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Franklin Massage Therapy / Lymphatic Massage

      Manual Lymphatic Drainage (MLD) is a form of massage therapy in which the massage therapist tries to manipulate lymph flow in the body.  The therapist does this by using gentle and rhythmic pumping techniques on the skin in the direction of the lymph flow.  By stimulating the lymphatic system through massage, it works more efficiently which in turn boosts the immune system, clears blockages, eliminates toxins, transports nutrients to cells and increases the metabolism.

     Unlike many forms of bodywork that use deep pressure, MLD uses light, gentle, rhythmic strokes that stimulate lymph flow and fluids toward the lymph nodes and eventually out of the body.  Once the cellular debris and toxins are removed, the body is better able to repair itself and give the proper nutrients to the muscles and tissues.

     This technique is extremely relaxingand many of my regular Swedish massage clients alternate between MLD and Swedish sessions.  Manual Lymphatic Drainage is wonderful for removing toxins from the body, and it just feels wonderful!  Many of my current clients notice a change in their sinuses during the sesson, and continue to notice improvements up to three days later!

     Some benefits of manual lymphatic drainage can be...

  • Helps Promote Healing---This can include promoting the healing of acute injuries, such as sprains and fractures.
  • Helps Prevent Illness---MLD is helpful in healing illnesses and injuries that currently exist in the client's body, and it can help the body prevent illnesses from occuring in the future.
  • Reduces Swelling---Because MLD helps to remove excess lymphatic fluids from the body, many clients see a reduction of swelling around the eyes, hands, arms and legs.  MLD is extremely effective for treating increased edema following the removal of lymph nodes in cancer treatments. 
  • Relaxation---Just as with most forms of massage therapy, MLD is a very relaxing therapy for the client.
  • Helps Promote Overall Well-Being---By reducing swelling, reducing pain, increasing immunity and helping to heal many illnesses, MLD is thought to increase the overall well-being of clients.


Lymph Massage
Armoring the Immune System
By Karrie Osborn

Originally published in Body Sense magazine, August/Winter 2005. Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.

     As the cold and flu season approaches, it's time to bolster the immune system and give it a coat of armor against the certain onslaught that awaits.

     Maybe you already take a defensive stand this time of year with a more diligent use of vitamins and herbal supplements, heightened precautions with hand-washing, or an extra glass of orange juice or serving of broccoli. But have you ever considered a lymph massage to help your body stave off the blues of winter illness?

     "At the start of the flu season, have one or two lymph massage sessions to really charge the immune system," says Ramona Moody French, author of Milady's Guide to Lymph Drainage Massage, and founder of the Desert Resorts School of Somatherapy in Palm Springs, Calif. "There's a lot of scientific evidence for how effective it is," she says, both in its ability to increase the production of white blood cells and to stimulate the immune system.

     Lymph massage, also known in variations as Manual Lymphatic Drainage (MLD) or Lymph Drainage Therapy (LDT), is a gentle, relaxing form of massage that helps the body's lymphatic system get moving again while reinforcing immune function. To fully understand the benefits of lymph massage, let's first take a quick look at how this lesser-known system works.


Lymph's Life
     As a vital component of the body's immune function, the lymphatic system is comprised of several organs (thymus, tonsils, spleen, adenoids), hundreds of lymph nodes, and a multitude of vessels that run throughout the body similar to our circulatory system of veins and arteries. These lymphatic vessels carry a clear fluid, known as lymph, that circulates around the body's tissues, absorbing fluid, waste products, dead cells, bacteria, viruses, fats, and proteins from the tissue as it goes, while also giving passage to immune cells as they're needed.

     Lymph nodes are found throughout the body -- including most notably the neck, armpits, and groin -- and have the job of filtering the lymph fluid and removing damaging elements they've picked up along the way, such as bacteria and cancer cells. When the lymph nodes detect these foreign elements in the fluid, they begin producing additional infection-fighting white blood cells, and become enlarged in the process, hence a swollen gland.

     If the system gets overtaxed because of ill health, surgery, stress, or poor diet, it can get sluggish and not do its job as efficiently. As a major player in the body's immune process, it makes sense that by waking up the lymphatic system you dramatically improve your chances for staying healthy.

A Massage That's Barely There
     With lymph massage, the system gets a wake-up call through delicate means. Lymph massage is extremely gentle and slow, not just as an aspect of its healing nature, but by necessity. "Most of the lymphatic vessels are just below the skin and are stimulated by .5 to 8 ounces of pressure per square inch," French says. That light, slow pressure mimics the pulse and rhythm of the lymphatic system itself and gets the vessels to respond as they should. Each stroke slightly moves the skin in the direction of the lymphatic flow to encourage the drainage of fluid and waste.

