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Lymphedema

Also called: Lymphatic obstruction

Basics

Summary

Start Here

Diagnosis and Tests

Treatments and Therapies

Summary

Lymphedema is the name of a type of swelling. It happens when lymph builds up in your body’s soft tissues. Lymph is a fluid that contains white blood cells that defend against germs. It can build up when the lymph system is damaged or blocked. It usually happens in the arms or legs.

Causes of lymphedema include

Infection

Cancer

Scar tissue from radiation therapy or surgical removal of lymph nodes

Inherited conditions in which lymph nodes or vessels are absent or abnormal

Treatment can help control symptoms. It includes exercise, compression devices, skin care, and massage.

NIH: National Cancer Institute

Lymphedema (Mayo Foundation for Medical Education and Research) Also in Spanish

Lymphedema (PDQ) From the National Institutes of Health (National Cancer Institute) Also in Spanish

Diagnosis and Tests

Lymphoscintigraphy (American College of Radiology, Radiological Society of North America) Also in Spanish

Treatments and Therapies

Treatment of Lymphedema From the National Institutes of Health (National Cancer Institute) Also in

For People With Lymphedema (American Cancer Society) Also in Spanish

Genetics Home Reference: Hennekam syndrome From the National Institutes of Health (National Library of Medicine)

Genetics Home Reference: lymphedema-distichiasis syndrome From the National Institutes of Health (National Library of Medicine)

Genetics Home Reference: Meige disease From the National Institutes of Health (National Library of Medicine)

ClinicalTrials.gov: Lymphedema From the National Institutes of Health (National Institutes of Health)

Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine)

Article: The development of a ‘wet leg’ pathway for chronic oedema.

Article: Mapping the geographical distribution of podoconiosis in Cameroon using parasitological,…

Lymphedema — see more articles

Lymphedema (American Cancer Society) Also in Spanish

Patient Handouts

Compression stockings (Medical Encyclopedia) Also in Spanish

Lymphatic obstruction (Medical Encyclopedia) Also in Spanish

Lymphedema (Medical Encyclopedia) Also in Spanish

MEDICAL ENCYCLOPEDIA

Compression stockings

Lymphatic obstruction

Lymphedema

Related Health Topics

Edema

Lymphatic Diseases

National Institutes of Health

The primary NIH organization for research on Lymphedema is the National Cancer Institute

NIH MedlinePlus Magazine

Leading Role in Lymphedema Awareness

Lymphedema: What We Know

With Lymphedema, Early Treatment is Key

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Page last updated on 1 March 2018 Topic last reviewed: 11 May 2016

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What Is Cancer-related Lymphedema?

Lymphedema (limf-uh-DEE-muh) is a build-up of lymph fluid in the fatty tissues just under your skin. This build-up causes swelling, most often in the arms or legs. Lymphedema can also affect the face, neck, abdomen (belly), and genitals – depending on the part of the body that was treated.

If you are being or have been treated for cancer, talk to someone on your cancer care team about your risk of lymphedema and what you can do to help lower it. Once chronic lymphedema has started, it cannot be cured. But early and careful management can reduce symptoms and help keep it from getting worse.

What is the lymph system?

Our bodies have a network of lymph nodes and lymph vessels that collect and carry watery, clear lymph fluid, much like veins collect blood from distant parts of the body (like the hands and arms) and carry it back to the heart.

Lymph fluid contains proteins, salts, and water, as well as white blood cells, which help fight infection. In the lymph vessels, one-way valves work with body muscles to help move the fluid through the body and control the flow.

Lymph nodes are small collections of tissue along the lymph vessels that work as filters for harmful substances and help fight infection.

color diagram showing the lymphatic system in the human body (location of lymph nodes, lymphatic vessels)/also shows the location of the thymus, spleen, bone marrow, stomach, colon and small intestine

The lymph system

What causes cancer-related lymphedema?

Any change in the structure of the lymph system puts a person at risk for lymphedema.

Surgery

During surgery for cancer the doctor may take out lymph nodes near the tumor to see if the cancer has spread. When lymph nodes are removed, lymph vessels that carry fluid from that area to the rest of the body are taken out, too, because they go through and are wrapped around the nodes.

Taking out lymph nodes and vessels makes it harder for the lymph fluid in the arms, legs, or other body parts to flow to the chest where it can get back into the bloodstream. If the remaining lymph vessels cannot remove enough of the fluid in the area, the fluid builds up and causes swelling, or lymphedema.

Radiation

Radiation treatment can affect the flow of lymph fluid by scarring and damaging the lymph nodes and vessels. This increases the risk for lymphedema.

Cancer

Sometimes, a tumor itself can block part of the lymph system and cause lymphedema.

Infection

Infections that restrict lymph flow can cause lymphedema.

Can lymphedema be prevented?

There is no sure way to prevent all cases of lymphedema, but there are ways to lower the risk of it developing. For example, when lymph nodes need to be removed, some modern surgery techniques might be helpful:

Sentinel lymph node biopsy (SLNB) is a major advance in cancer surgery. It’s used to find the lymph nodes the tumor drains into so they can be checked for cancer. If cancer is not found in these nodes, it allows the surgeon to remove fewer lymph nodes. SLNB has shown to help reduce the risk of lymphedema.

Axillary reverse mapping (ARM) is a technique that uses a blue dye put in the upper arm to help find the lymph nodes that drain the arm. The surgeon can then try to not alter these lymph nodes. Results are not clear that ARM helps reduce lymphedema.

