Massage Therapy Journal Winter 2024

Winter 2024 • 55

drains, feeding tubes, colostomy bags, morphine or insulin pumps, fibroids, hernias, liver cirrhosis and any unexplained pain. Intake and Assessment You should first ask if the client has ever received MLD before and, if their answer is no, spend some time educating them on the lymphatic system and how MLD can support optimal lymphatic function. Often, clients will request MLD by name, and for this reason it is important for massage therapists to understand exactly why they’re requesting this specific technique. Are they looking for help with a medical condition like lymphedema, or do they want relaxation? Following are questions you might ask during intake to give you a better idea of where MLD may prove beneficial and when a client may have a condition that would contraindicate MLD: • Have you received any recent surgeries? • Have you undergone any treatment for cancer? If so, how long ago? • Have you ever had lymph nodes removed or radiated? • Do you have any conditions that affect your cardiovascular function? Cardiac arrhythmias? Palpitations? • Do you have any conditions that affect your kidney function? • Do you have any concerns with your thyroid function? • Do you suffer from varicose veins? • Do you ever experience dizziness or fainting spells? • Do you suffer from hypertension (high blood pressure) or hypotension (low blood pressure)? • Do you suffer from chronic inflammation? • Do you experience any allergies? • Do you have any digestive system concerns such as IBS, Crohn’s disease or intestinal inflammation? • Do you have any implanted devices? • Are you currently pregnant or trying to get pregnant? • Do you experience difficulty sleeping?

• Do you suffer from depression, anxiety or other emotional/mood conditions? Inflammation is the body’s attempt at self protection and the start of a healing process: a local response to cellular injury marked by capillary dilation, leukocytic infiltration, redness, heat, pain, swelling and often loss of function. With an increase in the permeability of the capillaries, more plasma proteins move into the interstitium, resulting in a decrease in oxygen that leads to increased fluid volume in the interstitium. A certain amount of these plasma proteins are destroyed by macrophages in the region, but accumulations of plasma proteins in the damaged area can lead to chronic inflammation. The lymphatic system plays an important role in the healing process. MLD objectives: By stimulating and encouraging the lymph flow proximal to the inflammatory site, MLD can effectively reduce and remove the inflammatory substances that may be causing pain and irritation to the area. This will also help reduce protein load in the interstitial space and reestablish homeostasis. MLD considerations : MLD is contraindicated in cases of acute inflammation caused by bacteria, toxins and viral agents. Areas proximal to the inflammation can be treated, working more distally as healing allows. Post-surgical edema occurs following any surgical procedure that can cause edema, heat, pain, restricted range of motion and possible bruising. MLD objective: To decrease the edema, reduce pain, help promote ROM by removing excess fluid and possibly reduce the formation of scar tissue. MLD considerations: MLD can be applied proximal to the incision site immediately post-surgery. The affected areas can be treated within pain tolerance while following the recommendations of the physician. Treatments can be daily until the edema subsides. Any exacerbation in edema needs to be investigated to rule out the formation of a DVT. Sprains occur when tendons or ligaments have experienced trauma and inflammation occurs

Often, clients will request MLD by name, and for this reason it is important for massage therapists to understand exactly why they’re requesting this specific technique.

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