WHAT IS MANUAL LYMPHATIC DRAINAGE MASSAGE
(MLD)
Manual Lymphatic Drainage (MLD) is the
part of lymphedema treatment that patients usually refer to
as "massage." Some therapists prefer to call it
"manipulation," to distinguish it from the more usual
sort of massage done to relieve muscle tightness, or simply
for relaxation at a spa.
The manipulation involved in MLD uses
very light pressure to stimulate the lymph vessels that lie
just beneath the skin. Since these vessels are small and
thin, firm pressure in any one area can actually shut them
down momentarily, so the gentleness of the pressure is
essential. Some therapists visualize this process as pushing
the lymph fluid in the desired direction, while others see
it as directing the flow by pulling the skin slightly ahead
of the lymph flow. Either way, MLD is an important technique
for moving lymph fluid out of the congested area and back
into circulation in the center of the body.
The direction and order of MLD
manipulation is as important as the gentle stroke. First the
areas of the body where nodes are concentrated (neck, axilla,
or groin) are stimulated in order to ready them to receive
more fluid. Then the therapist begins, close to the nodes,
moving fluid toward them with slow and rhythmic strokes. The
massage continues with the therapist's hands moving farther
away from the cleared nodes by degrees, but always directing
the fluid back toward them.
For a therapist, every patient is a
new challenge. The length, condition and location of
surgical scars, the amount and position of any fibrotic
(hard) areas, the condition of the skin, the number and location of
lymph nodes that were removed, and the extent of
cancer treatment each individual received is taken into
account to determine the most efficient route for directing
the lymph fluid. Because no one massage pattern will work
for everyone, it's important to learn MLD from a
well-trained and experienced therapist, rather than from a
video or book.
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WHAT DOES MLD INVOLVE?
PREPARING FOR MLD TREATMENT:
On days when you will be having MLD,
avoid using lotions or other skin lubricants after your bath
or shower, since friction on the skin is important to
manipulating lymph flow. Wear comfortable, loose-fitting
clothing that is easy to get on and off.
Your therapist will work hard to make
you comfortable, as relaxation improves the effects of lymph
manipulation. Dimming the lights is standard procedure, and
some therapists add music or scented candles to enhance the
mood of rest and quiet. Most patients find this helpful, but
for others these mood-enhancers may create anxiety. If you
are uncomfortable with these preparations, don't hesitate to
let your therapist know.
For MLD therapy you will need to strip
to the waist. Your therapist will provide a pillow,
comfortable support for your knees, and a sheet or robe to
drape your upper body. Throughout the massage you will
remain modestly draped, with only those areas being worked
on at the moment exposed. Again, if you become uncomfortable
it's important to talk to your therapist about your feelings
so she or he can make the necessary accommodations.
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Lymph fluid cannot move through
hardened (fibrotic) areas, whether the fibrosis was caused
by surgery, radiation, or the lymphedema itself. If you have
areas of fibrosis blocking lymph flow, your therapist will
begin with a deeper massage designed to break up the
hardness over time.
Then the gentler MLD massage can
begin, with some instruction in deep, abdominal breathing,
followed by special motions to clear the nodes in your neck
and axilla or groin (depending on where the therapist plans
to move the lymph fluid.) Your therapist will then proceed
with the massage pattern, moving to your chest, shoulder,
arm, back and side. Your part in it all is to relax, breathe
deeply – and don't worry if you fall asleep!
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When you first begin MLD, you may find
it hard to believe that the kitten-petting gentle strokes of
the massage can have any positive effect at all. In fact, it
may seem like hocus-pocus and a waste of your time. But most
patients are pleasantly surprised at the quick response of
their body to this external means of moving the fluid
trapped inside.
When stagnant lymph fluid is
successfully moved back into circulation in your body, the
result is that more fluid is available to be processed by
your kidneys, so you may experience an urgent need to
urinate following MLD. You'll want to be sure to use the
bathroom before heading for home.
Occasionally, MLD that moves a lot of
fluid can result in feelings of nausea or a deep aching. It
is usually a passing effect and leaves no lasting problems,
but do let your therapist know if you develop any unusual
symptoms so your treatment can be adjusted.
LEARNING SELF-MLD
Besides the therapist's hands-on MLD,
you will learn an MLD routine you can do yourself. The hand
motions and steps will be similar to those your therapist
does, but simplified to make it easier to perform and
remember. That's why self-MLD is sometimes called "simple
MLD," even though it can be difficult to learn.
It can help to bring along a spouse or
significant other, or a close relative or friend, to learn
along with you. This person, who will be your MLD partner,
can begin by watching and taking notes, or by recording the
process with a video camera or cell phone for future
reference. Your MLD partner will be able to help you with
daily care by massaging those areas that are difficult for
you to reach. They can also provide needed relief for those
times when self-MLD is tiring, or encouragement when it
becomes boring.
If you have no one to partner with you
in learning self-MLD, don't worry. Your therapist will help
you manage all the necessary steps alone, and should provide
you with written information to help you remember all the
important points.
Be sure you understand the hand
movements, the direction of massage, and the order of the
massage steps before beginning self-treatment. Ask your
therapist to observe and correct your own self-massage and
that of your MLD partner (if you have one).
Just as patients are all different, so
are therapists. Some recommend self-MLD daily, some only as
needed, and others prefer that patients not do it at all,
since without frequent review and correction you may not be
performing it correctly. Whatever yours prefers, insist on
learning it anyway, as it can be an important tool for
maintaining control of your condition, especially at those
times when your therapist may not be easily available.
