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What Is Manual Lymph Drainage

Patients have told me that the term ‘Manual Lymph Drainage’ sounded rather frightening when they first heard of it. Nothing could be further from the truth!

Manual Lymph Drainage is a very gentle, but highly effective medical massage technique, that encourages the natural circulation of the lymph through the body, to improve the overall functioning of the lymphatic system. The lymphatic system plays a crucial role in protecting the body from infection and ridding it of waste products, but also has a vital ‘safety valve function’ as it maintains the correct balance of fluid throughout the tissues of the body.

Manual Lymph Drainage (MLD) is a complete system treatment, the therapeutic benefits of which have been shown through some scientific research. Although there is little robust evidence from randomized trials or meta-analyses, the 2020 consensus document from the International Society of Lymphology (ISL) provides useful, up-to-date, practical information for the staging and management of lymphoedema, and a summary of the research supporting the use of MLD and other treatment modalities.

It therefore has nothing in common with the more usual sort of massage done to relieve muscle tightness, or simply for relaxation at a spa! In fact, MLD massages are applied to bare skin, and no massage oils or lotions are used at all. What is more, since MLD treatment is based on a very thorough understanding of the body’s natural lymph flow, it should only ever be practised by a qualified MLD therapist.

So here is what really happens:

Teaspoon of water

Manual Lymph Drainage (also referred to simply as MLD) is a very detailed, light, slow and rhythmic massage, during which the skin is stretched in a circular manner. In fact, the pressure used on the skin is no more than the weight of a teaspoon of water! Yet, gentle as it is, this technique stimulates the flow of lymph fluid in the vessels and nodes of the lymph system. This increased movement accelerates the re-absorption of fluid and wastes present in the body tissues – due to, for example, injury or surgery- into the lymph system. The lymph system then processes and cleanses the wastes in the fluid and returns it to the bloodstream, finally enabling the body to excrete the wastes and excess fluid.

The direction and order of the MLD technique is as important as the gentle strokes. 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 treatment continues with the therapist’s hands moving farther away from the cleared nodes by degrees, but always directing the fluid back toward them.

The lymph moves through the lymph vessels by way of one-way valves.

From one one-way valve to the next is called a lymphangion. The lymphangions have a layer of smooth muscle that spirals around them. Angion means heart – so this is really the pump that pushes the lymph. Each lymphangion has an internal stretch sensor. The walls of the lymphangion stretch when they fill up with lymph, and then the stretch sensor tells the muscle to contract. This spiraling muscle contracts, squeezing the lymph into the next chamber. This swells the next lymphangion, which then contracts, pushing the fluid down the line. At the same time the lymphangion is pushing the lymph forward, it also is creating a vacuum behind it. It is partly because of this vacuum effect that the lymph gets pulled into the initial lymphatics in the first place.

Once the lymphangions begin contracting, they cause a chain reaction, or a wave of contractions that start to push and pull the lymph through the body. In this way, stimulating lymph flow in one area can increase lymph flow in another. Other factors that can assist the movement of the lymph are skeletal muscle contractions, breathing, the pulsing of arteries, as well the ability of the angions to contract independently of the stretch receptors.

Manual Lymph Drainage’s effectiveness lies in its ability to activate the stretch response, which significantly increases the pulsation rate of the lymphangions, increasing lymph flow through the vessels. By performing Manual Lymph Drainage correctly, we can stimulate the opening of the initial lymphatics and increase the volume of lymph flow by as much as 20 times.

But if a therapist pushes too hard, they can cause the collapse of the lymph vessels close to the skin, diminishing the lymph flow in two ways:

  1. Excessive pressure can break the filaments that hold the initial lymphatics (whose walls are only one cell thick) in place, and
  2. damage the tiny overlapping inlet vents, that allow lymph to enter into the whole system. (These are also the reasons that deep styles of massage are contraindicated in areas of oedema.)

When one has regular and multiple MLD treatments, the continued stimulation opens up additional pathways, rapidly increasing the flow of lymph. This accelerates healing, while any swelling and bruising resulting from injuries or surgery disappear more rapidly.

At the same time MLD also affects the parasympathetic nervous system, which produces a calming, relaxing effect on the body and mind. Many patients fall asleep during the treatment, and report sleeping extremely well later on.

A Manual Lymph Drainage treatment usually lasts from 45 minutes to an hour.

When you first begin MLD, you may find it hard to believe that the gentle strokes of the massage can have any positive effect at all. But most patients are pleasantly surprised at the quick response of their body to this external means of moving the fluid trapped inside them.

Direction of lymph flow


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 ensure you are comfortable, as relaxation improves the effects of MLD. Dimming the lights is standard procedure, and some therapists add music to enhance the mood of rest and quiet.

For most MLD treatments you will need to remove everything but your underwear. Your therapist will provide a pillow, comfortable support for your knees, and towels to drape your body. Throughout the massage you will remain modestly draped, with only the areas being worked on exposed at any one time.

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 your treatment, and again before heading for home.


The reason that no oil is used during MLD treatments is because the skin has to be stretched in order for the lymph to move in the vessels, and great precision is needed – the therapist’s hands cannot slip and slide.

The lightness of the touch is due to the fact that the walls of the lymph vessels close to the skin are only one cell thick, so greater pressure would result in the damage of these initial lymph vessels, which would be counter-productive.

The slow speed is due to the fact that the MLD mimics the normal rate at which the lymph flows in the body. If it is too fast, the system cannot cope, and one produces spasms in the lymphangions (the little compartments in the lymph vessels)

The repetition is vital, too, as one has to overcome the inertia of the lymph in the vessels…by repeating the strokes time and time again, the therapist ensures that the lymph actually moves.
Manual Lymphatic Drainage massage can go where Deep Tissue and Swedish cannot – into swollen areas! The paradox is that such a gentle, superficial technique has such a deep impact.


When it comes to hand pressure, learning the correct application of lymph drainage obligates massage therapists to change all their concepts of touch and the general philosophy of their practice.

Often patients also find it difficult to accept the possibility that light pressure can be effective in any way. While classic massage uses much harder pressures, in order to reach and affect the muscles, the opposite is true of MLD. What holds for a solid model (connective tissue, fascia, muscle etc), does not apply to a fluid model.


Everyone who participates in sports hopes to do so to the best of their abilities, to avoid injury and to maintain fitness.

MLD can quickly reduce swelling and inflammation following minor injuries and therefore helps these heal quicker, and it greatly speeds up the removal of lactic acid from the tissues. In Europe MLD is regularly used as a maintenance treatment by high performance athletes.

For the athlete, one of the great advantages of using MLD is that it is completely drug free.

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