Massage Therapy Journal Winter 2024

Winter 2024 • 47

lymphedema, such as arm lymphedema for a breast cancer patient or leg lymphedema for a melanoma patient. Massage for the Lymphatic System: Manual Lymphatic Drainage The most thorough approach to moving lymphatic fluid is the use of manual lymphatic drainage (MLD). While most massage techniques are known to stimulate lymph movement, the direct and specific movements of MLD have been developed to increase the removal of interstitial fluid from body tissues and accelerate the movement of lymph within the lymph vascular system. Manual lymphatic drainage incorporates four basic techniques that can be used alone or in combination, depending upon the area of the body being worked. These techniques include: stationary circle, rotary technique, pump technique and scoop technique. For best results, massage therapists must use relaxed hands, molding their hands around the tissue being worked.

MLD techniques. The stationary circle technique is appropriate for all areas of the body, and can be applied using the whole hand, the fingers or the thumb, depending on the size of the area being worked. The hand, finger or thumb initiates the circle, with the pressure moving toward the desired direction. Once the skin has stretched to its maximum, releasing the pressure allows the skin to spring back to the original position, carrying the hand back. The pump technique is best used on rounded areas of the body, such as the upper and lower extremities and the lateral trunks. The entire hand is used, and the pressure comes from the palm, although the fingers and thumb have contact. The web space between the thumb and index finger are placed around the extremity with the palm exposed distally. The palm is then lowered so that full contact is made with the skin, then a skin stretch is applied with the entire palm of the hand toward the desired drainage direction. The pressure free phase begins by lifting the hand back up to the palm facing the distal part of the extremity and moving the hand proximal before

MLD Technique Commonalities Though different, each of the four basic techniques have the following common characteristics: 1 Gentle primarily circular stretching of the skin that affects the epifascial lymph vessels, creating a stretching motion on the walls of the lymphangions that results in an increase of the lymphangio pulsation. The subsequent increased tissue pressure enhances lymph formation. A gentle pressure is indicated since the lymph vessels being worked on are less than 1 millimeter in diameter. The superficial valveless capillaries are even smaller, making the slow, gentle application of MLD necessary. Adequate pressure should be applied, however, so that a “gliding” of the skin does not occur. When using MLD, massage therapists must consider the delicate anchoring filaments that are attached to the lymph capillaries. Too much pressure could potentially cause damage, which could also cause the lymphangions to go into spasm. A reddening of the skin is an indication of too much pressure, although when there is dense fibrotic tissue due to lymph build-up, a deeper pressure can be used. The most appropriate and beneficial pressure will vary depending on the area being worked. 2 There is a pressure phase to all these techniques that directs the fluid into the required drainage pathways (collectors), followed by a pressure free/relaxation phase in which a vacuum caused by the passive distention of the tissue leads to the refilling of the lymph vessels from the periphery. 3 Application of the techniques are at a rate of one per second with 5–7 repetitions in the area. The frequency of the lymphangion pulsations is approximately six times per minute at rest and up to 20 times per minute when there has been an increase in lymphatic fluid.

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