There might be things you can do to lower your risk as well. Talk to your health care team about your risk of lymphedema. If you are at risk, it’s important to know what to watch for (see below), and to take the steps to help reduce your risk part of your daily routine for the rest of your life.

When does lymphedema develop?

Just after surgery: Temporary lymphedema

Lymphedema can start right after surgery. This is called temporary (or short-term) lymphedema. It’s usually mild and goes away in the next month or so. It can also start later, about 6 to 8 weeks after surgery or radiation.

Even though this type of lymphedema usually goes away on its own over time, you should tell your doctor about it right away. The swollen area may look red and feel hot, which could also be a sign of blood clot, infection, or other problem that needs to be checked.

If there are no other problems causing the swelling, temporary lymphedema might be treated by raising the arm or leg and taking medicines to help reduce inflammation.

Months or years after cancer treatment: Chronic lymphedema

This form of lymphedema develops slowly over time. It may show up many months or even years after cancer treatment. The swelling can range from mild to severe. The lymph fluid that collects in the skin and underlying tissues can be very uncomfortable. It can keep nutrients from reaching the cells, interfere with wound healing, and lead to infections.

Lymphedema can be a long-term problem, but there are ways to manage it. The key is to get help right away. Lymphedema is easier to treat and more likely to respond to treatment if it’s treated early.

Signs of lymphedema

If lymphedema does develop, it’s important to recognize it early so you can start treatment right away.

Common signs and symptoms you should watch for include:

Swelling

Part of your body (like your arm, leg, belly, or genitals) feeling full or heavy

Skin changing texture, feeling tight or hard, or looking red

New aching, tingling, numbness, or other discomfort in the area

Less movement or flexibility in nearby joints (like your hand, wrist, or ankle) or your eyelid(s), throat, or lips

Trouble fitting into clothes in one area, such as a sleeve, pant leg, or shoe being tight

Collars, rings, watches, and/or bracelets feeling tight even though you haven’t gained weight

At first, the skin usually stays soft, and raising the affected body part might relieve the swelling. But over time, the swollen area may become hot and red and the skin hard and stiff. If untreated, movement and use of the affected part may become limited.

When to get help

Call your doctor, nurse, physical therapist, or lymphedema therapist if you notice any of the signs of lymphedema listed above or any of these changes:

If any part of the affected area, such as an arm or a leg, feels hot, looks red, or swells suddenly. These could be a sign of infection or a blood clot, and you might need treatment right away.

If you have a temperature of 100.5°F or higher (taken by mouth) that’s not related to a cold or flu

If you have any new pain in the affected area with no known cause

Know what’s normal for you

If you’ve had lymph nodes removed or radiation treatment, look closely at your body in front of a mirror. Compare both sides of your body and look for changes in size, shape, or skin color. Get to know your body and what’s normal for you. This way you can spot changes and get treatment right away. Let your doctor or nurse know if you notice any of the signs listed above.

Some doctors measure the affected body part (like a leg or arm) before surgery, then re-measure afterward so that swelling can be detected and treated before it becomes obvious. You can ask your doctor to take these measurements or refer you to a physical therapist to have this done. If possible, ask to be referred to a certified lymphedema therapist (CLT).

Be sure to check your health insurance to make sure lymphedema screening and therapy is covered.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

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What Is Lymphedema?

In this Article

Causes and Types

Symptoms

Diagnosis

Treatment

Lymphedema is swelling that’s caused by a collection of too much lymph fluid. It usually happens in your arms and legs, but it can happen in other parts of your body, as well. This swelling may cause pain and limit how well the affected area moves.

Lymph is a protein-rich fluid that moves throughout your body in lymph vessels. It scoops up things like bacteria, viruses, and waste, and carries them to your lymph nodes. Your lymph nodes then filter the fluid to get the impurities out of your body.

You could get lymphedema for any number of reasons. There are treatments to help bring down the swelling so you feel and move better.

Causes and Types

If your lymphatic system is damaged or a blockage exists, the fluid can build up in the soft tissue beneath your skin.

There are two types of lymphedema:

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Secondary lymphedema is caused by another condition or disease that damages your lymph vessels or nodes. Secondary lymphedema may be caused by:

Continue Reading Below

An infection in your lymph nodes

Parasites

Cancer or radiation treatment for cancer

Surgery

Lymph node removal

Injury

Primary lymphedema is much less common. It’s a genetic problem that happens because your lymph nodes or vessels either aren’t adequately developed or are missing altogether.

Symptoms

The most common symptom of lymphedema is swelling in one or both arms or legs. This swelling, which can extend into the fingers or toes, usually develops gradually over time.

At first, the swelling is soft and fluid. In time, it can become more dense and fibrous, and it may make your skin look grainy. You could also have pain, heaviness, or limited range of motion in the affected limb, which may make it hard to exercise or do other activities.

Over time, these symptoms may lead to other problems including infection, and in rare cases, cancer. If swelling in your arm or leg doesn’t go away, you should see your doctor.

Diagnosis

Your doctor will want to know about your medical history. You may also get imaging tests to help diagnose the problem.

A lymphoscintigraphy is a scan that can detect blockages or missing lymph vessels. It is done by injecting radioactive material. Other tests to investigate the cause of your swelling include MRI, CT scan, and ultrasound.

