Is Lymphatic Drainage Massage Painful?
Updated: Feb 6
The short answer is NO. I decided to write this article because I have now had many clients arrive at our wellness center afraid that lymph drainage following their aesthetic procedures was going to be painful. Through discussions with my clients, I learned that this fear came from various sources. Some information came from the internet or reports from other patients at their surgical center or plastic surgeon’s office. Others already had a "lymph drainage" treatment that was painful. The take home message from this article is that lymph drainage should not be painful if the provider is trained in the proper techniques.
What is the Lymphatic System?
The lymphatic system is a series of vessels and lymph nodes that assist the body in removing excess fluid and debris from our tissues. Most of the fluid in our bodies is carried to and from our tissues by our arteries and veins. Our arteries pass fluid and nutrients through the arterial wall (membrane) to the tissues. Our veins absorb fluid and waste products through their membrane, and these can be recycled as needed or eliminated through our urinary and intestinal systems. Our bodies, however, also produce larger proteins, fatty acids, and cellular debris that are too large to pass back through the veins to be eliminated. This is where our lymphatic system helps.
The lymphatic system vessels are designed to be stretched by attached fibers. This stretching creates an opening between the cells where the fluid and larger molecules and particles can enter the lymph vessel system. This fluid and debris are then carried through the lymph nodes. Our immune response mechanisms are activated in the lymph nodes, and the larger molecules and debris are processed. The fluid continues to travel through the lymph vessels where it ultimately returns to the venous system. This happens through lymph vessel connections to veins near our neck on both sides. The excess fluid then leaves the body from the veins through the urinary system. The veins, arteries, and lymphatic system are normally able to maintain the fluid balance in our tissues. They have enough “functional reserve” to compensate for conditions that increase the “lymphatic load” (increase in tissue fluid). Examples of activities that increase tissue fluid are applying heat to the body, heavy exercise, or traditional massage techniques.
Unfortunately, if the functional reserve of our lymph system is exceeded, fluid and debris will accumulate in the tissues. In addition to larger protein molecules and fatty acids, many other byproducts of trauma, inflammation, and infection contribute to the load on the lymphatic system. These include cellular parts and debris such as red blood cells, white blood cells, lymphocytes, cancer cells, bacterial cells, and viral cells. In addition, dust, ink (from tattoos), and other particles that enter the body through inhalation, digestion, or injury are handled by the lymphatic system.
What is Lymph Drainage?
Manual lymph drainage is a noninvasive, painless, and effective technique that improves the activity and operating speed of the lymphatic system. Many people refer to manual lymph drainage as lymphatic drainage massage or lymph drainage massage. However, it really is not a massage technique in the traditional sense. Manual lymph drainage is a series of specific and coordinated strokes that stretch the lymph vessels and push fluid in an appropriate direction. The strokes open spaces between the lymph vessel cells and then route or re-route the fluid to an appropriate area. Training and expertise are needed to do this correctly. Different techniques and strokes are sequenced together as needed to address the appropriate areas and work around any complications or issues with the lymphatic system. This may include missing or overworked lymph nodes, surgical scars, or damaged lymph vessels. Techniques include light strokes that stretch across the skin and then direct the fluid in the right direction (which can vary depending on several factors). Techniques also include wave-like motions along the abdomen, ribs, spine, or sternum to engage the deeper lymphatic system and nodes. Depending on your stage of recovery, you may have some tenderness in some areas, but lymph drainage should not be painful.
What Can Lymph Drainage Do for You after surgery?
A skilled therapist can apply the principles and techniques of lymph drainage to help reduce swelling and fluid retention after most all surgeries and injuries. It is especially effective in assisting in recovery from aesthetic surgeries. These include liposuction, tummy tuck, breast implants or reduction, BBL, and facial procedures. Aesthetic surgeries can compromise the lymphatic system. Surgical incisions may block the normal flow of lymph and liposuction removes and damages lymph vessels. Never fear, the body normally adjusts for this damage over time. Manual lymph drainage (lymphatic drainage massage) helps the body to speed up fluid removal. It also helps with pain relief and the prevention of hardened areas under the skin.
I must emphasize that lymph drainage alone is not enough to manage swelling after aesthetic procedures. Compression is a very important part of fluid management and recovery. You must wear appropriately fitting compression garments as directed by your physician to achieve a good result.
Who is Qualified to Perform Lymph Drainage?
The most common health professionals who perform lymph drainage are physical therapists, occupational therapists, nurses, and massgae therapists. Aestheticians may be trained in lymph drainage for the face and neck. To provide effective treatment your therapist needs to have specialized training in the anatomy and physiology of the lymphatic system in addition to the many techniques and sequences to stimulate lymph drainage. Your therapist should be trained by a high-quality program and have credentials.
