NCBI Bookshelf. A service provided by the National Library of Medicine, National Institutes of Health.
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Manual Lymphatic Drainage (MLD) is a gentle massage technique that can be beneficial for managing lymphoedema, a condition characterized by swelling due to a build-up of lymph fluid. However, there are certain contraindications for MLD that healthcare providers should be aware of before performing the treatment. Some of these contraindications include:
- Acute infections
- Acute thrombosis
- Acute congestive heart failure
- Untreated hypertension
- Active cancer
- Acute cellulitis
- Recent skin grafts
It is important for healthcare providers to assess each patient carefully and consider these contraindications before administering MLD to ensure the safety and effectiveness of the treatment.
StatPearls [Internet].
Authors: Kailey Remien, Min Je Woo, Renato C. Vilella.
Writers
Associations
Last Modified: January 29, 2024.
Continuing Education Activity
The lymphatic system is interconnected with all body parts and has various functions beyond immunity. It helps remove toxins and waste through lymph fluid. Understanding its functioning is crucial for osteopathic treatment, especially lymphatic osteopathic manipulation treatment.
- Recognition of patients with symptoms of lymphatic system involvement where OMT can help.
- Screening patients for conditions affecting the suitability of lymphatic OMT.
- Choosing suitable OMT techniques based on the patient’s dysfunction.
- Collaborating with healthcare professionals for better patient outcomes.
- Educating patients on self-care techniques to support lymphatic system health.
- Regularly reassessing patients to monitor progress and adjust treatment plans as needed.
Introduction
The lymphatic system is essential for removing waste and maintaining homeostasis especially during inflammation. OMT plays a significant role in treating somatic dysfunctions and improving biomechanics.
Dr. Andrew Taylor Still highlighted the importance of the lymphatic system in osteopathy. Modern medicine recognizes the role of lymphatic vessels in chronic conditions and inflammation.
Inflammation is a vital response to injury or infection, and lymphatic drainage flow helps resolve it by removing markers.
Anatomy and Physiology
The lymphatic system originates from tissues with capillaries draining into collecting vessels and lymph nodes. The system is supported by smooth muscles and sympathetic innervation for fluid movement, especially near skeletal muscles.
The lymphatic system includes organs like spleen, lymph nodes, and tonsils that filter lymph fluid and produce white blood cells. Various body parts may face lymphatic vessel obstruction due to somatic dysfunctions.
Indications
Osteopathic medicine focuses on removing circulatory obstructions like lymphatic congestion, crucial in chronic and inflammatory diseases. Lymphatic techniques can benefit conditions like autoimmune diseases and inflammatory disorders.
Manual Lymphatic Drainage (MLD) is a specialized massage technique that is commonly used in the treatment of lymphoedema. While MLD can be highly beneficial for many individuals, there are certain contraindications where caution should be exercised or the treatment should be avoided altogether. Here are 7 contraindications of MLD:
- Acute infections
- Deep vein thrombosis
- Acute cellulitis
- Cardiac edema
- Renal failure
- Untreated congestive heart failure
- Active cancer
Contraindications
Lymphatic treatment can be highly beneficial in aiding recovery from infectious diseases such as pneumonia. It has been shown to shorten hospital stays by improving immune cell flow and facilitating antibiotic delivery to the infection site. However, it is important to note that lymphatic treatment may not be suitable for individuals with certain conditions, such as congestive heart failure or thrombosis. In such cases, it is recommended to consult with a healthcare provider before undergoing lymphatic treatment.
Equipment
There are both absolute and relative contraindications for lymphatic treatments, including acute injuries, cancer, and infections. Practitioners should be cautious in specific situations.
Preparation
Patient comfort is vital during any procedure. Consent and warm hands before treatment are essential for a positive experience.
Technique or Treatment
Chapman Reflexes: Target organ dysfunctions and enhance lymphatic return, beneficial for managing chronic hepatitis.
Thoracic (Miller) Pump: Gentle rib movements to improve lymphatic flow.
Pedal (Dalrymple) Pump: Useful for lymphedema and pediatric patients.
Thoracic Inlet Release: Releases Sibson’s fascia for better lymph flow.
Rib Raising: Improves lymphatic flow by enhancing costal motion.
Splenic/Liver Pump: Enhances lymph flow to the liver and spleen for improved immune responses.
Facial Sinus Pressure Techniques (Facial Effleurage): Alleviates sinus congestion by enhancing lymph movement.
Galbreath Technique: Opens eustachian tubes and stimulates lymph movement from the ears.
Doming the Diaphragm: Helps with diaphragmatic somatic dysfunctions to improve lymphatic flow.
Complications
Lymphatic treatments are mostly safe but may cause headaches or fatigue. Adequate fluid intake can help prevent adverse effects. Caution is advised in aggressive techniques.
It is important to consult with a healthcare professional before undergoing any lymphatic treatment, especially if you have any pre-existing medical conditions. It is also recommended to follow the aftercare instructions provided by the therapist to ensure the best results and minimize the risk of complications.
Clinical Significance
The impact of lymphatic treatment on various medical conditions is significant, as it has been shown to enhance immune defenses and respiratory function, improving outcomes in pneumonia and other infections.
Osteopathic medicine, practiced for over a century, still lacks widespread understanding of its benefits. Interprofessional collaboration is crucial for optimal patient care, and documenting OMT interventions in medical records can improve treatment planning and patient safety.
Patients with lymphedema and infections should avoid manual techniques due to increased infection risk, waiting for approval from a general practitioner before starting lymphatic drainage treatment.
– It is advised to avoid MLD during active infection to prevent pathogen spread.
– Consult a doctor before treatment as MLD may interfere with medication efficacy.
– Avoid MLD in swollen nodes to prevent pain for lymphedema patients.
Note: Treat infections before initiating lymphedema therapies.
Lymphedema often occurs after cancer treatment, especially in breast cancer patients. While cancer itself may not always cause lymphedema, certain cancer types and treatments can increase the risk. Seek permission from an oncologist or GP before undergoing lymphatic drainage treatments during cancer care to minimize risks.
Avoid lymphatic drainage on areas with blood clots or thrombosis to prevent dangerous complications.
Symptoms of thrombosis include warmth sensation, tenderness, redness, and pain over a vein. Postpone MLD if blood or lymphatic flow issues are present until the condition is resolved.
Wait for inflammation to reduce before starting MLD for acute inflammation, and supervise MLD in patients with cardiac edema. Consult an oncologist before MLD if active cancer is present. While MLD is essential for lymphedema treatment, it may have contraindications, so clearance from a GP is necessary before treatment. Choose an experienced therapist for optimal results.
For more information or to schedule treatments in Mill Hill or Islington, feel free to contact us. If you found this information helpful, share it with others!