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home / cancer health center / cancer a-z list / lymphedema center / lymphedema article

Lymphedema

Medical Author: Melissa Conrad Stöppler, MD

Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Lymphedema Center

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Lymphedema facts

What is lymphedema?

What does lymphedema look like (pictures)?

What causes lymphedema?

What are the symptoms of lymphedema?

How is lymphedema diagnosed?

What are possible treatments for lymphedema?

What are complications of lymphedema?

Can lymphedema be prevented?

What is the prognosis for lymphedema?

Where can one get help and support for lymphedema?

Lymphedema facts

Lymphedema is a condition that results from impaired flow of the lymphatic system.

Symptoms of lymphedema include swelling in one or more extremities. The swelling may range from mild to severe and disfiguring.

Primary lymphedema is present at birth; secondary lymphedema develops as a result of damage to or dysfunction of the lymphatic system.

Breast cancer treatment is the most common cause of lymphedema in the U.S.

While there is no cure for lymphedema, compression treatments and physical therapy may help reduce the swelling and discomfort.

What is lymphedema?

Readers Comments 10

Share Your Story

Lymphedema is swelling in one or more extremities that results from impaired flow of the lymphatic system.

The lymphatic system is a network of specialized vessels (lymph vessels) throughout the body whose purpose is to collect excess lymph fluid with proteins, lipids, and waste products from the tissues. This fluid is then carried to the lymph nodes, which filter waste products and contain infection-fighting cells called lymphocytes. The excess fluid in the lymph vessels is eventually returned to the bloodstream. When the lymph vessels are blocked or unable to carry lymph fluid away from the tissues, localized swelling (lymphedema) is the result.

Lymphedema most often affects a single arm or leg, but in uncommon situations both limbs are affected.

Primary lymphedema is the result of an anatomical abnormality of the lymph vessels and is a rare, inherited condition.

Secondary lymphedema results from an identifiable damage to or obstruction of normally-functioning lymph vessels and nodes.

Worldwide, lymphedema is most commonly caused by filariasis (a parasite infection), but in the U.S., lymphedema most commonly occurs in women who have had breast cancer surgery, particularly when followed by radiation treatment.

What does lymphedema look like (pictures)?

Mild lymphedema first may be noticed as a feeling of heaviness, tingling, tightness, warmth, or shooting pains in the affected extremity. These symptoms may be present before there is obvious swelling of an arm or leg. Other signs and symptoms of early or mild lymphedema include:

a decreased ability to see or feel the veins or tendons in the extremities,

tightness of jewelry or clothing,

redness of the skin,

asymmetrical appearance of the extremities,

tightness or reduced flexibility in the joints, and

slight puffiness of the skin.

As lymphedema progresses to a more moderate to severe state, the swelling of the involved extremity becomes more pronounced. The other symptoms mentioned above also persist with moderate or severe lymphedema.

Picture of Lymphedema

Picture of areas of the body with lymphedema

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Lymphedema Picture

A common chronic, debilitating condition in which excess fluid called lymph collects in tissues and causes swelling (edema) in them.

Click here to see a picture of lymphedema »

What causes lymphedema?

Primary lymphedema causes

Primary lymphedema is an abnormality of an individual’s lymphatic system and is generally present at birth, although symptoms may not become apparent until later in life. Depending upon the age at which symptoms develop, three forms of primary lymphedema have been described. Most primary lymphedema occurs without any known family history of the condition.

Congenital lymphedema is evident at birth, is more common in females, and accounts for about 20% of all cases of primary lymphedema. A subgroup of people with congenital lymphedema has a genetic inheritance (in medical genetics termed “familial sex-linked pattern”), which is termed Milroy disease.

Lymphedema praecox is the most common form of primary lymphedema. It is defined as lymphedema that becomes apparent after birth and before age 35 years and symptoms most often develop during puberty. Lymphedema praecox is four times more common in females than in males.

Primary lymphedema that becomes evident after 35 years of age is known as Meige disease or lymphedema tarda. It is less common than congenital lymphedema and lymphedema praecox.

Secondary lymphedema causes

Secondary lymphedema develops when a normally-functioning lymphatic system is blocked or damaged. In the U.S., breast cancer surgery, particularly when combined with radiation treatment, is the most common cause. This results in one-sided (unilateral) lymphedema of the arm. Any type of surgical procedure that requires removal of regional lymph nodes or lymph vessels can potentially cause lymphedema. Surgical procedures that have been associated with lymphedema include vein stripping, lipectomy, burn scar excision, and peripheral vascular surgery.

Damage to lymph nodes and lymph vessels, leading to lymphedema, can also occur due to trauma, burns, radiation, infections, or compression or invasion of lymph nodes by tumors.

Worldwide, however, filariasis is the most common cause of lymphedema. Filariasis is the direct infestation of lymph nodes by the parasite Wuchereria bancrofti. The disease is spread among persons by mosquitoes, and affects millions of people in the tropics and subtropics of Asia, Africa, Western Pacific, and parts of Central and South America. Infestation by the parasite damages the lymph system, leading to swelling in the arms, breasts, legs, and, for men, the genital area. The entire leg, arm, or genital area may swell to several times its normal size. Also, the swelling and the decreased function of the lymph system make it difficult for the body to fight infections. Lymphatic filariasis is a leading cause of permanent disability in the world.

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What are the symptoms of lymphedema?

