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Today we are discussing Manual Lymphatic Drainage (MLD)

March 2022

Written By Graham H

© Trusted Touch Therapies


As a therapist, MLD is the gentlest therapy I have ever practiced or received. It works only 1mm (yes 1 millimetre) into the body. There are very good reasons for this which will become clearer later on.

What is MLD?


MLD is a massage technique, which focuses on stimulating the movement of lymph through the body’s lymphatic system.


So what is the lymph and what is the Lymphatic System?


Well let’s start at the beginning of this process. Oxygenated, nutrient rich blood (containing glucose and other essential proteins) passes through the arterial part of the circulatory system, which finishes in the arterial blood capillaries. At this point, blood plasma carrying oxygen and nutrients passes from the capillaries into muscles and bathes muscle cells so that they can function and regenerate. Once plasma passes through the capillary wall, it is known as interstitial fluid. This fluid fills the spaces around the bodies cells and is composed of water, amino acids, sugars, fatty acids, hormones, coenzymes, neurotransmitters, salts and cellular products. So essentially, interstitial fluid is a transport mechanism to deliver materials to cells.


It then and then becomes the means by which metabolic waste can be taken away from those cells. As the pressure from newly deposited interstitial fluid builds up, older, toxin laden interstitial fluid is pushed through venous blood capillaries back into the blood stream, but because of low pressure some is left behind. This flows into lymph capillaries and becomes lymph.


Lymph capillaries group together to form lymph vessels, lymph nodes and lymph ducts. After a filtering process, lymph is deposited back into the blood stream where the toxins it still carries, can be filtered out by the body’s various organs designed for this purpose such as the kidneys and liver.


The lymphatic system is considered a sub-system of the circulatory system. The lymphatic system has no ‘pump’ or means of moving lymph along its various channels. The circulatory system has the heart, digestive system has peristalsis, and so on. Lymph is stimulated to move, as a by-product of other autonomic processes such as respiration, arterial pulse and peristalsis. Exercise and voluntary muscle movement is the only voluntary mechanism we can engage or increase to help with the removal of lymph. The only externally applied modality guaranteed to work is MLD. Due to the thorough removal of metabolic waste, excessive fluid, bacteria and other toxins from the body, this therapy has a deep cleansing, relaxing and pain reducing effect on the body. The sympathetic nervous system is relaxed, and the function of the immune system is improved.


Locally MLD can be used to reduce oedema, reduce fibrosis minimising scar tissue formation, can be useful post mastectomy, and surgery in general where oedema persists and is preventing rehabilitative therapy to begin.


So principle functions of the Lymphatic System include a:


  • Drainage system – collecting interstitial fluid including blood plasma, large protein cells and returning it to the blood stream

  • Waste removal – from cells

  • Defence system – helps immune response to infections through the presence of of lymphocytes and macrophages.

  • Part of the fat (lipid) absorption system transporting lipids from the intestine to the circulatory system


Structure of the Lymphatic System


This system consists of:


- Lymphatic vessels to transport lymph.

Lymphatic vessels are found throughout the body except in Avascular tissue such the epidermis, cartilage, ligaments and tendons and a few other areas. There are also no lymph vessels in the CNS (Central Nervous System). Mostly lymph vessels run parallel to blood vessels. Lymph capillaries are found around and near blood capillaries. Lymph capillaries have no arterial end and so originate from a closed tube. They also have a larger and more irregular lumen as compared to blood capillaries. The single cell capillary wall is composed of slightly overlapping endothelial cell walls which create single-direction openings which are pushed open by greater fluid pressure outside of the lymph capillary, allowing interstitial fluid into the lymph capillary, but not out. Once the pressure inside the lymph capillary is equal or greater to the pressure outside of the capillary the value is pushed closed, preventing the newly formed lymph from escaping.

Lymph capillaries form together to form lymph veins or lymphatics.

These are similar to blood conducting veins, but have thinner walls and more back-flow-prevention valves and larger lumens.


- Lymph Nodes

These are found all over the body and are connected by lymph vessels / lymphatic. This is the part of the lymphatic system responsible for filtering lymph.

Microbes, malignant tumour cells, dead and live phagocytes containing ingested microbes / malignant tumour cells, worn out or damaged tissue cells and inhaled particles are all filtered out along a series of lymph nodes as the lymph passes along the lymph vessels before being retuned to the blood stream. If a lymph nodes swells, it is usually because phagocytation is incomplete and swelling is a sign of infection.


The Lymphatic system as part of the Immune System


The Lymphatic System also has a concentration of specific types of white blood cells, which are cells that form part of the body’s immune system. White blood cells are produced in the bone marrow, found throughout the body and may need to interact with other parts of the body to be assigned their specific roles.

