Lymph Drainage Therapy (LDT) is an original method that offers new tools to achieve these results. For the first time, practitioners are able to feel the specific rhythm, direction and quality of the lymph flow and to map its direction through the lymphatic vessels. These advancements have been shown to bring improvement in a shorter period of time and to make the lymphatic drainage process more pleasurable to receive, as well as less tiring and straining to perform. Lymph Drainage Therapy has also demonstrated itself as a technique that can easily and effectively be integrated within the normal massage therapy session.

The Basis of Lymphatic Drainage
The proper functioning of the lymphatic system is essential to our body’s ability to detoxify and regenerate tissues, filter out toxins and foreign substances, recover crucial substances that have escaped from the blood, and maintain a healthy immune system. The system accomplishes these tasks using vessels to transport substances such as proteins, toxins, hormones, fatty acids, immune cells and waste products to the lymph nodes, which then filter out the harmful elements.

Unlike the circulatory system, which uses the pumping of the heart to circulate its blood flow, lymph vessels rely upon hundreds of tiny muscular units, or lymphangions (Mislin, 1961), contracting throughout the body to propel the lymph. Because these muscular units work in conjunction with the autonomic nervous system, their action can actually be hindered or stopped due to fatigue, stress, emotional shock, cold, infections, lack of physical activity, age, chemicals or food additives. When lymph circulation stagnates, toxins accumulate and cellular functioning is significantly compromised. This opens the way to many physical ailments and hastens the aging process.

This is when our hands can assist nature in its work by helping to stimulate the circulation of lymph and interstitial fluid.

The first researcher credited with developing a precise manual approach to working with the lymphatic system was osteopath Frederic P. Millard of Canada. Beginning in 1904, he conducted extensive lymphatic studies, the results of which he published in Applied Anatomy of the Lymphatics (1922). In his writings Millard used the term “lymphatic drainage” to describe his techniques.

The next great breakthrough came between 1932 and 1936 in France. Emil Vodder from Denmark developed a specific manual technique for lymph drainage that could be used to enhance lymphatic circulation. He first revealed his technique to cosmetologists in France. Vodder was not a medical doctor, physical therapist or even a massage therapist. (In France, the practice of massage therapy is restricted to registered physical therapists.) He was a doctor of philosophy (1928, Brussels). Although his technique was advanced for its time, Vodder had difficulty proving its efficacy and safety; thus, his work gained little acceptance initially from the scientific community. It was not until the end of the 1960s that Vodder’s Manual Lymph Drainage technique was scientifically tested and its effects finally recognized.

I developed Lymph Drainage Therapy based on the techniques of Millard and Vodder along with discoveries I made over the course of many years of intense study and practice in traditional medicine, osteopathy and manual therapies. The result is a process that enables trained practitioners to attune manually to the specific rhythm, pressure, quality and direction of lymph flow.

Advanced practitioners of LDT learn how to perform a full-body Manual Lymphatic Mapping (MLM), which consists of using the hands to assess the specific directions of lymph flow in addition to areas congestion and fibrosis. This can be performed before, during and after treatment. The process provides a dynamic aspect to LDT by permitting therapists to interact with the lymph and interstitial fluids at different levels—from the most superficial cutaneous circulation to that of the mucosa, muscles, tendons, periosteum and viscera.

Indications of Lymph Drainage Therapy
Lymph Drainage Therapy is effective for a wide range of conditions and can safely be applied to everyone from children to the elderly if the basic precautions and contraindications are respected. Here are just some of the known effects of lymphatic drainage on the body.

— Circulation of lymph, blood capillaries, veins, interstitial liquids, and cerebrospinal and synovial fluids (indirectly) is activated. This action helps to reroute stagnant fluid in the skin (i.e., edema, primary and secondary lymphedema), mucosa, muscles, viscera, joints, cranial sutures, periosteum, chambers of the eyes and cochlea.

— Toxins are removed, making lymphatic drainage especially effective in tissue regeneration. Scars, stretch marks, wrinkles and fracture or surgical-incision sites are improved. Many therapists also use LDT as part of detoxification and anti-aging regimens.

— Macromolecules (proteins) are drained, which helps to eliminate protein-rich fluid from the extracellular tissues and aid the reabsorption of edema.

— Fats are evacuated through lymphatic vessels. These vessels are located in virtually every area of the body where fats may accumulate.

— The functioning of the immune system is stimulated through increased lymph flow. The additional flow carries more antigens to the lymph nodes, thereby increasing antibody/antigen contact. This has been found to help with chronic or subacute inflammatory processes—chronic fatigue syndrome, autoimmune disease, bronchitis, sinusitis, amygdalitis, tonsillitis, laryngitis, arthritis, acne, and eczema.

— The functioning of the parasympathetic system is bolstered and sympathetic tone is diminished with stimulation of the lymphatics—the “fight or flight” response. This can be very helpful in dealing with stress, depression and sleeping disorders.

— Chronic pain is reduced as the drainage alleviates tissue-fluid stagnation and possibly inhibits nociceptors (pain receptors).

— Voluntary and involuntary muscle spasms are reduced, proving helpful in cases of constipation and other muscle-related maladies.

