains, etc.)
• Lymphedema after surgery (knee surgery, hip surgery, etc.)
• Lymphedema after liposuction
• Lymphedema after breast cancer or other tumor diseases
• Lymphedema after lymph node removal
• Lipedema (fat deposits, especially in the legs, arms and buttocks)
• Varicose veins
• Headaches and migraines

Lymphatic drainage is also of great importance in the follow-up treatment of surgical procedures, e.g. after breast cancer operations when lymph nodes have been removed, after knee surgery or after hip surgery. This promotes the healing process and complications can be avoided under certain circumstances (9) (10) (11).

This is how lymphatic drainage works

During lymphatic drainage, the affected areas must not be covered by clothing so that the therapist can perform the grips in a targeted manner. So it’s best to wear loose clothes that you can push to the side if you don’t want to undress completely.

The therapist massages the subcutaneous tissue with gentle pressure. Various handles are available for this:

• Circular motions
• Pump handles with the help of thumb and finger
• Cupping handles
• Twist grips in which the skin is shifted against the subcutaneous tissue

The treatment usually takes 30 to 60 minutes – depending on the symptoms. After that, the patient usually feels relaxed and liberated and the pain may have already improved. Often, the patient has to go to the toilet after lymphatic drainage, as the waste products are excreted in the urine. Fatigue after treatment is also not uncommon.

After lymphatic drainage, compression bandages are often used to prolong the effect of the treatment. For this reason, too, it is recommended to wear loose clothing. The bandages are worn until bedtime (or several days, depending on the bandage) and ensure that the fluid cannot flow back into the affected areas. In the further course of treatment, support stockings can also be used.

The difference between manual and mechanical lymphatic drainage

In contrast to manual lymphatic drainage, mechanical or mechanical lymphatic drainage, also known as intermittent compression, is carried out with the help of various equipment.

Compression pants for lymphatic drainage

Compression pants, for example, are often used; in this case, this is not so much a pair of pants per se as a kind of cuff consisting of two thick tubes for the legs. The legs are enclosed by air chambers in which the air pressure is regulated by a device. In this way, the pressure is built up and released, creating a massage effect. You lie on the massage table with your legs and sometimes your upper body in these compression pants, while the device stimulates the lymph flow.

Compression pants in sports

But there are also compression pants, which are actually pants and look like leggings/sports tights at first glance. Due to the tight fit and the nubs on the inside, they are said to have a massage effect on mild lymphedema. They are also being used more and more often in sports, because they are supposed to increase performance and, to a certain extent, prevent sports injuries.

Mechanical lymphatic drainage: No substitute for manual lymphatic drainage!

Mechanical lymphatic drainage is often advertised by beauty salons and fitness studios for use with skin and figure problems, cellulite, but also water retention. It can certainly contribute to better blood circulation, massage and prevention. For the treatment of lymphedema, however, we recommend that you consult a trained therapist or masseur.

Some therapy practices also have lymphatic drainage devices that can complement the treatment, such as the compression pants mentioned above or similar devices with cuffs for the feet, arms, etc., which generate pressure waves – but mechanical lymphatic drainage is not a substitute for manual drainage.

How often is lymphatic drainage performed?

How often lymphatic drainage should be performed depends on the symptoms. Wound healing (e.g. after surgery or after an accident) can be roughly divided into three phases: the inflammatory phase lasts about five days, the proliferation phase about 16 days and the regeneration phase up to 500 days.

Lymphatic drainage is mainly used in the first two phases. At the beginning of a therapy, it is sometimes carried out daily – later one to three times a week.

How is lymphatic drainage prescribed?

Manual lymphatic drainage is prescribed by the doctor and performed by a therapist or masseur. In order to be able to offer manual lymphatic drainage, additional training is required. Can be prescribed (12):

• a 30-minute manual lymphatic drainage (“partial treatment”)
• a 45-minute manual lymphatic drainage (“major treatment”)
• a 60-minute manual lymphatic drainage (“full treatment”)

Whether a treatment lasts 30, 45 or 60 minutes and how many treatments the prescription applies to (usually several treatments over several weeks) is decided by the doctor based on the severity of the symptoms:

In partial treatment, only the affected area is treated, for example an arm or a leg. In large-scale treatment, several parts of the body are treated – e.g. both legs. Whole treatment is prescribed for severe edema. It involves several parts of the body.