     The delicate nature of each stroke as it carefully glides across the skin can sometimes make it feel as if nothing is happening, especially for those who are used to deep bodywork. But it's exactly that noninvasive quality of lymph massage that makes it work. "The results can be profound," French says.

     Depending what your complaints are, the focus of a lymph massage for general immune stimulation is typically on the upper body, including the face, neck, and arms. The massage always has fluid moving toward a healthy lymph node, and while most therapists don't work directly on the breast, they do address the tissue surrounding the breast.

     If your primary complaint is swelling, scar tissue, or inflammation, therapy should focus on the part of the body where that occurs. For anyone wanting to address issues of musculature, as well as lymph, French recommends 20-30 minutes of deep tissue massage, followed by 20-30 minutes of lymph massage.

     After your lymph massage, it's important to drink plenty of water as things get moving again. French says it's possible you could feel some mild, flu-like symptoms, depending on how toxic your body is (i.e., what environmental pollutants you've been exposed to, what sort of diet you've been following, what types of medications you're taking, and how much sugar or alcohol you consume). While most people come out of a typical lymph massage feeling nothing but relaxed, French says if you do feel a little off-kilter afterward, the best solution is to "drink plenty of water, watch your salt intake, and get up and move." Movement, she says, creates a greater lymphatic response and will hurry the process along.


Today or Year-Round
     During the often-stressful holidays and the viral barrage of the cold and flu season, French says it's especially important to pay attention to your body. If you're feeling tired or run-down, she recommends getting a lymph massage. It will help charge your batteries, so to speak, and prep the immune system for the road ahead.

     French also advises her clients to consider a good lymphatic work over when the seasons change. Two to three sessions, preferably all in one week, but at least over a few week's time, is what the body needs to recharge itself, she says.

     On a year-round basis, lymph massage is a good treatment for edema (or swelling), any kind of inflammation (such as tendinitis), or a recent injury (like an ankle sprain), and is really helpful with sinus conditions and a general sense of congestion. "It also helps to reduce scar tissue and stimulate the circulation and production of white blood cells," she says.

     But this work might even have greater opportunities for those who want to explore them. "Lymph massage can get you moving on a deeper level," French says. It's not only relaxing, but very hypnotic, she explains. Mimicking the natural pulsation of the lymph system, lymph massage can create a sensation not unlike listening to the ebb and flow of the ocean's waters. "It's like feeling the waves flow over you," she says. "Like being bathed in the ocean."

When the Body Fights Back
     When the lymphatic system is especially compromised, as in the presence of cancer or after it's been disrupted by surgery, it can slow to a near negligible pace. This is when a swelling of the lymph passages occurs, known as lymphedema, creating a painful, potentially debilitating condition. One of the most common causes for lymphedema is undergoing a mastectomy, where breast tissue and/or lymph nodes under the arm are removed. Of the women having this operation, up to 15 percent are likely to get lymphedema. But it's not just mastectomies where lymphedema is showing up.

     According to the National Lymphedema Network, if lymph nodes are removed, there is always a risk of developing lymphedema, anywhere from hours after the surgery to 20 years later. Even when there's been no surgery, lymphedema can come into play if there have been radiation treatments. Like surgery, radiation therapy creates scar tissue that stalls the normal flow of lymphatic fluids through the body.

     Lymph massage has shown to be effective for lymphedema, especially when caught early. When significant scar tissue has started to form as a result of chronic swelling, the work can take a much longer time, but is still effective.

     If you are a postsurgery patient, be mindful of the signs of lymphedema -- tightness in the skin, a feeling of "fullness" in the affected area, and persistent swelling. It's important to report these symptoms to your health-care provider and even seek out a second opinion. Unlike the protocol in Europe, where it's the third most prescribed health treatment, lymph massage, and lymphedema itself, are not always discussed between U.S. physicians and their patients. If you are at risk and your doctor doesn't bring it up, it's important you start the conversation.

     In addition to lymphatic massage, combined approaches for lymphedema include the use of compression garments, bandaging, diet control, skin care, and condition-appropriate exercise. Many therapists like to send their lymphedema clients home with the knowledge of how to administer this massage for themselves. "For long-term problems like chronic edema or scar tissue, clients can learn to self-treat," French says, allowing the work to keep going between sessions.

     If you, or someone you know, is dealing with the debilitating effects of postsurgical lymphedema, lymph massage is something to be considered. Talk it over with your doctor, and see if your massage therapist can offer this work or refer you to a colleague.

     Whether it be to alleviate the more serious effects of post-surgery lymphedema, or simply to give the lymphatic system a good kick start as flu season approaches, consider a lymph massage. Feel what it is to be "lighter," to be "opened," to be awash in the waves of healthy lymph, and have things moving again.

Karrie Osborn is contributing editor to Body Sense magazine.

Lymph Drainage Therapy
An Effective Complement to Breast Care

By Bruno Chikly, M.D.

