FROM HEAD TO TOE - HOW LYMPHATIC DRAINAGE HELPS THE BODY

Unlike the circulatory system, the lymphatic system has no central pump in the form of the heart to regulate the flow of lymph. Instead, the fluid is transported around the body by squeezing the vessels as muscles move. The constriction causes the lymph fluid to be pushed further and further, while small valves in the vessels are closed. In this way, the body prevents the fluid from flowing back in the wrong direction.

If the amount of fluid to be removed is sometimes too great, the body can also temporarily move the excess lymph out of the way. To do this, vessels expand and form small tributaries. When the lymph flow stabilizes again, the excess fluid is removed from these tributaries and the vessels shrink again.

If, on the other hand, increased lymph fluid is directed into the lymphatic system over a longer period of time, the vessels can no longer compensate for the excess. The vessels change and fluid accumulation occurs, which is called lymphedema.

In the early stages, lymphedema causes the affected areas of the body to swell. The affected areas feel relatively elastic. After light pressure is applied to the swellings, they only slowly disappear. However, the more lymph that is stored in the edema, the firmer the swelling also becomes. Every movement and every form of pressure on the edema triggers pain and the affected limbs feel increasingly heavy.

In addition, the natural protective coating of the skin over a lymphedema recedes over time. The taut skin becomes dry and cracked, making it easier for viruses and bacteria to enter the body. At the same time, wound healing is impeded. Even small areas heal with difficulty and pose an increased risk of infection.

Doctors distinguish between two forms of the lymphatic system. On the one hand, there is primary lymphedema, which results from congenital disorders of lymphatic drainage. The lymph vessels of affected individuals are too narrow or they are defectively formed. A disorder of the vascular valves may be present or the vessels may not be able to expand. Faulty development of the lymph nodes can also be responsible for the backlog of lymph fluid and lead to the formation of primary lymphedema.

The swellings already begin during puberty or within the first three decades of life. Primary lymphedema can also develop as a result of pregnancy. At first, areas far from the body, such as the toes or fingers, are affected. However, over time, the lymphedema spreads further and further toward the center of the body.

One third of all edema patients suffer from primary lymphedema. Almost 80% of those affected are women.

On the other hand, there is secondary lymphedema. This form is also called “acquired lymphedema” because the fluid deposits occur as a result of other diseases or trauma. Patients who have to lie in bed for a long time due to an accident or surgery, for example, tend to develop secondary lymphedema.

The lack of movement favors the storage of fluid and thus promotes the formation of edema. But infections with viruses or bacteria can also disrupt the drainage of lymph. Especially if the lymph nodes are permanently swollen due to a disease, a backlog of lymph in the body is very likely.

However, many patients who develop secondary lymphedema suffer from serious diseases such as renal insufficiency or cancer. Unlike primary lymphedema, however, secondary lymphedema more often occurs on one side. Patients then have disturbed lymph drainage only in the left leg or only in the right leg, but not on both sides at the same time.

In order to remove the fluid that has been incorrectly stored by the body, therapists use what is known as lymphatic drainage. Unlike the name suggests, however, lymph is not simply drained. If an external drain were used to allow the fluid to flow out of the body, the abnormally stretched tissue of lymphedema would refill with fluid in a matter of weeks.

Manual lymphatic drainage, or MLD for short, is a so-called internal drainage procedure that supports the body’s original function of removing lymph. For this purpose, circular pumping or scooping movements are applied with light pressure to the swollen parts of the body.

These movements stimulate the decongestion of the lymphatic fluid and support the drainage of the fluid through the lymphatic system. However, lymphatic drainage should not use excessive pressure to force the lymph fluid out of the edema. If too much pressure is applied, the excess fluid can only be pushed further into the tissue, creating even more space for lymph fluid to enter.

Lymphatic drainage does not begin with the edema itself, but starts at the neck and collarbone. This has to do with the fact that in this region of the body there are a lot of lymph nodes close to each other, which are to be stimulated by the lymphatic drainage. In addition, the neck represents the part of the body where the lymph fluid is returned to the bloodstream.