Broadly speaking, there are two types of white blood cells (leukocytes) found in the lymphatic system. Some of these may be found in other areas. They are:


- Macrophages

Macrophages are a type of phagocyte produced in the bone marrow. A phagocyte is a type of cell which preforms phagocytosis where by a large particle (such as pathogens and cell debris) are engulfed by the phagocyte’s cell membrane in order to break down the particle or kill it, depending on the phagocyte. They are non specific and so will act against various particles, thus they are considered part of the innate immune response – first line of the bodies response.


 - Lymphocytes

Lymphocytes are is the name given to a group of white blood cells when found in the lymphatic system. These are: T (Thymus) Cells and B (Bone Marrow) Cells.

The function of T cells and B cells is to recognise specific "non-self" antigens. This is known as a antigen presentation. Once they have identified an invader, the cells generate specific responses to eliminate specific pathogens or pathogen-infected cells. Afterwards, B cells and T cells leave a lasting legacy of the antigens they have encountered, called memory cells. This is known as the body's adaptive immune system and is the body's second line of defence as it is learned along the way. 



- NK (Natural Killer) Cells

NK cells are a part of the innate immune system. They play an important role in defending the body from tumours and virally infected cells. NK cells modulate the functions of other cells, including macrophages and T cells.


Lymphatic Circulation


Although the lymphatic system is a sub system of the circulatory system, they are not intrinsically connected and the lymphatic system does not have a pump of its own. So movement of lymph is stimulated in a variety of ways:

  • In the viscera, lymphatics tend to form plexuses around arteries, so the arterial pulse stimulates lymph movement.

  • During inspiration, the negative pressure in the thorax, draws lymph into the thoracic duct

  • During expiration, negative pressure draws lymph into the subclavian vein

  • As interstitial fluid flows single directionally into lymph capillaries, the pressure inside the lymph capillary pushes the lymph along the lumen towards lymph nodes.

  • Muscle movement (exercise) stimulates lymph movement

  • Valves prevent back flow of lymph

  • Artificial stimulation from Manual Lymphatic Drainage


Disorders associated with the Lymphatic System


- The spread of disease

As the lymphatic system is essentially a transportation system and whilst it usually works for the benefit of the body and assists in homeostasis and the body’s immune response, it can also transport infected material and//or tumour cells, the later causing a cancer to metastasise. Lymphangitis is when the microbes present in lymph may infect the walls of the lymph vessels



- Lymphatic obstruction

Lymphoedema is when lymph accumulates distally to a lymphatic obstruction. The most common cause in the UK is trauma caused by surgery and tumours. Lymphoedema can cause low grade inflammation and fibrosis. Enlarged lymph nodes (lymphadenopathy) occurs when they filter a lot of material due to infection and usually reduce in size once the infection has been resolved by the body’s immune response. Except when infection is chronic or there is excessive or prolonged foreign particulate matter present in lymph, the lymph node may become fibrosed.


- Lymphoma

This is a malignant tumour of lymphoid tissue and can be either Hodgkin’s lymphoma or non-Hodgkin’s lymphoma.


- Oedema

This is a symptom of disease rather than a disease in itself. Oedema or swelling commonly forms in the following situations:


  • Skin injuries cause by a bite or sting

  • Around the ankles during long flights, pregnancy or hot weather

  • Muscle/joint injuries such as strains or sprains

  • Where excessive fluid removal is compromised such as heart of kidney conditions

  • Diuretic drugs which stimulate excessive water removal



The presence of the following conditions, will restrict treatment:

  • Presence of any skin infections

  • Inflammatory diseases

  • Presence of fever

  • Active cancer patients – if a tumour has not been removed or not under medical control

  • Undiagnosed lumps or bumps

  • Malignant melanoma

  • Risk of circulatory conditions – Thrombosis, embolism or phlebitis

  • Risk of heart conditions – acute angina pectoris, coronary thrombosis.

  • Lymphatic drainage techniques increase the amount of fluid in the circulatory system and so put extra load on the heart arteries and veins

Medical approval would be strongly suggested if a client has the following conditions:

  • Diabetes

  • Low blood pressure

  • Thyroid conditions

  • Kidney conditions

  • Bronchial asthma

  • Epilepsy

  • Spleen removed

  • Breast implants

  • Organ transplants

  • Joint replacement

  • During menstrual cycle

  • During course of antibiotics

  • If treatment causes pain


Medical conditions that may benefit from Manual Lymphatic Drainage:


  • Recent recovery from regularly occurring cold and flu – must not be ill at time of treatment

  • Recent recovery from glandular fever

  • ME / Chronic Fatigue Syndrome

  • Migraines

  • Sinus problems

  • Allergies

  • Post surgery (pre if oedema is present)

  • Post cancer treatment

  • Cellulite reduction

  • Digestive problems

  • Sedentary lifestyle

  • Stress / anxiety

  • Acne, rosacea and scar reduction post surgery


Anecdotal benefits


  • Alleviates low energy

  • Supports poor respiratory system

  • After long haul flight

  • Boosts immune function

  • Increase general feeling of well being

  • Improves skin complexion

  • Promotes body’s own healing mechanisms


Written by Graham H

© Trusted Touch Therapies.

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