Massage.
Physiology of massageDraft

The lymphatic system and massage

Lymph moves slowly under low pressure, and specialised lymphatic drainage can add a small benefit in lymphoedema care, but there is little evidence that a relaxation massage changes lymph flow in healthy people.

Evidence
limited

A Cochrane review of six small trials found MLD was safe and may add a modest benefit to compression bandaging for arm swelling after breast cancer treatment, with low confidence and inconsistent results. There is little direct evidence that ordinary relaxation massage measurably increases lymph flow or "boosts immunity" in healthy clients. Lymphoedema management is specialist work and outside Cert IV scope.

Effects

  • Light, slow strokes directed towards the lymph nodes are used in specialised manual lymphatic drainage (MLD)
  • In breast-cancer-related lymphoedema, MLD added to compression bandaging gave a small extra reduction in arm swelling in a few small trials
  • Clients often report that light rhythmic work feels soothing and that swollen areas feel lighter, whatever the treatment

The basics

The lymphatic system is a network of thin vessels and lymph nodes that collects excess fluid (lymph) from the tissues and returns it to the bloodstream. It is also part of the immune system: lymph nodes filter the fluid and house immune cells.

Unlike blood, lymph has no central pump. It is moved by:

  • Rhythmic contraction of the lymph vessel walls
  • Skeletal muscles squeezing the vessels as we move (the “muscle pump”)
  • Pressure changes when we breathe
  • Gentle stretch and pressure on the skin, because many lymph vessels sit just under the skin

Where massage fits

Manual lymphatic drainage (MLD) is a specialised technique using very light, slow, skin-stretching strokes towards the lymph nodes. In people with lymphoedema (chronic swelling after lymph nodes are damaged or removed), it is used alongside compression bandaging, skin care and exercise. The best review of this found MLD may add a small extra reduction in swelling, based on a few small trials. Interestingly, 60–80% of people in those trials reported feeling better whichever treatment they had.

For a healthy relaxation-massage client, there is little evidence that massage makes a measurable difference to lymph flow or immune function. Claims that massage “drains toxins through the lymph” are not supported (see What massage research does and doesn't show).

Practical points for a Cert IV therapist

  • Lymphoedema, unexplained swelling or swelling on one side only: refer on to a qualified lymphoedema therapist or the client’s doctor. Do not treat it yourself.
  • Strokes on the limbs are usually directed towards the heart. That is a sensible habit for comfort and flow, not a treatment.
  • An introduction to the technique is in the planned beyond-scope note on lymphatic drainage.

Sources

  1. Ezzo J et al. (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev (5):CD003475
  2. Wikipedia: Lymphatic system