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Patients suffering from edema are very familiar with lymphatic drainage. The therapy method for stimulating the lymphatic flow is used almost as a standard, especially with existing water retention. However, there are a variety of other indications that speak for the use of lymphatic drainage. We will tell you in our special article on which complaints you can use the treatment method in detail, what function the drainage procedure has and how exactly it is carried out.
Our lymphatic system
The lymphatic system (Systema lymphaticum) denotes an essential part of our immune system as well as our metabolic system. Like the blood circulation, it consists of a body-wide network of vessels that ensure a comprehensive circulation of the so-called lymph (lymph) in the organism. The word lympha is borrowed from Latin and translates roughly as "clear water". And in fact, the lymph is a clear liquid, which due to its transparent, thin character is often referred to as body water.
This body water consists of a large number of different components, but its composition is very similar to that of tissue fluid. The main ingredients of the lymph are:
- and proteins.
The lymphatic fluid is formed from part of the blood plasma, which is initially released into the surrounding body tissue from small capillaries due to the effect of the osmotic pressure. The lymph already fulfills one of its most important functions, namely the supply of nutrients to tissue cells.
At the same time, the lymphatic fluid in the tissue also absorbs cell breakdown products, of which around 90 percent are transferred back to the blood vessels. The remaining ten percent of these cellular metabolic products consist of material particles such as proteins or lipids that are too large to be transported in the bloodstream and therefore have to be transported together with the lymph via the lymphatic vessels (vasa lymphatica). The lymphatic vessels conduct a good two to three liters of lymph daily, which circulates continuously in the body and thus transports nutrients and metabolic products through the body.
Another important function of the lymphatic system is the analysis of pathogens. For this purpose, samples from previously discovered pathogens are transported through immune cells to the lymph nodes (nodus lymphoideus). The five to ten millimeter large nodes of the lymphatic system serve on the one hand as filtering units for metabolic products dissolved in the lymph. On the other hand, you evaluate pathogen components and then activate the production of specific defense cells to combat the identified pathogen type.
By the way: The immune cells acting in the lymphatic system are also known as lymphocytes, although it is not difficult to see that they got their name directly from the lymphatic system.
A lymph node swelling in existing infectious diseases, but also in cancer diseases, in view of the lymph node function, initially indicate an increased activity of the lymph nodes that occurs as part of the defense against pathogens. The swellings mainly occur in body regions that have a particularly large number of these “filter stations” for the lymph. Which includes:
- and hollow of the knees.
With regard to cancer, the defense functions of the lymphatic system are relatively tricky. Because by transporting cancer cells to the lymph nodes, they can spread further in the lymphatic system itself.
In this regard, the complexity of the lymphatic channels even promotes the body-wide spread of cancer cells, which then accumulate again on parts of the body rich in lymph nodes, such as the armpit or chest. In addition to its use in edema, lymphatic drainage is therefore a popular method, particularly in breast cancer, to stimulate lymph drainage after surgery and to ensure that any remaining cancer cell residues are quickly removed before they re-establish and provoke metastases or new cancer formation.
Definition - what is lymphatic drainage?
Traditional Chinese Medicine (TCM) already dealt with the presentation of various body cycles some 3000 years ago. At that time, the so-called Qi flow was in the foreground as an essential energy cycle of the body, which through special techniques of manual therapy such as
- or cupping
could be stimulated. The idea of certain meridians as energy channels that span the entire body like a network and, depending on the type of meridian, determine the health of various body organs has been an important part of TCM to date and is the basis of a large number of treatment measures.
She gave doctors early insights into the importance of holistic therapy concepts, in which even body regions that at first glance are not connected to the actual complaint can significantly accelerate the recovery process through targeted treatment. The mere stimulation of the body's flow and its pathways can be used to remedy organ and vascular problems caused by a congestion or blockage of the Qi flow and thus impair physical health.
Manual lymphatic drainage works in a very similar way. Here too, targeted massage treatments are used to stimulate lymphatic flow. The massage expert uses his hand movements to build up focused pressure on the lymphatic vessels in order to improve the removal of the lymph inside.
In the meantime there is even the so-called lymphatic drainage, in which special devices such as a pressure cuff are used to stimulate the lymphatic system instead of the hands.