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The swelling of lymphedema usually occurs in one or both arms or legs, depending upon the extent and localization of damage. Primary lymphedema can occur on one or both sides of the body as well. Lymphedema may be only mildly apparent or debilitating and severe, as in the case of lymphatic filariasis (see above), in which an extremity may swell to several times its normal size. It may first be noticed by the affected individual as an asymmetry between both arms or legs or difficulty fitting into clothing or jewelry. If the swelling becomes pronounced, fatigue due to added weight may occur, along with embarrassment and restriction of daily activities.

The long-term accumulation of fluid and proteins in the tissues leads to inflammation and eventual scarring of tissues, leading to a firm, taut swelling that does not retain its displacement when indented with a fingertip (nonpitting edema). The skin in the affected area thickens and may take on a lumpy appearance described as an orange-peel (peau d’orange) effect. The overlying skin can also become scaly and cracked, and secondary bacterial or fungal infections of the skin may develop. Affected areas may feel tender and sore, and loss of mobility or flexibility can occur.

Other symptoms can accompany the swelling of lymphedema including:

Warmth, redness, or itching

Tingling or burning pains

Fever and chills

Decreased flexibility in the joints

Aching, pain, and fullness of the involved area

Skin rash

The immune system function is also suppressed in the scarred and swollen areas affected by lymphedema, leading to frequent infections and even a malignant tumor of lymph vessels known as lymphangiosarcoma.

How is lymphedema diagnosed?

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A thorough medical history and physical examination are done to rule out other causes of limb swelling, such as edema due to congestive heart failure, kidney failure, blood clots, or other conditions. Often, the medical history of surgery or other conditions involving the lymph nodes will point to the cause and establish the diagnosis of lymphedema.

If the cause of swelling is not clear, other tests may be carried out to help determine the cause of limb swelling.

CT or MRI scans may be useful to help define lymph node architecture or to identify tumors or other abnormalities.

Lymphoscintigraphy is a test that involves injecting a tracer dye into lymph vessels and then observing the flow of fluid using imaging technologies. It can illustrate blockages in lymph flow.

Doppler ultrasound scans are sound wave tests used to evaluate blood flow, and can help identify a blood clot in the veins (deep venous thrombosis) that may be a cause of limb swelling.

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What are possible treatments for lymphedema?

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There is no cure for lymphedema. Treatments are designed to reduce the swelling and control discomfort and other symptoms.

Compression treatments can help reduce swelling and prevent scarring and other complications. Examples of compression treatments are:

Elastic sleeves or stockings: These must fit properly and provide gradual compression from the end of the extremity toward the trunk.

Bandages: Bandages that are wrapped more tightly around the end of the extremity and wrapped more loosely toward the trunk, to encourage lymph flow out of the extremity toward the center of the body.

Pneumatic compression devices: These are sleeves or stockings connected to a pump that provides sequential compression from the end of the extremity toward the body. These may be used in the clinic or in the home and are useful in preventing long-term scarring, but they cannot be used in all individuals, such as those with congestive heart failure, deep venous thrombosis, or certain infections.

Manual compression: Massage techniques, known as manual lymph drainage, can be useful for some people with lymphedema.

Exercises: Exercises that lightly contract and stimulate arm or leg muscles may be prescribed by the doctor or physical therapist to help stimulate lymph flow.

Surgical treatments for lymphedema are used to remove excess fluid and tissue in severe cases, but no surgical treatment is able to cure lymphedema.

Infections of skin and tissues associated with lymphedema must be promptly and effectively treated with appropriate antibiotics to avoid spread to the bloodstream (sepsis). Patients affected by lymphedema must constantly monitor for infection of the affected area. In affected areas of the world, the drug diethylcarbamazine is used to treat filariasis.

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What are complications of lymphedema?

As noted before, secondary infections of the skin and underlying tissues can complicate lymphedema. Inflammation of the skin and connective tissues, known as cellulitis, and inflammation of the lymphatic vessels (lymphangitis) are common complications of lymphedema. Deep venous thrombosis (formation of blood clots in the deeper veins) is also a known complication of lymphedema. Impairment of functioning in the affected area and cosmetic issues are further complications of lymphedema.

Those who have had chronic, long-term lymphedema for more than 10 years have a 10% chance of developing a cancer of the lymphatic vessels known as lymphangiosarcoma. The cancer begins as a reddish or purplish lump visible on the skin and spreads rapidly. This is an aggressive cancer that is treated by amputation of the affected limb. Even with treatment, the prognosis is poor, with less than 10% of patients surviving after 5 years.

Can lymphedema be prevented?

Primary lymphedema cannot be prevented, but measures can be taken to reduce the risk of developing lymphedema if one is at risk for secondary lymphedema, such as after cancer surgery or radiation treatment.

The following steps may help reduce the risk of developing lymphedema in those at risk for secondary lymphedema:

Keep the affected arm or leg elevated above the level of the heart, when possible.

Avoid tight or constricting garments or jewelry (also avoid the use of blood pressure cuffs on an affected arm).

Do not apply a heating pad to the affected area or use hot tubs, steam baths, etc.

Keep the body adequately hydrated.

Avoid heavy lifting and forceful activity with the affected limb; but normal, light activity is encouraged.

Do not carry a heavy purse on an affected arm.

Practice thorough and careful skin hygiene.

Avoid insect bites and sunburns.

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What is the prognosis for lymphedema?

