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manual lymphatic drainage

Manual lymphatic drainage (aka lymphatic drainage) is a light-touch modality that is applied to reduce swelling of the face or body through specialized skills, techniques and practices.

It is often applied by massage therapists despite being quite different from massage.

In Swedish massage, clients can request work almost anywhere they wish, in any order they wish, with a variety of pressures that can be changed from one appointment to the next. In lymphatic drainage, a specific order or routine is followed, with minimal pressure that cannot be altered without medical reasoning.

Why Massage Therapists Learn and Practice Lymphatic Drainage

Lymphatic drainage can be practiced on clients who are contraindicated for massage therapy because of swelling. A reduction of excess swelling will often decrease pain and increase healing, especially in most oncology, sports injury and post-surgical medical situations. That is why massage therapists learn and practice lymphatic drainage. Lymphatic drainage skills can provide extra appointments for clients who would be normally contraindicated for massage.

For example: A client with a strained, swollen ankle might book a full-body massage appointment because they are in pain. However, it is contraindicated to massage an acutely swollen ankle. As such, the practitioner can provide lymphatic drainage on the swollen ankle and regular massage skills throughout the rest of the body. A trained lymphatic drainage practitioner is more likely to relieve this client’s pain rather than send them home without working on the one area the client might want or need it most: their swollen ankle.

The Practice of True Lymphatic Drainage

A practitioner’s lymphatic drainage goal is to encourage excess interstitial fluid—swelling or edema—within the body’s tissues to enter the lymphatic capillaries to form lymph. When this fluid is within the body’s interstitial tissues, it is called interstitial fluid. Once the interstitial fluid enters a lymphatic capillary, it is called lymph.

This fluid transference is known as forming lymph. This newly formed lymph is then gently manipulated toward regional lymph nodes where it is filtered and then travels through progressively larger lymphatic vessels back to the cardiovascular system.

Lymphatic drainage follows different pathways than a typical Swedish massage therapy session. Massage is generally provided in one direction—toward the heart—to increase overall cardiovascular circulation through venous return. Lymphatic drainage has several different pathways that include working toward the cervical, inguinal or axillary nodes. These sophisticated pathways become complicated when a client has an obstruction due to surgery, oncology treatment, birth defect or other physical trauma. (A high-quality CE course in lymphatic drainage will explain the different directions, pressures and tissues that are manipulated and used in this highly specialized bodywork.)

Lymphatic Drainage Bodywork Pressure and Application Explained

True lymphatic drainage is commonly called capillary work because practitioners work to encourage permeable superficial lymphatic capillaries to absorb excess interstitial fluid to form lymph, with extremely light touch and highly specialized skills. Gentle techniques are then applied to encourage this newly formed lymph to travel to lymph nodes and progressively larger lymphatic vessels.

Extremely light pressure is used because applying any type of moderate-to-deep pressure around a swollen or stretched tissue could further stretch or tear the swollen tissue. Also, too much pressure bypasses the initial lymphatics where most of the interstitial fluid is collected to form lymph and reduce swelling.

Despite this fact, there are some who perform lymphatic massage, skipping the light, skilled touch of lymphatic capillary work by claiming to do greater work on larger lymphatic vessels. A lymphatic massage applies kneading or ischemic compression over the lymphatic system’s unique pathways with moderate pressure, which is not a true holistic application of lymphatic drainage, nor is it an appropriate amount of pressure to work with on swollen tissues. Some of these lymphatic massages are performed through clothing, which requires a practitioner to apply even more pressure which could harm a swollen client.

It is critical to properly advertise and provide lymphatic drainage services. In the State of Florida, a licensed massage therapist was recently served an emergency restraining order for advertising lymphatic drainage as forcibly expelling bodily fluids out of their client’s surgical incisions. In the emergency restraining order, the state focused on the fact that lymphatic drainage bodywork is a gentle application that would not include any such forceful practice.

Is Your Client Taking Opioids?

Many acute medical conditions that cause swelling are indicated for lymphatic drainage but contraindicated for massage. Most acute medical conditions such as surgery, sports injuries or oncology treatments can be traumatic to the body, which could result in that client’s doctor prescribing an opioid.

Lymphatic drainage is one of the lightest forms of hands-on bodywork. It is difficult for a client to feel the light touch of lymphatic drainage bodywork when they are swollen and in pain but on opioids. As such, a client on opioids may ask a practitioner for more pressure during their lymphatic drainage session so they can “feel it working.”

Unfortunately, the excessive use of opioids over the past few decades has likely led to practitioners feeling compelled to apply greater pressure in lymphatic drainage to satisfy their clients’ request to feel the work.

Instead of applying more pressure, it is a practitioner’s ethical duty to explain how lymphatic drainage works with light, skilled touch and to find different ways to show the client how their lymphatic drainage is working, especially when the client cannot feel it.

5 Common Types of Treatments

Lymphatic drainage is practiced to reduce swelling within the body. Manual lymphatic drainage is performed solely by a practitioner’s hands while lymphatic drainage can be performed by a practitioner’s hands, machine or a combination of both.