As sophisticated as the procedure for lymphatic drainage is today, it took much longer to develop than it is the case with the manual treatment techniques of TCM. On the one hand, this was to blame for the fact that the first approaches to the existence and function of the lymphatic system initially disappeared for thousands of years before they were rediscovered by modern medicine. On the other hand, from a medical point of view, some extremely risky treatment practices persisted that were carried out for far too long instead of the gentle lymphatic drainage.
History of lymphatic drainage
Compared to the body meridians, the body's own system cycles such as the lymphatic system or the blood circulation were only researched in modern times. The functioning of the lymphatic vessels in particular has long been a mystery to doctors. Although the function of blood as a “red juice of life” was clear relatively early on, the exact meaning of blood flow for human health, as well as the interplay between blood and lymph flow, was recognized very late by science.
This did not always benefit the treatment measures that were carried out in connection with (supposed) blood diseases. Just think of therapeutic measures such as bloodletting, which was used both in antiquity and in the Middle Ages for sometimes very nonsensical purposes. Many patients died at the time, partly due to high blood loss that occurred as a result of disproportionate blood draws, but also partly due to the sheer lack of bloodletting.
This could certainly help with some health problems such as diabetes or poisoning. In various other illnesses, such as iron deficiency or infectious diseases such as plague and syphilis, he increased the death rate rather than reducing it due to the inefficient application basis. Lymphatic drainage for more differentiated cleaning of the diseased body system would often have achieved better results here and even saved lives. Especially with complaints like
- Edema (water retention),
- Pain discomfort
- or metabolic disorders
even then, this form of therapy would have been a much gentler procedure.
First approaches in ancient Greece
However, the first ideas for a second vascular circulation in the sense of the lymphatic system, which exists alongside the blood circulation and how it serves to cleanse or supply body cells, only came up in the late Middle Ages, around the beginning of the 17th century. This is despite the fact that there were first approaches to a transport system for "white blood" as early as 500 BC, as the lymph was then called by medical scholars like Hippocrates or Aristotle.
The scientists at the Alexandrian School, including the famous doctor Philon, even gave the system a name. You called it Ductus lactei (Latin for milk ducts) and described it as a combination of vessels that emanate from the intestines and flow into "glandular bodies". Undoubtedly, this means the lymph nodes, which shows how close you were to deciphering the lymphatic system in ancient times.
Unfortunately, and most likely due to the great fire in the Library of Alexandria in 47 BC, in which innumerable treasures of knowledge fell victim to the fire, the old, still very vague knowledge of the lymphatic system has been forgotten for over 2000 years .
Rediscovery in the early modern period
It was more by chance that it was rediscovered by the Italian doctor Gaspare Aselli during a dog's operation on July 23, 1622, when the doctor discovered two white strands in the animal's body that ran along the abdomen and chest area and the Aselli initially mistakenly for nerve strands held. When the same strands were severed, however, a milky white liquid emerged from the vessels, the lymph.
When the doctor operated on another dog a few days later, he was amazingly unable to find the same vessels. He concluded that the first animal had consumed food prior to the surgery and that the lymphatic system was therefore visibly busy transporting nutrients during the operation.
The second animal, on the other hand, was fasting and the lymph channels were therefore very thin and could not be seen with the naked eye. The Italian doctor consequently deduced from this that the lymph flow is closely connected to the digestive process. Aselli gave the discovered lymphatic system a name similar to that of the scholars of the Alexandrian school. He called them "milk veins".
First description of the lymphatic system
It was only 30 years after Aselli's rediscovery of the lymphatic system that the Danish physician and anatomist Thomas Bartholin finally gave the lymph vessels their current name in 1652. He is also considered the first to describe the lymphatic system, the anatomical descriptions of the course of the lymphatic system have remained largely unchanged to this day.
They were later taken up again by other anatomists and doctors, such as the Dutch anatomist Anton Nuck or the French medical experts Marie Philibert, Constant Sappey and Henri Rouvière, in order to develop methods with which the lymph vessels could be made more visible. In the 19th century and thus 200 years after Aselli's rediscovery of the lymphatic system, copper engravings were finally made for the first time, tracing the course of the lymphatic vessels in the human body, and special drainage points were discovered within the lymphatic system.
Development of lymphatic drainage in the 1930s
Even more recently, the technique of manual lymphatic drainage is itself an effective treatment method for the lymphatic system to stimulate lymphatic flow. It was only developed in the 1930s by the Danish physiotherapist Emil Vodder after he noticed that patients with chronic colds had enlarged neck lymph nodes.