Originally published in Massage & Bodywork magazine, June/July 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved
.


     Legal and ethical issues often provide a controversial backdrop to the subject of breast massage. Further fueling the debate is the question of who exactly is qualified to perform this technique. While there may be many schools of thought, the fact remains there is an appropriate and practical manual technique -- Lymph Drainage Therapy -- that can be used by trained therapists for specific conditions and indications relating to breast care.

     Lymph Drainage Therapy (LDT) is a gentle, light-touch, noninvasive technique that offers qualified therapists a natural complement to their existing health care protocols. Within the context of breast care, LDT can help alleviate numerous conditions related to pregnancy, including engorgement, sore nipples (transient, chronic), plugged ducts, wounds, fissures, ulcerations, bruises and dermatitis (eczema). This therapy also can provide relief from chronic inflammation and pre- and post-surgical applications, and can be used for cosmetic applications, such as mastoptosis, scars and traumas.

     Best results are obtained with accurate knowledge of the specific anatomy, physiology and related hand techniques involved so the practitioner can attune to the precise rhythm, direction, depth and quality of the lymph flow.

     When studying the numerous lymphatic vessels of the breast and the pelvic organs, it becomes clear the rich lymphatic networks found in these areas are highly amenable to the light touch of LDT. For example, heavy pressure should not be applied to breast tissue. Petrissage and kneading may not only hurt, but may destroy the few suspensory ligaments (Cooper's ligament) and elastic fibers which prevent sagging (mastoptosis). Additionally, since breast tissue is well-supplied with lymphatics but lacks sources of external compression (such as muscles or strong overlying fascia) to promote the natural lymphatic drainage found in most other body tissues, fluid has a tendency to accumulate in the breast. The light-touch specific approach of LDT provides an ideal solution to fluid stagnation.


The Lymphatic System
     The physiology and physiopathology of the lymphatic system was slowly unraveled over time by a group of scientists interested in this mysterious fluid. While medical schools only provide very basic training concerning this body system, the critical function of the lymphatic system is now more readily acknowledged as a means to improve our overall health and well-being.

     The lymphatic system absorbs fluid, macromolecules, microorganisms, toxins, waste products and foreign substances from the interstitial tissue. Numerous substances (electrolytes, proteins, hormones, toxins, debris) and immuno-competent cells (lymphocytes, macrophages) pass through the regional lymph nodes, where this fluid is filtered, purified and concentrated.

     The lymphatic flow can stagnate for many reasons, such as swelling, chronic inflammation, lack of physical activity, stress, fatigue, emotional shock, age, poorly fitted brassieres, or brassieres worn for an excessive amount of time. When lymphatic circulation slows down, the regeneration of cells becomes less effective. This condition allows toxins and proteins to accumulate around the cells, causing cellular oxygenation to decrease and tissue regeneration to diminish.

     LDT practitioners can facilitate nature by stimulating the natural peristaltic contractions of the two to three layers of muscles located along the lymphatic pathways, also called lymphangions (Mislin, 1961). Stagnating fluid, toxins and wastes will be drained through the flow of lymph. During its passage through lymphatic nodes, the body will generate production of more lymphocytes to reinforce immune response and accelerate contact antibodies/foreign substances.

     Advanced practitioners of Lymph Drainage Therapy are trained to interact with the fluids at different levels, from the superficial cutaneous circulation to the mucosa, muscles, tendons, periosteum and viscera. They also perform Manual Lymphatic Mapping and assess the direction of lymph flow before, during and after treatment to see if the location of lymph stagnation has improved.


Applications and Contraindications of LDT
     The applications of Lymph Drainage Therapy are numerous:
- Circulation of lymph, blood capillaries, veins, interstitial liquids and cerebrospinal and synovial fluids (in-directly) 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.

     Therapists must also know the contraindications and precautions of LDT, remembering as well to use common sense. Lymph drainage should never cause pain. If there are any doubts, practitioners need to work under the guidance of a physician. The basic contraindications of lymphatic drainage are:

- Acute infectious/early onset inflammatory disease and fever. The therapist should wait until the fever breaks or until clinical signs have clearly diminished. (This usually takes 24-72 hours if antibiotic therapy is used.)

- Serious circulatory problems such as thrombosis. If there is a risk of embolism and phlebitis, the therapist should not risk tampering with the clot.

- Major cardiac problems including acute angina pectoris and coronary thrombosis (heart attack). Lymphatic techniques may increase the cardiac load.

- Hemorrhage (bleeding). The therapist should be absolutely sure the bleeding has stopped before draining. You can, however, drain the same day to reduce hematoma.