Lymphedema cannot be cured, but compression treatments and preventive measures for those at risk for secondary lymphedema can help minimize swelling and associated symptoms. As mentioned above, chronic, long-term edema that persists for many years is associated with an increased risk of developing a rare cancer, lymphangiosarcoma.

Where can one get help and support for lymphedema?

Many hospitals and treatment centers have support groups for people dealing with specific chronic conditions. Health care professionals may be able to recommend a local support group for those with lymphedema.

The National Lymphedema Network (NLN) (http://www.lymphnet.org/) is a non-profit organization founded in 1988 to provide education and guidance to lymphedema patients, health care professionals, and the general public by disseminating information on the prevention and management of primary and secondary lymphedema.

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Lymphatic Drainage Massage Technique

LYMPHATIC DRAINAGE MASSAGE

Within us all there is a silent system working to keep us healthy- the lymph system. Without it our bodies would swell up like balloons, swamping our cells with stagnant fluid. The lymph system’s impact is so far reaching that many don’t even realize that minor aches and pains, low energy or susceptibility to colds and flu may be due to a sluggish lymph system and a compromised immune system. In this article we’ll discuss the anatomy of the lymph system, what happens during edema and how lymph drainage massage can help, as well as contraindications to lymphatic massage.

LYMPH VESSELS:

Lymph vessels make an intimate meshwork that covers every inch of your skin, and surrounds each organ in great detail. The lymph vessels start very small in what are called the initial lymphatic. Over 70% of the initial lymphatics are in and just under the skin. The initial lymphatic is a very delicate structure, one cell thick. Those cells are supported within the connective tissue by collagen and elastin fibers that help to anchor them in place. When the pressure within the interstitial space increases due to a buildup of fluid, or when the skin is slightly stretched, the filaments deform the wall of the initial lymphatic, opening it up. Then the interstitial fluid flows in and starts to move along the channel. At this point we start calling it lymph. Although only 2-3 liters of lymph is filtered through the lymph system per day, it is vital because it helps to remove proteins that that are too large to get back through the capillary wall. (Guyton and Hall, Human Physiology and Mechanisms of Disease, 6th edition, W.B Saunders Company, Philadelphia, 1997, page 139) The spaces that open in the initial lymphatic are 4 to 6 times bigger than the spaces in the capillaries. Removal of protein is essential because they draw water to themselves, so excess protein in the interstitial spaces causes swelling or edema. The lymph vessels also collect dead cells, waste products, bacteria, viruses, inorganic substances, water and fats.

By performing lymphatic drainage massage correctly, we can stimulate the opening of the initial lymphatic and increase the volume of lymph flow by as much as 20 times. But if we push too hard, we collapse the initial lymphatic, diminishing the lymph flow. Excessive pressure can even break the filaments that hold the initial lymphatic in place. This is one reason that deep styles of massage are contraindicated in areas of edema. Luckily if deep pressure has broken any filaments, they usually reform within 24 hours.

After the lymph has entered the initial lymphatic, the lymph moves into a larger vessel called the pre-collector, and then into even larger vessels called the collectors. The collectors are 100-600 microns in diameter. These vessels have one way valves every 6- 20 mm that only allow the lymph to move in one direction. When you’re performing lymphatic drainage massage, you never have to worry that you are damaging your clients by pushing the lymph in the wrong direction- because it literally can’t flow backwards. Pushing in the wrong direction won’t be very effective, but it won’t hurt your client unless you are using deep pressure- and in that case, you are not doing lymphatic drainage massage.

From one one-way-valve to the next is called a lymphangion. The lymphangions have a layer of smooth muscle that spirals around them. Angion means heart- so this is really the pump that pushes the lymph. Each lymphangion has an internal stretch sensor. The walls of the lymphangion stretch when they fill up with lymph, and then the stretch sensor tells the muscle to contract. This spiraling muscle contracts squeezing the lymph into the next chamber. This swells the next lymphangion, which then contracts, pushing the fluid down the line. At the same time the lymphangion is pushing the lymph forward, it also is creating a vacuum behind it. It is partly because of this vacuum effect that the lymph gets pulled into the initial lymphatic in the first place. (Kasseroller, R., Compendium of Dr. Vodder’s Manual Lymph Drainage, Haug, Heidelberg, 1998)

Once the lymphangions begin contracting, they cause a chain reaction, or a wave of contractions that start to push and pull the lymph through the body. In this way stimulating lymph flow in one area can increase lymph flow in another. Other factors that can assist the movement of the lymph are skeletal muscle contractions, breathing, the pulsing of arteries, as well the ability of the angions to contract independently of the stretch receptors. Lymphatic Drainage Massage’s effectiveness lies in its ability to activate the stretch response, which significantly increases the pulsation rate of the lymphangions, increasing lymph flow through the vessels.

lymph

Lymph vessel and lymph node

LYMPH NODES:

Eventually, all lymph vessels lead to lymph nodes. Lymph nodes can be as small as the head of a pin, or as big as an olive. There are 400-700 lymph nodes in the body, half of which are located in the abdomen, and many are in the neck.

The primary function of lymph nodes is to filter and purify the lymph. The lymph nodes produce various types of lymphocytes. Lymphocytes destroy harmful substances within the body, and are a big part of the immune system. The lymph nodes reabsorb about 40% of the liquid content of the lymph. This makes the lymph much thicker. Because of this thickening and the filtering process, the lymph nodes offer the greatest resistance to the flow of lymph. In fact the lymph nodes offer about 15 times more resistance than the vessels themselves. Lymphatic drainage can help overcome this resistance and get the lymph flowing.