Does the health insurance cover manual lymphatic drainage?

Except for the co-payments of 10 percent and a fee of 10 euros for the prescription, the health insurance company covers the costs of manual lymphatic drainage for those with statutory health insurance. Without a prescription, manual lymphatic drainage must be paid for by yourself.

In the case of privately insured persons, it depends on the individual tariff benefits who pays for the treatment. If your insurance covers remedies completely and without deductible, you do not have to pay for the therapy.

A 30-minute manual lymphatic drainage costs between 30 and 45 euros, a 45-minute one between 45 and 70 euros and a 60-minute one between 60 and 90 euros.

What you can do yourself

You can also do a lot to ensure that your lymphatic system functions optimally – regardless of whether you have complaints or not:

• Do not wear clothing that is too tight or constricting.
• Drink enough water – because the more you drink, the more liquid the lymph is and the better it can flow. How to tell if you’re drinking enough water
• Put your legs up in between if you stand or sit a lot.
• Even if your range of motion is limited, you should try to incorporate exercise into your daily routine. Go for regular walks or swims, or try tai chi or yoga. Tai Chi and Yoga are extremely gentle yet effective forms of movement that you can also perform at home and adapt to your own flexibility. Even if you are no longer good on your feet, there are fitness programs in a sitting position.
• The healthier your lifestyle and diet, the less work you put your lymphatic system through.
• Lymphatic cleansing is also a good idea, as you can read in the next section.

Cleansing the lymph holistically

Through a holistic lymphatic cleansing, the lymphatic system is stimulated and relieved. It consists of various measures – lymphatic drainage can be one of them. You can read about how lymphatic cleansing works at the previous link.

You can also find out how to cleanse your lymph with the help of your diet in our article on 3-day lymphatic cleansing. There you will find two variants, each lasting only three days.

Perform lymphatic drainage yourself

Ideally, lymphatic drainage should be performed by a therapist because it is difficult to learn. The lymphatic system is a densely branched network that runs through the entire body. It is not for nothing that therapists have to undergo additional training. However, your therapist can certainly show you a few simple steps that you can do yourself at home.

You can also find numerous videos on the Internet demonstrating how you can perform lymphatic drainage on yourself. Always proceed very gently and do not exert too much pressure: the skin should only be pressed in a few millimeters.

Avoid areas where you feel pain, because pain indicates swollen lymph nodes. You should not massage them yourself, because if you stroke in the wrong direction, for example, the lymphatic congestion may be aggravated.

Is lymphatic drainage an option for you?

In the case of the following clinical pictures, you should definitely have it clarified whether and under what conditions lymphatic drainage is an option for you. Depending on the severity of the disease, lymphatic drainage may not be performed at all or certain precautions must be taken:

• Acute thrombosis
• Heart failure (cardiac insufficiency)
• Acute pulmonary edema (water in the lungs)
• Stroke
• Renal and thyroid dysfunction
• Acute inflammation caused by bacteria or germs
• Cancers
• Hypotension

As a rule, however, a doctor is consulted before manual lymphatic drainage anyway so that the treatment is covered by health insurance.

Lymphatic drainage during pregnancy

Manual lymphatic drainage can usually be performed without any problems during pregnancy – for example, in the case of heavy legs. Inform your therapist of your pregnancy so that they can tailor the treatment accordingly. The abdominal region in this case is left out.

Manual lymphatic drainage – a helpful measure for a wide range of ailments

Manual lymphatic drainage is an extremely effective form of therapy that not only helps with numerous complaints, but also relaxes the entire body. In addition, it supports the lymphatic system in detoxification and can therefore also help with skin problems (such as acne).