There are many different types of treatments available that are all called lymphatic drainage, despite being quite different in practice. Here are five of the most common treatments:

1. Manual Lymphatic Drainage: True manual lymphatic drainage is performed solely with a practitioner’s hands on dry bare skin. It is also commonly called capillary work because practitioners work to encourage permeable superficial lymphatic capillaries to absorb excess interstitial fluid, to form lymph with extremely light tough. More hands-on lymphatic skills and techniques are then practiced, encouraging this newly formed lymph to travel to lymph nodes and progressively larger lymphatic vessels.

2. Lymphatic Drainage Massage: Lymphatic massage does not recognize or practice the light, skilled touch of lymphatic capillary work. Some practitioners are simply massaging over the lymphatic system’s unique pathways with light to moderate pressure, yet they still call their work lymphatic drainage, despite it being more like ischemic compression or kneading with a lymphatic pathway influence.

3. Incisional Drainage: These treatments are the most controversial. In incisional drainage, a practitioner will forcibly expel excess bodily fluid through a recent surgical incision. An emergency restraining order was recently issued by the State of Florida against at least one practitioner for performing this type of treatment while advertising it as lymphatic drainage.

4. Pressotherapy: In this treatment, a client often wears boots, pants or an entire bodysuit garment that fits over their clothing. The garment will then slowly fill with air to gently compress against the body and then decompress. That process will repeat over and over again. The compression effects are powered by electricity. There is no need for a practitioner to provide the treatment, other than to possibly help a client in or out of their pressotherapy garment.

5. Lymphatic Drainage Machinery: There are many devices manufactured and sold that claim to have lymphatic drainage benefits. These sessions may include a practitioner’s application, or in some cases, the service can be provided as a do-it-yourself session.

How can so many different treatments be called the same thing?

This is a frustrating question the bodywork industry is now facing. Clients are showing up for lymphatic drainage appointments that are being administered by machines, when they thought they would receive a hands-on therapy session. Because manual lymphatic drainage is being administered with anything from light- to moderate- to deep-tissue pressure, these various practices have created a lot of confusion in the lymphatic drainage industry, for both clients and practitioners.

So Which Treatment is True Lymphatic Drainage?

To evaluate what is true lymphatic drainage, there are several factors that can define what is acceptable lymphatic drainage practice but, more importantly, what is not.

Manual lymphatic drainage must be practiced as a hands-on bodywork application. A machine application should not be called manual lymphatic drainage.

The primary focus of lymphatic drainage practice should be to reduce swelling, gently and safely, with medically proven methods. As such, any machine or hands-on treatment that involves applying moderate-to-deep pressure into swollen tissues should not be considered true lymphatic drainage. Applications that apply anything other than the lightest pressure into swollen tissues could further stretch or tear swollen tissues.

Lymphatic Drainage and Informed Consent

The goal in lymphatic drainage is to allow the body’s sluggish lymphatic system to collect excess interstitial fluid and transport it back to the cardiovascular system. Any treatment that provides this could be labelled lymphatic drainage; however, lymphatic drainage providers should explain the type of lymphatic drainage treatment that they will administer to a client prior to scheduling an appointment. Proper informed consent would include detailing the different types of lymphatic drainage treatments that are available, including their own, with any potential risks or benefits.

While some of these five various types of treatments discussed in this article may increase circulation or reduce swelling, the gentle, light, skilled touch of manual lymphatic drainage continues to be the most popular form of lymphatic drainage appointment requested or performed within the bodywork industry.

Selena Belisle is the founder of CE Institute LLC ( in Miami, Florida. She originally trained in the Vodder method of manual lymphatic drainage in 1995 at the Massage Institute of New England. Today, she teaches evidence-based, National Certification Board for Therapeutic Massage & Bodywork-approved lymphatic drainage CE courses. She has over 25 years of lymphatic drainage research, practice and experience.

How to Show Lymphatic Drainage Therapeutic Results

Practitioners should physically show a client their tangible lymphatic drainage appointment results though pre-treatment and post-treatment measurements or pictures. This is important because some lymphatic drainage clients might not be able to feel their lymphatic drainage bodywork for various reasons. Cloth-type measuring tapes can be used to measure a swollen extremity and photos are the best option to review any reduction of swelling or puffiness in the face.

To conclude, almost the only thing in common between massage and lymphatic drainage is it can be offered by a massage therapist on a standard massage therapy table. Beyond the practitioner and table, these two modalities are extremely different for important therapeutic reasons, which becomes increasingly apparent with greater lymphatic drainage training.

About the author

Selena Belisle

Selena Belisle is the founder of CE Institute LLC in Miami, Florida. She originally trained in the Vodder method of manual lymphatic drainage in 1995 at the Massage Institute of New England. Today, she teaches evidence-based, National Certification Board for Therapeutic Massage & Bodywork-approved lymphatic drainage CE courses. She has over 25 years of lymphatic drainage research, practice and experience.

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Drainage, Lymphatic, Manual, massage, Swedish

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