EDEMA:

Each cell is nourished by the nutrients, oxygen and proteins that flow across the walls of capillaries into the interstitial fluid. There is a dynamic balance between the forces that help those nutrients to first exit the capillaries, and then get reabsorbed back into the blood stream. Proteins play a big part in this transfer because they have a tendency to draw water to themselves. This means that the proper amounts of protein on both sides of the capillary wall are vital to keep the tissues balanced. If there are too many proteins within the interstitial spaces, fluid will start to accumulate, causing edema. The lymph system’s role of removing proteins is vital to keeping edema down. If the lymph system becomes sluggish, or is damaged by surgical removal of lymph nodes, edema can develop. This type of edema is called lymphostatic edema- or a high protein edema. Lymphatic drainage can be helpful in reducing this type of edema because the cause is a reduced functioning of the lymph system.

Other causes of edema can be a chemical imbalance in the body caused by liver disease, diabetes, or a variety of other ailments. This type of edema is called lymphodynamic edema, and requires other forms of therapy due to the fact that it is a chemical imbalance. (Kasseroller, R., Compendium of Dr. Vodder’s Manual Lymph Drainage, Haug, Heidelberg, 1998)

INDICATIONS:

Lymphatic drainage massage is a profound technique to help increase lymph flow. With an increase of lymph flow immune function is increased. Harmful substances are removed from the tissues and neutralized in the nodes. It has also been shown that an increase in lymph flow stimulates an increased production of lymphocytes- enhancing immune function.

Patients that have extreme amounts of edema should work with a group of healthcare practitioner trained in lymph drainage, bandaging and other modalities. However, with a proper understanding of contraindications and some basic training, massage therapists can enhance the health of their clients and reduce minor cases of edema.

Lymphatic drainage in this arena can be applied to clients who are suffering from a lack of energy, or a sluggish immune system.

Lymphatic drainage massage is also useful when working with clients who have sports injuries. After the initial inflammatory stage has passed, lymphatic work can be applied after Sports or Neuromuscular massage has been completed. This will help to clear the tissue of debris, and help to reduce the minor edema that sometimes occurs after deep massage. Continued applications of lymphatic drainage while the client is healing can help to enhance the tissue regeneration process by keep the tissue as healthy as possible.

Not only is lymphatic drainage useful for sports injuries, but it can also help scars. (Godart, S., “Lymphatic regeneration after second degree burn,” Progress in Lymphology, 1975/ Hutzshenreuter, P.O. and Brummer, H., “Manual Lymph Drainage used for Scar Healing,” University of Ulm). Lymph work has been shown to help the scarring process by enhancing circulation and immunity. As the lymph flow around the scar is increased, lymph vessels that have been damaged are stimulated to heal, and the increased lymph flow also draws away toxins, improving the health of the tissues.

When attempting to assist healthy scar formation, it is important not to push the lymph into the scar, which can cause the formation of keloids (a buildup of collagen fibers). All scar work should be done without deforming a newly forming scar- so as to not rip the tissue. One way is to work above the scar (closer to the node that drains the area). For example, a lymph therapist could work in the axilla and upper arm to help increase the lymph flow around a scar in the forearm.

Beyond its application for injuries, Estheticians have been using lymph drainage massage for years to enhance the quality of the skin, especially on the face. When the lymph is flowing, the cells are being bathed in fresh fluid, causing the skin to look fresh and alive. We have all experienced having minor edema in our faces- that puffy feeling and baggy eyes when we first wake in the morning after a long night. Usually after a few minutes of being vertical the lymph system starts to drain the face. A great way to see the power of lymph drainage is to apply a few strokes on one of those mornings, and watch in just a few minutes the tissues drain right before your eyes- leaving you looking vibrant and healthy.

Another common use for lymph drainage massage is with women who have had breast cancer and had some axillary lymph nodes removed. Sometimes these people develop edema in their arm. If there is a great deal of swelling, then this is out of the scope of practice for a most massage therapists due to the need for bandaging. If the swelling is minor however, then a fully trained lymphatic drainage therapist working in conjunction with medical supervision can do a great amount of good.

CONTRAINDICATIONS:

For the most part lymphatic drainage massage is safe. With such a light touch, the danger of causing damage to the tissue is slim. However, there are a few conditions that are contraindicated, and these happen when an increase of lymph flow would be detrimental. It is a good idea to get clearance from their doctor if you ever feel uncertain about working on someone. Acute inflammation, Malignant tumors, Thrombosis and major heart problems are all contraindications to lymphatic drainage massage. Lets look at these one at a time.

Acute inflammation caused by bacteria, viruses, poisons or allergens is contraindicated. You can tell if this is the case because the tissues will be hot, red and painful, with congestion accompanied by fever. Lymphatic drainage massage will push these substances into the lymph channels before the body has a chance to eliminate them through phagocytosis in the interstitial spaces. If you perform lymphatic drainage you can spread the toxic substances throughout the body. Wait a few days until the condition is not acute, and the body has had a chance to clean up the area.

Malignant tumors are a contraindication for lymphatic drainage massage because of the fear of spreading the cancer. Wait until after the malignancy is treated to perform lymphatic drainage massage.

