Lymphedema Self Massage Therapy

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Lymphedema Self Massage Therapy

Postby patoco » Sun Jun 11, 2006 9:43 pm

Lymphedema Self Massage Therapy

Our Home Page: Lymphedema People


All the Lymphatic Drainage strokes are based on one principle motion.

Research has found that the initial lymphatics open up and the lymph angions are stimulated by a straight stretch, but even more so with a little lateral motion. After these 2 motions, we need to release completely to allow the initial lymphatics to close and the lymph to be sucked down the channels. In this zero pressure phase don’t completely disconnect from the skin, just return your pressure to nothing. Also don’t pull the skin back with you as you return, let it spring back by itself.

This basic motion may resemble a circle, and is called stationary circles. All motions are based on this principle.

In orienting this motion, we always want to push the lymph towards the correct nodes, so the last, lateral stretch motion should be going towards the nodes.

Think about moving water. Visualize those initial lymphatics just in the skin, stretch, opening them up, then release and wait for the lymph angions to pump the lymph down the vessel. Remember how superficial this is. If you are feeling muscle, or other tissue under the skin, you are pushing too hard.

Here are four points remember when performing Lymphatic Massage-

1. Correct pressure is deep enough so that you do not slide over the skin, but light enough so that you don’t feel anything below the skin. This is about 1-4 ounces. It is very common for massage therapists trained in Swedish or deep tissue to apply too much pressure with lymphatic drainage massage. Sometimes it is hard to believe that something so light could be effective. Always remember- you are working on skin. How much pressure does it take to deform the skin? Almost nothing. Remember- if you push too hard you collapse the initial lymphatic.

2. Direction of your stroke is of great importance, because we always want to push the lymph towards the correct nodes. If you push the lymph the wrong way, your work will not be effective.

3. Rhythm is very important because with the correct rhythm and speed, the initial lymphatics are opened, and then allowed to shut and then there is a little time that is given for that lymph to get sucked down along the vessel. An appropriate rhythm will also stimulate the parasympathetic nervous system, causing the client to relax.

4. Sequence means the order of the strokes. When we want to drain an area, we always start near the node that we are draining to. Always push the lymph toward the node. Then as we work, we move further and further away from the node, but always pushing the fluid back in the direction of the node. In this way we clear a path for the lymph to move, as well as create a suctioning effect that draws the lymph to the node.


Self MLD for the Lower Extremity

v Rules for MLD:

o The strokes should be made with arcing motions or half circle motions.

o Do not slide over your skin, but rather, keep your fingers in contact with your skin and stretch it gently over the underlying tissues.

o You should have NO PAIN.

o Each stroke should be done 10-15 times SLOWLY, taking about 2 seconds for each stroke.

o If redness occurs, you are pressing too hard.

o For lymphedema of BOTH legs, perform all moves on both sides.

o The best position to be in for this is seated reclined, or lying
down and propped up slightly.

o Make sure you can make skin-to-skin contact for all of these strokes. They won't work when done over clothing.


1. Neck: Place the flats of your fingers on your opposite shoulder, in the triangular part just above the collarbone and next to your neck. Move your hand in an arcing motion stretching the skin forward and down towards your chest. Repeat this on the other side.

2. Armpit: Raise your arm (on the same side as the leg in which you have lymphedema), bend you elbow, and place the hand behind your head. Place the flat of your opposite hand in your armpit. Stretch the skin in an arcing motion up towards the neck.

3. Above the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) below the breast, but above the waist. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

4. Below the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) on or just below the waist, but above your hip. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

5. Deep (diaphragmatic) breathing: Place both open palms on top of each other below the belly button. Take a slow breath in and feel your belly rise up into your hands as it expands to take in the air. Then breath out and feel your belly sink in as the breath leaves you. As you get better at this you can use your hands to resist your stomach slightly as you breath in, and press in slightly with your hands as you breath out. Don’t get dizzy. Start with only 2 or 3 breaths and work up to 10 as you get stronger.

6. Groin: Place the flat of your hand on the front of your groin, right where your underwear falls. Make a scooping motion in the groin, rolling your hand from the thumb to the little finger. Imagine that your hands are the bottom of a water wheel.

7. Back of knee: Place the flat fingers of both hands behind your knee. Perform a scooping motion up towards the body.

8. Repeat steps 3, 4 and 6 (waist and groin areas)

A very special Thanks to Katy from

LymphedemaTherapists · Lymphedema Therapists ... =143325747


Step One

Supra Clavical fossa:

Find the hollow just above the collar bone, hunch shoulders to find the hollow, then using the end of the longest finger press downward and towards the center of the neck with a firm action, release pressure but do not take finger off the skin, wait a second or so then repeat. Do this 20 times (you can do both sides together.)

Step Two


Using the middle finger as above press firmly up and into the arm and chest, using a circular motion press upward and then accross the center of the body, pressure should be applied gradually and released gradually, release pressure but do not take finger off the skin, wait a second then repeat . Do this 20 times (you can do both sides together.)