He then began to gently massage the swollen lymph nodes, which apparently accelerated his patients' recovery. Since then, massage of the lymphatic channels has been used as manual lymphatic drainage not only for infectious diseases, but also for a variety of other health complaints that benefit from stimulation of the lymph nodes and lymphatic vessels. In addition, the procedure is an important measure in physiotherapy and is an integral part of training as a physiotherapist as well as a massage therapist.
Areas of application of lymphatic drainage
Basically, lymphatic drainage should always serve the purpose of stimulating the mass transfer within the lymphatic system and thus improving the cleaning of certain tissue sections. Such a stimulation of the lymph flow can be important for very different health problems.
In the case of edema, the drainage process can be used, for example, to quickly remove water deposits in the tissue. As a result, the edema is enormously reduced, if not completely emptied.
In this context, lymphatic drainage also forms an essential part of the so-called complex physical decongestive therapy (KPE), which is the standard treatment for lymphedema. It consists of a total of four treatment steps, which in addition to drainage include targeted skin care, the application of compression bandages and targeted, decongesting movement exercises.
Lymphedema can be a concomitant to a number of diseases. For example, diseases that are associated with heavy fat deposits (e.g. obesity) are characterized by an increased risk of edema. Vein weakness and related disorders in venous blood transport often require lymphatic drainage to stimulate blood flow.
A third reason for the drainage procedure is edema that occurs during an operation. In the context of cancer, it is not uncommon for corresponding postoperative swellings to occur if one or more lymph vessels were severed during the surgical procedure. Here, a quick removal of lymph and tissue water would be particularly important to prevent residues from being insufficiently flushed out of cancer cells.
Speaking of surgery: lymphatic drainage can also reduce the formation of scars in the course of an operation wound. This applies especially to surgical interventions in the area of the breast (e.g. breast cancer). If lymphatic channels and / or lymph nodes are affected during the operation, the drainage of the lymph in the wound area is massively disrupted.
The result is an increase in the accumulation of lymphatic water in the tissue, which subsequently exerts pressure on the surgical wound and thus impairs wound healing. The drainage procedure enables improved lymph drainage and not only faster wound healing, but also reduces the risk of scarring and even stimulates the formation of new vessels.
Far from edema and congested lymphatic water, there are other illnesses for lymphatic drainage. Among other things, the immunological aspect should be mentioned here. As already mentioned, this contributed to the original invention of the drainage process. In fact, manual lymphatic drainage can strengthen the immune system by stimulating the defense mechanism that takes place there by gently massaging the lymph nodes. This also reduces the lymph node's error detection rate, which can counteract allergies and autoimmune diseases, for example.
General secretion jams
In addition to the drainage of lymphatic water, lymphatic drainage can also help in the discharge of inflammatory secretions, blood, fat deposits and tissue water. Even metabolic disorders, which usually also mean an unnatural incorporation of secretions into the tissue, respond well to the drainage procedure. For this reason, the massage of the lymphatic system is also performed as part of
- Diet measures,
- Broken bones,
- Torn muscle fibers,
- and swelling
applied. Lymphatic drainage also stimulates the discharge of pus and secretions, which is why even beauticians learn the massage technique during their training, for example to treat blemishes such as acne.
Pain and tension
It is emphasized again and again that lymphatic drainage not only has a draining, decongestant and immune-boosting effect, but also a pain-relieving and relaxing effect. For example, doctors teach themselves
- A headache,
- Sudeck's disease,
- Muscle tension,
- Pain after surgery,
- and strains
used. The relaxing effect on the muscles goes so far that the intestinal muscles benefit in particular from this and digestive disorders and intestinal cramps can be solved with the help of lymphatic drainage.
Process of lymphatic drainage
As shown above, manual lymphatic drainage is a special form of massage that uses slight circular and pressure movements to increase the frequency of the lymphangione and thus the lymphatic flow.
The usual frequency rate at rest of around ten to twelve contractions per minute can be increased to up to 20 contractions per minute by the drainage massage, which already shows how strong the massage-related stimulation can be. The secret of lymphatic drainage lies in the changing pressure that the masseur builds up on the lymphatic system through the different grip techniques. It sends a rhythmic stimulation stimulus to the lymphatic tissue, which increases the pumping capacity of the lymphatic system and thus increases the lymphatic flow.
The process of lymphatic drainage itself has been perfected again and again in recent decades and developed further according to medical standards. As an alternative to the manual process, technologically advanced medical devices nowadays also offer a form of apparatus in which the massage handles are simulated using appropriate apparatus.