The gold standard for training in manual lymph drainage is the Academy of Lymphatic Studies (ACOLS). They offer certification as a Certified Lymphedema Therapist (CLT) which is an intensive 10-day course in all components of treatment of lymphedema known as complete decongestive therapy (CDT). CDT includes manual lymph drainage (MLD), compression and compression wrapping, skin care, and appropriate exercise. ACOLS also offers a comprehensive 5-day course in just the manual lymph drainage portion. The Lymphology Association of North America (LANA) offers an additional level of certification for lymphedema therapists through comprehensive testing.
Look for the credentials of CLT-LANA for therapists with comprehensive training and experience. Therapists can also have the designation of Advanced Lymphedema Management (ALM). This is advanced training provided by ACOLS. ALM training includes more advanced techniques such as wound care, taping, treatment of the head and neck, and use of suction as a tool for lymph drainage. The Norton School of Lymphatic Therapy also offers comprehensive training and certification for lymph drainage and management of lymphedema. You can be assured that therapists with the designation “CLT-LANA, ALM” are highly skilled to meet your lymph drainage needs and be able to adapt treatment skillfully to your unique situation. Examples of credible techniques of lymph drainage include the Vodder, Foldi, and Ludec methods.
Please be aware that "lymphatic drainage massgae" or "lymphatic massage" is currently being marketed as a style of wellness massage in many spa settings and by many massage therapists. I have had it done myself, and I love it. Light strokes that stimulate the lymphatic system are wonderfully pain relieving and relaxing. Unfortunately, this is not the same as manual lymph drainage techniques that are needed to combat post-surgical and fluid retention due to other medical conditions. These techniques are specific and both skill and practice are required to apply and adapt them to your specific situation. Regardless of the type of license your practitioner holds (DPT, OT, LPN, RN, ARNP, LMT), please seek a provider who is at least credentialed as a CLT. While training in a MLD technique alone may provide enough knowledge to perform the lymph drainage, it does not offer the more compressive training of CDT, including the use of compression. A CLT can assist you and advise you in matters of compression management, fibrosis management and prevention, and scar management.
What Lymph Drainage is NOT…
I feel compelled to write this section in response to some of my clients sharing their experience with “lymph drainage.” Several have described receiving a procedure involving a practitioner opening (pulling off the scab) from one of their small liposuction insertion points and having fluid forcibly pushed through these openings. This is NOT manual lymph drainage. It may be considered a form of post-op massage, but it does not have anything to do with using the physiology of the lymphatic system to drain the excess tissue fluid from the body tissues. I do not yet know why this has become a practice in the United States. This is not taught in any credible lymph drainage or lymphedema management course or certification program. Also, this is not within the scope of practice of a licensed massage therapist my home state of Florida. Neither is this type of external fluid drainage needed. Skilled manual lymph drainage using the physiology of the lymphatic system is a safe, effective, and painless technique for assisting the body to remove excess post-surgical fluid.
If external fluid drainage is recommended by your physician, it is my professional opinion that a procedure such as this should be performed by a physician or a nurse under the direction of a physician. Complications may include increasing the risk of infection and scarring. Although I will say that moving fluid with lymph drainage techniques can be applied to wound care and fluid retention associated with wounds, it does not involve opening wounds or use of aggressive techniques to push fluid through a wound. The same gentle techniques of manual lymph drainage should be applied by a certified practitioner in these cases as well.
The bottom line is that lymph drainage is the gentle stimulation of the lymphatic system. It leverages your body’s natural ability to clear fluid through the lymphatic system, vascular system, and kidneys. It should NOT involve forcibly removing fluid. These practices have the potential to damage the lymph system rather than stimulate it and increase tissue fluid retention instead if reduce it.
What Makes Lymph Drainage at Blue Lotus Wellness Different?
Our owner and chief therapist, Dr. Margaret, holds a Doctorate Degree in Physical Therapy and has been serving as a health care provider since 1996. She is a Certified Lymphedema Therapist and holds the advanced certification through ACOLS. She also holds the LANA credential. Not only can she provide manual lymph drainage, but she can also provide advice on other aspects of your recovery. These include help managing fibrosis, advice on mobility issues, advice on return to activity and exercise, scar management, constipation reduction, and pelvic health concerns. Dr. Margaret and her staff are also trained in the use of MediCupping as a tool to assist with lymph drainage. Additionally, Dr. Margaret has undergone multiple aesthetic surgeries herself to body and face and can uniquely relate to your journey to recovery.
With the help of Blue Lotus Wellness, you can