A brief history
Dr. Emil Vodder and his wife Estrid, a naturopath, developed manual lymph drainage (MLD) in France in the 1930s. They treated patients at a physical therapy institute. For years Dr. Vodder had an interest in the lymphatic system and studied this living environment which he felt was the most important organ system in the body. While treating patients with conditions such as acne, migraines and sinusitis, he could feel swollen lymph nodes in their necks. He believed the swelling or congestion was the underlying cause of the disorders because the lymph nodes had become unable to cleanse the tissues therefore contributing to these symptoms. He believed the lymph nodes could be massaged in a way to relieve their congestion. From here he intuitively invented the techniques of MLD. His technique involved lightly pressured circular stretching and pumping of the skin over the congested lymph nodes and with this method the symptoms disappeared. In the 1960s, various doctors became interested in Dr. Vodder’s work and put together the first list of conditions that would benefit from lymphatic massage. In 1966 in Austria, the Wittlingers, a family of physical therapists met and worked closely with Dr. Vodder. They opened a spa facility equipped in treating various ailments. Dr. Vodder taught them his technique and they continue to this day to be a treatment centre for lymphatic disease. The Wittlinger Clinic has medical doctors on staff, lymphatic therapists who treat with MLD, use water therapy, nutrition, exercise classes and also house a teaching school. To this day the Wittlingers have ensured the Dr. Vodder technique has been kept in its original form. Instructors have undergone rigorous training and travel around the world to teach the Dr. Vodder MLD technique to therapists.
How manual lymph drainage works
Lymphatic drainage massage stimulates the lymph vessels to contract in the region being treated. Studies conducted by Professor Mislin have demonstrated this effect. Lymphatic massage uses a specific sequence of strokes which is repeated several times depending on the condition being treated. Studies have shown an increase of lymph activity in an opposite body part than the one under treatment (e.g. lymphatic massage performed on the left leg results in stimulation of lymph flow on the right leg). This kind of remote stimulation is used in therapy where a certain body part may not be able to receive treatment. For example, if a right arm recently had a skin transplant, and cannot receive treatment due to the delicate tissue that needs to adhere to surrounding skin, a therapist can treat the left arm with the goal of reducing swelling and improving healing on the right arm.
Lymphatic massage therapy may have decongestive benefits achieved in various ways. Lymphatic massage stimulates lymph flow and drains the affected tissue of excess water and protein. It is necessary for the pressure exerted by the lymphatic massage therapist to be adjusted precisely to the texture of the tissue. Too much pressure can increase the amount of fluid in the tissues, a result we want to avoid. Lymphatic vessels in the skin are microscopic in size and do not need a lot of pressure to get them to contract and move fluid forward into the lymphatic system.
Manual lymph drainage acts on the skeletal muscles. Insufficient oxygen supply results in an increased accumulation of lactic acid. This metabolic disorder leads to a palpable form of increased muscle tension. In such cases, lymphatic massage will greatly speed up the removal of lactic acid thus resulting in rapid and painless regeneration of muscle fibres.
The smooth muscles in the intestinal wall respond promptly to manual lymph drainage. It relieves spasm and improves the tone of weakened muscle segments. Lymphatic massage can activate the mechanism by which smooth muscle contracts on its own. Lymphatic massage has a similar effect on the smooth muscle lining the lymph vessels. Spastically blocked lymphatic pathways will relax and open up therefore increasing lymph flow frequency and amplitude.
Lymphatic massage is deeply relaxing and soothing. Evidence is still insufficient to determine whether this rebalancing of our nervous system is largely due to the psychological benefits of human touch or whether Lymphatic massage plays a role to stimulate the release of serotonin and catecholamine. Dr. Hutzschenreuter demonstrated in his scientific studies that lymphatic massage leads to a decrease in sympathetic tone (the part of the nervous system responsible for the fight or flight response). A decrease in sympathetic tone allows our bodies to rest and digest. It also allows for the lymphatic channels to fill then causes a contraction of the vessels to propel lymph fluid forward.
In many applications lymphatic massage has a pain reducing effect. Stimulation of mechanoreceptors (cells that respond to touch) in the skin interrupt the pain signals to the brain. Lymphatic massage also removes fluid from the tissues containing pain causing chemicals.
There is no scientific evidence for the immunological benefits of manual lymph drainage massage but it is well known from clinical experience that this technique reinforces the body’s own mechanism for resisting illness. In the clinic, we see improved rates of healing in chronic wounds or bruising for example. This may be due to the fact that proper lymphatic circulation improves the removal of toxins in the tissues. Toxins or other foreign substance that induce an immune response in the body may also be delivered to the lymph nodes, from where the anti-bodies formed by the lymph nodes cells are rapidly distributed by the lymphatic and blood system to areas of the body where they are needed.
Manual lymph drainage techniques
The Dr. Vodder method of manual lymph drainage works with continuous spiral type or shearing strokes of increasing and decreasing pressure. This constant change in pressure generates a pumping effect in the lymphatic vessels of the skin. Pressure is increased toward the natural direction of lymph flow. This gentle technique is mostly applied to the skin. In some instances a deeper pressure is used to stimulate lymph nodes or to soften dense fibrotic tissue. The lymphatic massage therapist works with steady and rhythmic strokes which follow one another, stretch the skin and match the natural contraction rate of lymph vessels. These hand movements should not cause pain or reddening of the skin as this would have a negative effect on the lymph flow. It is important to use a light pressure in order to access the tiny lymphatic vessels in the skin. Too much pressure would compress the vessels and would not promote flow into the lymphatic structures. The four main strokes of MLD are:
- stationary circles
- pump technique
- scoop technique
- rotary technique
Dr. Vodder MLD sessions begin with treating the lymph nodes and vessels of the neck where the lymph system for the body terminates. From here lymph fluid enters into veins in order to return this cleansed fluid to the heart. For lymphatic massage to be effective it is essential to both competently apply the specialized techniques and to adjust therapy sessions to symptoms of the individual patient. Manual lymph drainage sessions require different lengths depending on the condition being treated. Book an appointment with one of our lymphatic massage therapists and they will do a thorough assessment of the condition and offer a treatment plan based on the goals to be achieved.
Below is a video showing stimulation of lymphatic propulsion in the foot and calf of a normal healthy volunteer before and during manual lymphatic drainage.
Denise Drisdelle is a registered massage therapist and co-founder of FLOW Lymphatic Health Services.
Sources:
Mislin H, Schipp R., “Structural and functional relations of the lymph vessels. Progress in Lymphology.” Proc Intl Symp Lymphol Zurich, Switzerland 1966, 360–365.
Mislin H., “Active contractility of the lymphangion and coordination of lymphangion chains.” Experientia 1976;32:820–822.
Schillinger A, Koening D, Haefele C, et al. “Effect of manual lymph drainage on the course of serum levels of muscle enzymes after treadmill exercise.” Am J Phys Med Re-hab 2006;85:516–520