- Malignant ailments such as an undiagnosed lump. At the beginning of the 20th century, people were afraid of the possibility of provoking metastasis in cancer that was either evolving or not under medical supervision. A few studies have been made comparing groups of cancer patients treated with lymph drainage vs. untreated control groups. The results showed no increase in complications or metastasis in the treated group. At this date, no rigorous scientific study has demonstrated the spread or severity of cancer was aggravated by lymph drainage. This notion is also shared by consensus of the International Society of Lymphology (1995): "Rare reports suggest that MLT [Manual Lymphatic Therapy] may promote metastatic disease, although, theoretically, only diffuse carcinomatous infiltrates which have already spread to lymph collectors as tumor thrombi could be mobilized by mechanical compression…Mobilization of dormant tumor cells by arm compression in patients after treatment of carcinoma of the breast remains speculative and thus far unconvincing or unfounded."

     For the therapist's own protection, however, they should not work on active-cancer patients if the tumor has not been removed and is not under medical control, and always check with a physician. The therapist must bear in mind that only a physician is qualified to make a diagnosis and prescribe a treatment for any of the above described disorders.

     Further, when working on a patient's breast, it is important for the therapist to be aware of the trust the client has given him or her. A therapist must respect and honor this trust at all times. Proper draping should always be used to provide comfort and security to the client. In addition, prior to beginning the treatment session, the client should sign a release form giving the therapist permission for breast work. This form should describe why and how this technique is applied, as well as explain the comfort level of touch between the therapist and client. It also should state a client can stop the massage for any reason at any time during the treatment process. This decision will be honored, no questions asked.


How to Achieve Optimal Results with LDT
     In order to acquire the skills for an efficient LDT session, there are several points that need to be learned and observed by the therapist:

Rhythm and frequency of movements.  Therapists are trying to help serve the client. They carefully listen to the clients' specific lymph rhythm and follow and enhance this natural rhythm of life. The best results can be expected if they can tune in to this gentle pulse in each part of the body.

Hand pressure.  The way lymph drainage is applied often obligates therapists to change all their concepts of touch and the general overview of their practice. LDT works so subtly it may lead to a new way of approaching the body and getting information from it.

     The motions for drainage should be gentle, steady and harmonious. The manual maneuvers must also be gentle enough so as not to increase filtration from the blood capillaries. The pressure should be just enough to stimulate reabsorption and the pacemaker-like motoricity of the lymphangions. Optimal pressure prevents the lymphatic capillaries from collapsing (<45 mm Hg). Too much pressure may aggress and damage the filaments of the lymphatic capillaries and the breast tissue. It cannot be emphasized enough that in cases of edema and lymphedema, the touch must be very light.

     The average pressure used is usually around 33 mm Hg, or 1 oz. / cm2, which is about 8 oz./ in2. This can be thought of as a "feather touch." The pressure of the superficial drainage is barely the weight of a nickel or a dime. The pressure to be applied depends on the client, the area being worked on (e.g., pressure for the breast tissue is lighter than that for the legs) and the pathology (e.g., lymphedema or inflammation).

Direction of flow: Manual Lymphatic Mapping (MLM).Whatever lymph territory the therapist is working on, the lymph must be sent to the group of nodes responsible for drainage of that area. MLM usually gives accurate information concerning the direction of lymph flow.

     Manually assessing the lymphatic rhythm and direction requires time and dedication. Without previous training, it may seem totally impossible to feel such a subtle component of the lymph circulation. It is recommended therapists new to this 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. They are then are able to determine the specific direction of lymphatic flow. In my experience, more than 90 percent of participants in the second-level LDT workshop are able to meet the challenge of manually finding the specific lymphatic pathways in an unknown lymph territory or lymphotome. Students repeatedly find answers that are consistent with superficial or deep lymphatic circulation as shown on anatomical charts.

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

Hand techniques. Remember, wrists are the best indicators and activators of movement.

Duration of movements. The sequence of movements (proximal to distal, then distal to proximal), the duration of a session and other observations can be properly learned only in the setting of a professional seminar.

     Contraindications and precautions should always be learned, observed and respected.

     Lymphatic drainage techniques are among the most scientifically documented, gentle and efficient hands-on therapeutic tools practiced today. They are widely utilized in hospitals and clinics across Europe and are reimbursed by Medicare in Florida for lymphedema. Because the acquired touch of Lymph Drainage Therapy is very respectful and nonstimulating, it can be used by massage therapists to effectively ease numerous breast conditions -- as well as the controversies concerning massage therapists and breast care.


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. Dr. Chikly 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. He is a member of the International Society of Lymphology and an associate member of the American Academy of Osteopathy and the Cranial Academy. He serves on the international advisory board of the Journal of Bodywork and Movement Therapies and lives in Arizona with his wife and partner Alaya Chikly. Information in this article is taken from a new book by Dr. Chikly: Silent Waves, Theory and Practice of Lymph Drainage Therapy (LDT), published by I.H.H. Publishing. For more information about this subject, contact Dr. Chikly at bchick@aol.com.