Thrombosis and phlebitis are two conditions that can lead to free floating blood clots. Usually people with these conditions will be in a hospital on blood thinners. If you are working in a hospital setting, do not work on these patients. In your practice, one indication of a possible femoral thrombosis is when the client has pain in one leg and a sudden swelling and bluish discoloration of the skin. People who are bedridden have a greater likelihood of developing thrombosis in the legs.

Major heart problems. If the heart is not fully functioning the edema can be lymphodynamic, due to lack of venous return. Putting more fluid into the heart would only stress it more, worsening the condition.

After reading the contraindications for a modality, many therapists experience fear of working on anyone. The most appropriate response to this list is to add it to your client intake questionnaire. It should also make you take pause to reflect on the power of this type of work- to do harm as well as good.

Lymphatic drainage massage is a great ally in any massage therapist’s tool kit. By being able to address the lymph system directly, client’s immune system function can be significantly increased. When we have a strong immune system, we are happy, balanced and whole. Lymphatic drainage massage can go where Deep Tissue and Swedish cannot- into swollen areas. The paradox is that such a superficial technique has such a deep impact.

Sean Riehl is the author of the DVD Lymphatic Drainage Massage.

Continue learning.

Take our online Lymphatic drainage course today.

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Here is a great article on the lymphatic system.

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Lymphatic drainage massage class online

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Home Health & Wellness Balanced Living Wellness Therapies Article

Lymphatic Massage Therapy

lymphatic massage

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5 min

What is lymphatic massage?

Lymphatic massage, also called lymphatic drainage or manual lymph drainage, is a technique developed in Germany for treatment of lymphedema, an accumulation of fluid that can occur after lymph nodes are removed during surgery, most often a mastectomy for breast cancer. Lymphedema can also be present at birth or develop at puberty or during adulthood. This type, known as primary lymphedema, can affect as many as four limbs and/or other parts of the body. The cause is unknown. Lymphatic drainage massage for conditions other than lymphedema is not medically recommended, although it may be promoted by some therapists.

What conditions is lymphatic massage used for?

Up to 25 percent of breast cancer patients whose surgery includes removal of lymph nodes in the area of the armpit eventually develop lymphedema. The condition can also occur in the legs or other parts of the body if lymph nodes are removed in the course of other types of surgery – for melanoma, colon, prostate or bladder cancer, for example – or are damaged by radiation treatment, infection or trauma. Symptoms include swelling and pain near the site of the removed or damaged lymph nodes. Lymphedema can occur immediately after radiation therapy or surgery, or weeks, months, and even years later.

What should one expect on a visit to a practitioner of lymphatic massage?

A lymphatic massage session for women who develop lymphedema after surgery for breast cancer starts with light massage on the surface of the skin of the neck. The therapist gently rubs, strokes, taps or pushes the skin in directions that follow the structure of the lymphatic system so that accumulated lymph fluid can drain through proper channels. Lymphatic drainage is very gentle, is not painful and doesn’t have a stimulating effect. Each session lasts from 45 to 60 minutes, and therapy usually is performed once a day four or five times a week for two to four weeks. One study showed that the greatest reduction in swelling from lymphedema occurs in the first week of treatment and stabilizes during the second week.

Are there any side effects or conditions where lymphatic massage should be avoided?

The National Lymphedema Network lists four circumstances under which lymphatic massage or drainage should be avoided:

When patients who have developed lymphedema after surgery experience a sudden, marked increase in localized swelling. Under these circumstances, patients are advised to stop treatment and to see their physicians for evaluation as soon as possible.

Patients with a sudden onset of lymphangitis (an infection) should immediately discontinue treatment until the infection is treated and completely clears up. Patients who are at increased risk for blood clotting should be tested to rule out deep-venous thrombosis before being treated. During treatment, these patients should be followed closely, and testing should be performed on a regular basis.

Patients who have congestive heart failure must be monitored closely to avoid moving too much fluid too quickly, which could put a strain on the heart.

When pain is present, treatment should be discontinued until the underlying cause has been determined and the pain subsides.

Is there a governing body that oversees or credentials practitioners of lymphatic massage?

Lymphatic drainage and massage practitioners may be physicians, nurses, physical or occupational therapists or massage therapists. In addition to their traditional course work, most require additional instruction in lymphedema therapy. Guidelines for training have been established by the Lymphology Association of North America, which administers certification examinations.

How does one get in touch with a practitioner of lymphatic massage?

To find a therapist skilled in lymphatic massage, visit the National Lymphedema Network website. Your physician may also be able to recommend someone who treats lymphedema and provides lymphatic massage.

 

Are there other therapies that might work well in conjunction with lymphatic massage?

In addition to lymphatic massage, patients may be advised to do self-massage following instructions from their therapists, as well as special light exercises designed to encourage the flow of lymphatic fluid out of the affected limb. Some patients may also be advised wear compression garments such as long sleeves or stockings designed to compress the arm or leg and encourage lymphatic flow out of the limb.

Other recommended therapies for lymphedema may include wrapping the affected limb to encourage the fluid to flow back out of the limb into the trunk, or pneumatic compression which involves wearing a sleeve over the affected arm and leg that is connected to a pump that intermittently inflates it, putting gentle pressure on the arm or leg and thereby moving the lymph fluid away from the fingers and toes and reducing swelling. The combination of these therapies plus lymphatic massage is called complete decongestant therapy (CDT). This approach usually is not recommended for patients with high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.