However, the four basic Vodder lymphatic drainage procedures are still valid today and are as follows:
- Standing circle: To make the standing circle, it is important to lay your hands flat in the area of the lymph nodes. Then the palms are gently massaged in the drainage direction of the lymph nodes. Only very little pressure should be exerted on the tissue. As a result, the grip technique is repeated several times before the next grip is used.
- Twist grip: With this massage grip, the massage therapist or physiotherapist places his thumb flat on the skin, while only the fingertips of the remaining fingers touch the skin. Starting from this finger position, the course of the lymphatic system is then followed in slight rotary movements. The twist grip is usually repeated several times.
- Ladle handle: This handle technique basically works like the twist grip. The only difference is that it is not circling with, but against the direction of the lymphatic system. In an alternating version, the twist and scoop handle provide a good example of how the changing rhythm of hand movements in lymphatic drainage sends stimulation stimuli to the lymphatic system.
- Pump handle: Here, all fingers except the thumb are straight. The thumb, on the other hand, is attracted, causing the web to spread slightly between the thumb and index finger. Pumping pressure is now exerted on the treated limb at an angle of 45 degrees. The pump handle works particularly well on the shoulders and extremities.
Special lymphatic drainage handles against edema
In addition to these four traditional lymphatic drainage handles, other handles have emerged over the years that are used very specifically against edema and fibrosis. Three of them are particularly noteworthy:
- Skin fold handle: The skin fold handle is mainly used in the presence of fibrosis. To perform this, a patient's skin fold is raised with one hand and then the thumb of the other hand is pressed against the skin fold. A deep movement follows, during which the thumb is pressed further down. The aim of this handle is to loosen fibrosis and thus relieve tension in the tissue.
- Windshield wiper grip: Another grip that aims to defuse fibrosis and alleviate the symptoms caused by it. Both hands are placed flat next to each other on the wiper handle and then opened and closed repeatedly like a wiper. This handle is sometimes the most similar to conventional massage handles.
- Ultrafiltrate displacement handle: This handle technology exists specifically for the drainage of edema fluid. It is intended to help transfer the fluid accumulations into the bloodstream more quickly so that they can be removed from there. For this purpose, the fingers are pressed tightly together and then the flat hand is placed on the edema. For about 20 to 30 seconds, increasing pressure is exerted into the depth of the tissue, which is supposed to press the edema content towards the blood vessels.
Usually, lymphatic drainage is not performed separately, but in combination with other treatment measures such as physiotherapy or compression therapy. A drainage session takes about 20 to 60 minutes as part of such full therapy and may only be carried out by trained personnel, i.e. a physiotherapist or masseur with appropriate training.
Lymphatic drainage - side effects
Lymphatic drainage should not be used if there are certain chronic diseases or vascular weakness. Here, the drainage could lead to serious side effects. In the case of existing cancer and serious infectious diseases, the procedure increases the risk of further spreading the pathogens across the lymphatic vessels. The treatment procedure must therefore never be used for one of the following diseases:
- Bronchial asthma,
- chronic low blood pressure (hypotension),
- Skin inflammation,
- Heart failure,
- Irregular heartbeat,
- as well as in the presence of malignant tumors.
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Kasseroller, Renato and Brenner, Erich: Compendium of Lymphangiology, Georg Thieme Verlag KG, 2015
- Wittlinger, Hildegard; Wittlinger, Andreas; Wittlinger, Dieter and Wittlinger, Maria: Manual lymphatic drainage according to Dr. Vodder, Georg Thieme Verlag KG, 2018
- Bertelli, D.F .; de Oliveira, P .; Gimenes, A.S .; Moreno, MA :: Postural drainage and manual lymphatic drainage for lower limb edema in women with morbid obesity after bariatric surgery: a randomized controlled trial, in: American Journal of Physical Medicine and Rehabilitation, 92 (8): 697-703, 2013, PubMed
- Ebert, Jay R .; Joss, B .; Jardine, Berit .; Wood, David J .: Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty, in: Archives of Physical Medicine and Rehabilitation, 94 (11): 2103-2111, 2013, PMR
- Working Group of the Scientific and Medical Associations (AWMF): S2k Guideline Diagnostics and Therapy of Lymphedema, AWMF Reg.-Nr. 058-001 (accessed November 12, 2019), German Society for Lymphology