Step 3.

Clearing Cisterna Chyli:

Lying on back, lift knees by pulling feet towards buttocks, place hands on front of thighs near groin, (Top picture) take a deep breath then breath out violently, whilst doing this slide hands up front of thighs towards knees, this should lift your shoulders just off the massage table and round them a little as if you wished your shoulders to touch. Wait a second or two then repeat.
Do this 10 times.

Step 4.

Clear the sub inguinal nodes.

With fingertips push down into tissues and then pull towards tummy on nodes using a circular motion. Fingers do not slide over the skin. Release pressure, wait a second or so then repeat 19 more times.
See picture at right for location of sub inguinal nodes.
Clear sub ingunal nodes on both left and right sides

Step 5.

clear the deep nodes located in the abdominals, (Iliac nodes). Place both hands (one on top of each other) over the tummy button and apply a little pressure onto the tummy.

Now, breathe out and at the same time as doing this, press down firmly with hands on tummy to expel all the air, then as the last vestiges of air leave the tummy press down more firmly with the outside edge of the hands (see red arrow denoting side of hands) and pull them up towards the top of the tummy (the hands must not slide across the skin to do this).

Step 6.

Bounce knee towards chest.

Lying on your back bend knee, then reach down and by interlocking fingers together half way down the tibia (shin bone) pull towards your body (1) and bounce your leg towards the chest (2) Do this 10 times to each leg


Thanks to Poppy Lane Skin Care and Lymphoedema Clinic
139 Hollywood Drive
Lansvale NSW 2166

(02) 9723 5402
(61 + 2 + 9723 5402)
Fax: (02) 9726 3322
(61 + 2 + 9726 3322


Simple lymphatic drainage (SLD)

Simple lymphatic drainage is based on the principles of manual lymphatic drainage. It involves the use simple hand movements and is designed to be easily accessible to patients and their relatives. It can be applied by the patient, carer or by the therapist and is used daily within a lymphoedema treatment programme, when patients are managing their own care.

The aim is to provide a technique of manual drainage that the patient can perform independently of the therapist.
This is achieved by; incorporating simplified hand movements in a set sequence, which work across lymphatic watersheds towards functioning lymphatics.

Treatment is mainly to the neck and trunk area, although the limb may be treated. This depends on the needs and abilities of the patient and the condition of the limb.
no oils or creams are used

Contraindications to Lymphatic Drainage (both MLD and SLD) Presence of acute inflammatory episode such as cellulitis, erysipelas, influenza or active tuberculosis
Acute thrombosis

Lymphatic drainage techniques (both MLD and SLD) may be used with caution in patients with;
Cardiac insufficiency
Superior vena cava obstruction
chronic inflammation (includes skin problems such as fungal infections in the non-acute stage)
thyroid dysfunction
history of thrombosis.

In advanced cancer, lymphatic drainage techniques may be used with careful consideration of disease status and patient needs. Where there is a complex aetiology including cutaneous tumour infiltration, occlusion of venous blood flow resulting from deep abdominal or pelvis tumours, ascites and untreated hypoalbuminaemia there may be a poor response to these techniques. Lymphatic drainage may be indicated alongside other treatments in order to contain swelling at a comfortable level, reduce pain and fibrosis and enhance relaxation and feelings of well being.

Further Reading
Badger,C., Twycross,R (1988) Management of lymphoedema, Guidelines. Sir Michael Sobell House, Churchill Hospital, Oxford
British Lymphology Society Directory of Lymphoedema Treatment Services 2000-2001. British Lymphology Society, Sevenoaks
Casley-Smith, Judith R., Casley-Smith, J.R (1997) Modern Treatment for Lymphoedema. 5th Edition. Terrance Printing, Adelaide
Földi,E., Földi,M., Weissleder,H (1985) Conservative treatment of lymphoedema of the Limbs. Angiology, 171-80
Földi,M., Kubik,S (1993) Lehrbuch der lymphologie für Mediziner und Physiotherapeuter. Gustav Fischer Verlag, Stuttgart
Kasseroller,R (1998) Compendium of Dr Vodder's Manual Lymph Drainage. Karl Haug Verlag, Heidelberg
Leduc O, Bourgeois P, Leduc A (1988) Manual lymphatic drainage scintigraphic demonstration of its efficacy on colloidal protein reabsorption. In Partsch H (ed)Progress in Lymphology X1. Excerptas Medica, 551-4
Leduc A (1986) Le drainage lymphatique - theorie et practique. Masson,Paris.
Stijns HJ, Leduc,A(1977) The contribution of physical therapy in the treatment of lymphoedema. In Clodius L. Lymphoedema, Georg Thieme Publishers,Stuttgart

© BLS September 2001
First published April 1997, second edition August 1999For further information and details please contact:
Tracy Hirst-Marsden, Administration Office,
British Lymphology Society
1 Webb's Court, Buckhurst Avenue, Sevenoaks, Kent, TN13 1LZ, England
Tel: 01732 740850
Fax: 01732 459225

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