The circular movements are intended to improve the flow rate of lymph and virtually warm up the lymphatic vessels. Therefore, a therapist slowly works his way from the neck region through the chest to the actual edema. As the central treatment site, the edema receives the most attention. However, as the lymphatic drainage draws to a close, the therapist slowly moves back to the neck region. This is for the simple reason that he wants to prevent possible fluid reflux as much as possible.

On average, a lymphatic drainage session lasts just under 60 minutes. Affected patients often feel relief from pain and general relief immediately after drainage.

While lymphatic drainage treats swelling acutely, forms of aftercare must be applied to reduce renewed fluid buildup. For this purpose, patients are fitted with compression bandages, for example. The bandages are designed to prevent the lymphatic vessels from expanding too much, which would directly lead to the formation of new edema.

In the long term, patients may also be prescribed orthopedic compression stockings. These stockings, made of nylon, are knitted in such a way that they exert the highest compression pressure in the area of the feet, which continues to decrease towards the top.

Compression stockings are also intended as an everyday solution because patients can wear them under their normal clothing.

Lymphatic drainage can be used both for the acute treatment of edema and as a preventive measure. For example, patients who are required to remain on bed rest for a long period of time and are not allowed to get out of bed receive regular preventive lymphatic drainage.

This is to avoid the risk of excessive fluid build-up in the limbs. Especially after surgery, lymphatic drainage is therefore recommended several times a week until patients are able to move on their own again.

Patients who are prone to increased edema as a result of cancer or chemotherapy may also receive lymphatic drainage. Because lymph nodes are removed during cancer treatment or can be destroyed by radiation, the body tends to drain lymph more slowly. Drains are administered to counteract this.

In addition, many physical therapists recommend lymphatic drainage for pregnant women. During pregnancy, even otherwise healthy women tend to have water retention in the limbs. This is due, among other things, to the hormonal changes that a woman undergoes during pregnancy. Because the swollen feet and legs of pregnant women often hurt due to the increased weight of the baby and make movements uncomfortable, regular lymphatic drainage is recommended to relieve pain.

However, the treatment method should not be used if patients suffer from chronic inflammation or if arterial circulatory disorders are present. It should also be avoided after deep vein thrombosis. There is a risk that the movements could set a thrombus in motion and thus block blood vessels.

Applying lymphatic drainage sounds relatively simple. However, it takes a lot of experience to know how to perform drainage and what to look out for. Physiotherapists and orthopedists with an appropriate additional qualification have learned the correct application of manual lymph drainage. They know exactly how to start, what the sequence of movements should look like and how much pressure to apply.

It is not recommended that patients try to perform lymphatic drainage on themselves. Since they lack practical experience, there is a high probability that they will make mistakes during the exercise. Either they apply too much pressure or they push the lymphatic fluid rather than make it move. Instead of helping, incorrectly applied lymphatic drainage can only increase the pain, which is why the treatment method should only be performed by medical professionals who really know how to do it.

The frequency of lymphatic drainage is based on the one hand on the causes of fluid accumulation and on the other hand on possible further treatments. A pregnant woman is usually planned by edema during her pregnancy. After the birth of the child, however, her lymphatic system may return to normal as the woman’s hormonal balance changes again. The drainage of lymph usually improves again, and limbs begin to swell. In such a case, lymphatic drainage would no longer be necessary.

The same is the case when lymphatic drainage is used as a preventive treatment after an operation or an accident. As long as patients have to lie in bed and are not allowed to move at all or only a little, they receive lymphatic drainage at regular intervals. However, once treatment is complete and they are more mobile again, patients are advised to do light exercise to improve the regulation of lymphatic fluid in the body.

On the other hand, the situation is different for patients who suffer from a chronic disease that affects the lymphatic system. Even in patients who have already suffered from edema, there is always a risk that fluid will be deposited again and the affected areas of the body will swell up again. Regular lymphatic drainage can help to alleviate the symptoms caused by edema. However, they cannot cure patients who suffer from fluid accumulation.

Physical therapists usually decide how regularly to treat with lymphatic drainage based on a patient’s overall health, predisposition to edema formation and age. Since older people and those with higher body weights are more likely to have fluid buildup, a therapist would also advise them to have lymphatic drainage more often. On the other hand, younger people with good health, who also do sports, are less prone to lymph fluid buildup. Therefore, it is quite possible that they would need treatment less often.