What is Dr. Weil’s view of lymphatic massage?

Dr. Weil believes that lymphatic massage is a worthwhile treatment for lymphedema, but he emphasizes that individuals who do not have lymphedema do not need lymphatic drainage, no matter what health claims are made for it. He notes that some internet sites warn of the health consequences of “sluggish lymphatic flow” and promote lymphatic drainage for all manner of supposed benefits ranging from detoxification of the body, regeneration of burned, injured or wrinkled tissue, anti-aging effects, and relief of sinusitis, bronchitis, ear infections, chronic pain, fibromyalgia, constipation, insomnia, memory loss, cellulite, and obesity. He also says he has seen lymphatic drainage promoted as a beauty treatment. However, Dr. Weil has not seen good evidence supporting any of these effects of manual lymphatic drainage. Dr. Weil emphasizes that manual lymphatic drainage is not a necessity for general health and explains that lymph fluid circulates as result of muscular contraction, including the muscles used during normal physical activity. As long as long as your lymphatic tissues or lymph nodes have not been damaged or removed, Dr. Weil maintains that that there is no need to worry about lymphatic flow and drainage.

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How to Perform Lymphatic Drainage Massage

Your lymphatic system helps eliminate your body’s waste. A healthy, active lymphatic system uses the natural movements of smooth muscle tissue to do this. However, surgery or other damage can cause fluids to build up in your lymph system and your lymph nodes, a condition known as lymphedema.

If you’ve ever had a surgery on or involving your lymph nodes, your doctor may have suggested lymphatic drainage massage.

Lymphadema

Procedures that affect or remove your lymph nodes can cause lymphedema as a side effect. Lymphedema will only occur in the area of your body near the surgical site. For example, if you have lymph nodes removed as a part of cancer surgery to your left breast, only your left arm, not your right, might be affected with lymphedema.

Lymphatic massage is a gentle pressure technique used to move the waste fluids from the damaged area. Raakhee Patel, PT, DPT, CLT is a physical therapist and certified lymphedema specialist who trains patients to perform their own lymphatic massage after surgery. Lymphatic massage is one technique used to reduce lymphedema.

“We don’t talk enough about lymphedema,” says Patel. Not only is fluid buildup uncomfortable, causing pain and heaviness in the affected area, but according to Patel, “Stage 3 lymphedema can be devastating,” causing significant depression and lack of mobility that could further complicate healing.

Clearing and Reabsorption

Patel teaches two stages of lymphatic massage: clearing and reabsorption. The purpose of clearing is to create a vacuum with gentle pressure so the area is prepared to bring in more fluid, creating a flushing effect.

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Clearing involves:

the supraclavicular lymph area: located directly under the collarbone

the axillary lymph area: located under the arms

the inside of the elbows

Clearing motions can be repeated as many as ten times a day. Patel advises, “Always massage both sides of your body, not just the side with the lymphedema.”

A Guide to Clearing

There are three stages to clearing. Be sure to clear the supraclavicular area, the axillary area, and the inner-elbow area, in order.

To clear the supraclavicular area:

Begin by lying on a comfortable, flat surface.

Cross your arms on your chest, with your hands resting just below the collarbones.

Then simply lift your elbows slowly. The muscle action is as much pressure as is required to prepare the area to flush lymphatic fluid.

Next, clear the axillary area:

Lay your hand above your head.

Use your other hand to gently scoop the underarm area from top to bottom. The only pressure required is that which is gentle enough to move the surface of the skin.

Finally, clear the area inside the elbows:

Lay your arm straight at your side.

Use the fingers of your opposite hand to gently pull the skin inside the elbow an inch at a time.

Only very gentle pressure is required. “In lymphatic massage, you’re only working the superficial skin structure,” says Patel. That’s where the fluid is trapped.

A Guide to Reabsorption

The second part of lymphatic massage is reabsorption. To perform this stage of massage:

Begin at the affected part of the body farthest from the core of the body. Begin at the tips of the fingers if you have lymphedema in your hand, arm, and shoulder.

Using a gentle, sweeping motion with just enough pressure to shift the surface of the skin. Massage from fingertip to hand, from hand to elbow, and from elbow to shoulder.

“Patient compliance is the hardest part of self-care, especially for women, who are so used to taking care of others,” says Patel. She advises patients to set aside at least 20 minutes a day for lymphatic drainage massage. “If you only have a brief amount of time, perform the clearing stage of massage.”

Measuring Effectiveness

How do you know if lymphatic drainage massage is effective? “This is a maintenance technique,” says Patel. “Your lymphedema should not get worse if you regularly practice lymphatic massage.”

Managing your lymphedema can also include using a compression sleeve to prevent fluid buildup. You can see a qualified therapist for in-office drainage massage.

When choosing a therapist, learn as much about their education as possible. “Massage is very good for you, but deep tissue massage can be too heavy for someone with lymphedema, so don’t assume you can just go to a massage therapist.”

Look for someone who is a certified lymphedema therapist, CLT, and preferably a physical or occupational therapist with oncology and pathology training.

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Coping with lymphedema. (n.d.)

fredhutch.org/en/treatment/survivorship/survival-strategies/lymphedema.html

Lymphedema. (n.d.)

mayoclinic.org/diseases-conditions/lymphedema/basics/definition/con-20025603

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Medically reviewed by Peggy Pletcher, MS, RD, LD, CDE on February 25, 2015 — Written by Elea Carey

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