Massage Therapy Journal Winter 2024

Winter 2024 • 51

AMTA Continuing Education

increase in lymph volume within the collectors. The collectors then respond to the accumulation of fluid by amplifying the frequency of lymphangion contractions (lymphangio-pulsation). Calms the nervous system. The slow rhythmic nature of MLD decreases the sympathetic nervous response and activates the parasympathetic nervous response, creating a calming, soothing effect. Relieves pain. MLD can enhance the removal of nociceptive substances from the tissues while providing a stimulus for the gate control theory, which changes the way pain signals are transmitted to the brain. Redirection of lymphatic fluid. For many different reasons, the lymphatic system’s transport capacity can become either compromised or deteriorate as a result of trauma, surgery or general wear and tear, and if movement of lymph fluid is interrupted, lymphedema can occur. Lymph stasis can create a dermal thickening as protein-rich fluid causes inflammatory responses and scar formation within the interstitium. When applied correctly, MLD can remove the fluid from the tissue—away from the blocked or scarred area—and direct it toward a healthy, uncompromised region of the lymphatic system. Although MLD is an effective modality for most clinical presentations, massage therapists need to keep in mind that because MLD techniques directly move fluid from the interstitial space and return it back to the systems of the body that are responsible for fluid management, notably the cardiovascular and urinary systems, there are some serious contraindications to this technique. Prior to providing MLD on a client, ruling out any possible contraindications is imperative, including the following: Untreated congestive heart failure (cardiac edema). The heart performs as a central pump for the cardiovascular system, providing a high pressure mechanism for transporting blood throughout the body, enabling a life sustaining supply of oxygen and nutrients to the cells and tissues. The amount of blood pumped around the body will depend on the demand the body has for the blood. The heart will always accommodate

the body’s demands unless it is experiencing mechanical difficulties. If the pump weakens or even fails, Cardiac Insufficiency, also known as Congestive Heart Failure (CHF), can occur and, if left untreated, will eventually cause death. Certain pathological abnormalities can weaken the cardiac muscles, such as narrowed arteries or excessive high blood pressure, often leading to CHF. When the heart is unable to function adequately as a pump, blood that is circulating around the body in the venous system backs up, leading to fluid build-up in the lower extremities, abdomen and in certain cases, the lungs. MLD is therefore contraindicated, as moving more fluid back into the cardiovascular system will increase breathing difficulties whilst exerting more pressure on an already poorly functioning heart. Signs and symptoms of CHF are dyspnea, (shortness of breath), fatigue, bilateral lower extremity edema (swelling), and an irregular or rapid heartbeat. If you have a client that comes to you for support with edema, it is essential that you ask if they have experienced any of these symptoms and if the answer is yes, it is very important that they receive immediate medical attention . Acute infections and fever . Infections caused by pathogens such as cellulitis are contraindicated in any massage modality, particularly MLD, where the movement of lymphatic fluid will move the pathogen throughout the system. Signs of infection are redness, edema, heat and often soreness. Clients with a compromised lymphatic system, such as cancer patients who have had lymph node removal, are at an increased risk of developing localized infections due to the decreased immune response in the area. Cellulitis is an acute infection of the subcutaneous tissue that causes inflammation and edema of the superficial dermal lymph vessels. The cause of this infection is most typically the streptococci bacteria, and it’s commonly treated with intravenous antibiotics. If left untreated, cellulitis can cause fatigue, fever and may require hospitalization to prevent sepsis from developing.

Manual lymphatic drainage is a gentle massage technique specifically focused on supporting the functions of the lymphatic system and at the same time has a powerful effect on the nervous system.

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