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Manual Lymphatic Drainage: A Not-So-Deep Dive

Updated: Mar 26, 2023

Manual Lymphatic Drainage, or MLD for short, is a series of gentle techniques used to increase the contraction rate of the lymphatic vessels, leading to elimination of swelling in a traumatized area, pain relief, increased relaxation, & decreased scar tissue formation. Here you will learn its purpose, how it differs from massage, who is or is not a candidate, and where to find a reliable practitioner.


Your Lymphatic System & You

To understand MLD, you first need to know about your Lymphatic System. One of the unsung heroes of the human body, this system has its proverbial hand in everything from immunity, to digestion, and excretion. It works in conjunction with the cardiovascular system to help with elimination of metabolic waste (cell poop) and extra fluid produced by surgeries/traumatic injuries/medications/disease (swelling). The lymphatic system has no central pump like the heart. It instead relies on the contraction of muscles during movement, the pulsating of blood vessels, and deep breathing to help usher lymphatic fluid along its way. You probably remember seeing depictions of it on the body posters hanging up in your science classroom—red for the arteries, blue for the veins, and the green string-of-pearls situation representing your lymphatic vessels.

Red for arteries, blue for veins, green for lymphatics

Ranty Sidebar:

Our blood is not blue. The common misconception of our blood being blue until it is exposed to the oxygen in the air through a cut is just that—a common misconception brought on in part by the aforementioned science classroom posters we saw growing up. The illustrators needed a way to show the difference between arteries and veins; hence, red and blue. Yes, I know that veins look blue under the skin. Yes, I know that veins are responsible for bringing the deoxygenated blood back to the lungs by way of the heart and that lack of oxygen is associated with a blue color (cyanosis) -- like when someone's lips turn blue after they stop breathing. The fact of the matter is that normal deoxygenated blood in a fully functional circulatory system is actually a darker red than its oxygen-rich counterpart. The way the light travels through the skin makes the veins closest to the surface, and consequently the blood within them, appear blue. Nothing more. Hemoglobin, the iron-rich protein that binds oxygen to red blood cells, makes our blood red for always—whether it is oxygenated or not. Think back to that science poster from the good 'ol days of yore. The lymphatic vessels are illustrated as green. Does that mean our lymph is green??? I can assure you it does not. Depending on its location in the body, lymph is either clear or milky. And now you know. Be a good friend and share the knowledge.

What is the purpose of MLD?

At our normal baseline the smooth muscle in our lymphatic vessels contracts on average approximately 6-10x/minute to uptake the fluid in the space between our cells (AKA the interstitium). When something physically traumatic happens to us—sickness, surgery, injury, pregnancy, etc..—it causes our small blood capillaries to leak fluid into the interstitium. This dramatic increase in fluid retention is known as swelling or edema and it can happen almost anywhere in the body.

At its current rate of operation our lymphatic vessels would eventually be unable to keep up with the sudden influx of fluid. That's where MLD comes in. It creates an optimal environment where the lymphatic vessels can contract at a much higher rate, approximately 60x/minute, creating a "suction" effect to aid in draining the edema. Clinically speaking, MLD increases lymphangiomotoricity. Say THAT 3 times fast!

Massage vs MLD

The only commonality between massage and MLD is that both are applied manually. What is important to remember is that MLD is not, in fact, massage. It is its own entity completely. Our lymphatic vessels are located just 1mm below the epidermis. The lightest of touch will begin to affect them. Give it a try: lightly place your fingertips over the skin on your forearm and gently stretch the skin in all directions. Congratulations, you've just come into contact with your lymphatic vessels. The word 'massage', on the other hand (Ha! Hand.), literally means 'friction of kneading'. Cue visions of all the squeezing, pulling, punching, and slamming that comes with kneading dough into bread. While some massage work falls within the realm of the superficial (think: light Swedish massage strokes), even those strokes are far too heavy to optimally affect your lymphatic system. The amount of pressure used during MLD has been likened to the amount of pressure you would use to stroke a newborn baby's head.

Who can or cannot have MLD?

Below are a few examples of those who are or are not candidates for MLD. This list is by no means exhaustive. Whether you feel your condition is indicated or contraindicated, it is important to first discuss your medical history with your potential MLD practitioner.

Who should I see for MLD?

In most states there are no laws governing which bodywork practitioners can or cannot perform MLD. The gamut ranges from LMT's to OT's to PT's. For most of us it is a subject that is barely touched on in our initial schooling and is therefore up to each individual therapist to seek out additional enrichment. Needless to say, there are a lot of therapists in the U.S. with additional training amounting to a 2-hr 'Intro to MLD' continuing education course running around, calling themselves an MLD practitioner. Please, please, please do your research to find qualified practitioners in your area. They will have put in hundreds of hours of study with a legitimate institution of learning to provide you with the safest care available. Don't be afraid to inquire about your potential practitioner's credentials. Chances are they will be grateful that you knew enough to ask and will happily provide proof of their expertise. The Academy of Lymphatic Studies offers a Find A Therapist database that will put you in contact with the kind of MLD practitioners you are looking for.

Interested in MLD? Myo can help. We are certified to perform MLD for injuries, post-plastic surgery, general relaxation and more. Feel free to contact us directly or book a treatment session online.


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