As with any technique, there are conditions under which lymphatic drainage should not be used. These include acute infection or inflammation (especially any condition with fever), major circulatory and cardiac problems, acute bleeding, and malignancy not under medical control. Therapists should always consult and work under the guidance of a physician if there are any safety concerns.

Application of LDT With Massage Therapy and Other Modalities
The most effective application of Lymph Drainage Therapy requires a keen understanding of the lymphatic system structure along with sharpened listening skills and intuition. A major component of this therapy is learning to listen and tune in to the natural rhythms of your clients, allowing their specific rhythm and the movement of their liquids to move your hands at the right time and in the right direction.

When integrating Lymph Drainage Therapy with other modalities, it is essential to be aware that varying pressures and rhythms are involved. In some pathologies, such as edemas and lymphedemas, it is of utmost importance to use light pressure so that the few remaining, fragile lymphatic vessels are not damaged. Hand pressure should remain just enough to stimulate the reabsorption and automotoricity functions of the lymphangions, but not to increase blood capillary filtration. O. Eliska and M. Eliskova demonstrated scientifically that pressure more than 30 mm Hg applied to the pathology can cause damage to the lymphatic vessels (“Are Peripheral Lymphatics Damaged by High Pressure Manual Massage?” Lymphology, 1995, 28:21-30). The ideal hand pressure generally is 1_ to 2 oz. (0.5 to 2 oz.) / cm2, which is about 4 to 8 oz. per square inch, or the approximate weight of a nickel or dime. Examples of modalities that benefit from integration of LDT are Swedish massage, CranioSacral Therapy, Visceral Manipulation and acupressure.

Provided the lymphatic system is not damaged, a few minutes of LDT can help release most of the trigger points, fascia pulls, chronic pain and inflammation. Deep-tissue massage, neuromuscular therapy, Rolfing, Hellerwork, and other techniques involving heavier pressure, can then be applied with greater ease. To avoid the potential side effects of heavy-pressure massage, however, it is very important to also spend at least 10 minutes at the end of the session applying Lymph Drainage Therapy. This helps to evacuate waste products released in the circulation and alleviate any muscular inflammation, spasms or bruising incurred by the tissue. Specific lymphatic drainage of the lobes of the liver is also valuable for releasing most of the post-treatment effects.

The distinctive enhancements Lymph Drainage Therapy brings to the field of lymphatics make it a highly effective adjunct to the massage therapist’s practice. Using LDT, therapists are able to connect to their clients in a much deeper way—feeling the flow of the lymph, moving with it, following the results as the work is done. And it is from this place of deep connection between the therapist and client, together with the applied technical advances, that profound outcomes are emerging.

Manual Lymphatic Mapping (MLM) and Its Clinical Application
Manual Lymphatic Mapping (MLM) represents one of the most recent advances in lymph drainage techniques. A noninvasive process, it enables trained practitioners to manually assess the specific direction of lymphatic circulation, and then use that information to determine the most efficient alternate pathways for draining areas of fluid stagnation.

For example, in a case of post-mastectomy lymphedema presenting in the upper extremity, the obstructed lymph flow must reroute to an unaffected lymph territory (lymphotome). There are some 20 anterior and posterior alternate pathways from which it may choose to accomplish this task, including the axilla, inguinals, clavicles, intercostals, Mascagni’s pathways, and vasa vasorum. It may be difficult for a practitioner to determine which pathway the lymph flow will take. Making a wrong assumption can cause a significant loss of time and resources. Using Manual Lymphatic Mapping, the therapist can find the specific alternate pathway preferred by the lymph.

Manual assessment of the lymphatic rhythm and direction requires time and dedication. It is recommended that therapists new to the method first develop their skills for assessing the rhythm of the lymphatic flow. With training and practice, most are able to attain the sensitivity required to evaluate the rhythm, and then to determine the specific direction of lymphatic flow.

While the scientific means for measuring the accuracy of client mapping are not yet available as of the writing of this article, investigations are currently underway using protocols to help measure and document the efficacy of this technique (lymphangioscintigraphy).

For more information on Lymph Drainage Therapy, contact The Upledger Institute at 1-800-233-5880 or www.upledger.com.

Bruno Chikly, M.D., is a graduate of the medical school at Saint Antoine Hospital in France, where his internship in general medicine included training in endocrinology, surgery, neurology and psychiatry. He is the recipient of the Medal of the Medical Faculty of Paris, VI, a prestigious acknowledgment for his in-depth work and scientific presentation on the lymphatic system. Dr. Chikly is a member of the International Society of Lymphology and an associate member of the American Academy of Osteopathy and the Cranial Academy. He also serves on the international advisory board of the Journal of Bodywork and Movement Therapies and is listed in the Millennium Edition of Marquis’ Who’s Who in the World. Dr. Chikly’s book Silent Waves: The Theory & Practice of Lymph Drainage Therapy (LDT) is due for release in August 2001; it served as the basis for this article. Dr. Chikly lives in Arizona with his wife and partner, Alaya Chikly, who is the curriculum director of Heart Centered Therapy (HCT): Mastering Voice Dialogue, a course that addresses the emotional component in disease.