Manual lymphatic drainage (MLD) is a gentle and effective technique used to stimulate the movement of lymphatic fluid throughout your body. Your lymphatic system is a critical component of your immune system, playing several essential roles in your health, including maintaining fluid levels, supporting your immune response and aiding in fat absorption.
The lymphatic system plays a key role in removing waste, toxins and excess fluid, but unlike the circulatory system, it lacks a central pump like the heart to move lymph fluid through your body. Instead, the movement of lymph — the fluid that circulates through your lymphatic system — relies on the contraction of surrounding muscles, respiratory movements and the gentle contractions of lymphatic vessels themselves.
This makes your lymphatic system more susceptible to becoming sluggish or blocked, leading to issues such as lymphedema and more. MLD helps by manually stimulating the flow of lymph, encouraging it to move through the lymphatic vessels and toward your lymph nodes, where it can be filtered and eventually returned to your bloodstream.
This manual assistance is crucial, especially in individuals who have impaired lymphatic function due to surgery, trauma or congenital conditions, as it helps to prevent the buildup of lymph fluid and maintains proper lymphatic circulation. This practice significantly reduces swelling, enhance detoxification, support immune function and promote relaxation. Here’s a detailed guide on how to perform MLD for self-care and wellness.
Benefits of Manual Lymphatic Drainage (MLD)
One of the primary benefits of MLD is its ability to reduce fluid retention and swelling, also known as edema. When lymphatic fluid accumulates in the tissues, MLD helps drain it, preventing fluid build-up and easing the swelling. People recovering from surgery, injury or even those dealing with chronic conditions like lymphedema1,2 see noticeable improvements in swelling reduction through regular MLD.
In fact, MLD is commonly used to treat lymphedema,3 a condition characterized by the accumulation of lymph fluid, usually in the arms or legs, which causes swelling, pain and discomfort. By promoting lymph flow, MLD helps reduce the swelling and associated symptoms.4
MLD also supports your immune system. The lymphatic system is integral to immune function, carrying white blood cells that fight infection. By promoting lymphatic flow, MLD improves the circulation of these immune cells, enhancing the body’s natural defense mechanisms.
This makes your body more efficient at warding off infections and recovering from illnesses. Some key lymph node areas to focus on include:
• Cervical lymph nodes — Located in your neck
• Axillary lymph nodes — Located under your armpits
• Inguinal lymph nodes — Located in your groin
• Cisterna chyli — Located deep in your abdomen
By stimulating the flow of lymph fluid through your lymphatic system, MLD is important for:
• Post-surgery recovery — MLD is often recommended after surgery,5 particularly in cases involving the removal of lymph nodes, to prevent or reduce lymphedema6 and promote healing by improving lymphatic drainage.
After an injury or surgery, the body produces inflammatory substances, and your lymphatic system works to remove these along with excess fluid. MLD aids in this process by speeding up the removal of cellular debris and reducing inflammation, helping tissues heal faster.
• Relieving pain and discomfort — The gentle massage techniques used in MLD help alleviate pain and discomfort associated with conditions like chronic venous insufficiency, fibromyalgia7 and rheumatoid arthritis by reducing swelling and improving circulation.
• Enhancing skin health — MLD improves the appearance and health of your skin by reducing fluid retention, promoting detoxification and enhancing the delivery of nutrients to the skin cells.
• Promoting relaxation —The gentle, rhythmic nature of MLD has a relaxing effect on your body, triggering the parasympathetic nervous system, which is responsible for your body’s “rest and digest” functions. As a result, MLD helps alleviate stress, tension and anxiety, and improves sleep,8 making it a soothing therapy for your mind and body.
• Encouraging detoxification — Your lymphatic system filters and removes toxins from your body, but this process slows down if you have a sedentary lifestyle or health issues. By stimulating lymphatic flow, MLD helps your body get rid of these toxins more effectively. This reduces bloating, increase energy levels and improve overall wellness.
General Principles of Manual Lymphatic Drainage
For MLD to be effective, it’s essential to understand a few key principles:
1. Apply extremely light pressure — The pressure applied during MLD should be extremely light. Your lymphatic vessels are located just beneath your skin, so deep pressure will compress the vessels and hinder the flow of lymph fluid. Gentle, light pressure — just enough to feel your skin move under your fingers — is all that is needed to move lymph through the vessels.9
2. Use slow, rhythmic strokes — Slow, rhythmic strokes are another crucial aspect of MLD. Lymphatic fluid moves at a slow pace, so the strokes should mimic this natural rhythm. Quick or erratic movements won’t help the lymph fluid move effectively, but slow, steady strokes will gently guide the fluid toward the lymph nodes. Use light, rhythmic strokes to stimulate lymph flow.
3. Direct movements toward your heart — Direction is also important. Your lymphatic system moves lymph fluid in a one-way direction toward the thoracic duct and eventually into the subclavian veins near your heart, where it reenters your bloodstream. Lymph fluid always flows toward specific areas of the body where lymph nodes are located, such as your neck, armpits and groin.
When performing MLD, you should always stroke in the direction of these nodes to ensure the fluid drains properly. Ultimately, all lymph fluid is directed toward your heart, so keep this in mind when performing strokes.
Generally, this means working from your extremities, such as your hands or feet, toward the center of your body and then upward toward your heart. Starting from your lower abdomen and working upward toward your upper abdomen or chest is also effective.
4. Pay attention to your breathing — Deep abdominal breathing helps with lymphatic movement. Breathe deeply and rhythmically as you massage, as the movement of the diaphragm naturally helps move lymph fluid. Start by taking a few deep breaths using diaphragmatic breathing, or belly breathing. This helps engage the diaphragm, which naturally promotes lymphatic flow.
Place one hand on your belly, and as you inhale, allow your belly to rise; as you exhale, let your belly fall. This rhythmic motion helps move lymph toward the cisterna chyli, a sac-like lymphatic reservoir located in your upper abdomen.
5. Create a calm environment — It’s important to be in a relaxed position when performing MLD. Whether sitting or lying down, make sure you’re in a calm and peaceful environment. Being relaxed helps facilitate lymphatic flow, as stress and tension slow down the process. Ideally, find a comfortable, quiet space where you can lie down or sit in a semi-reclined position.
Practical Instructions for Implementing Manual Lymphatic Drainage
To begin a self-care MLD routine, start by ensuring you’re properly hydrated. Drinking a glass of water before MLD helps keep your lymphatic fluid moving smoothly. Once hydrated, take a few moments to relax, which will prepare your body for the gentle stimulation required during MLD.
Start by focusing on the lymph nodes, which serve as filtering points for the lymphatic fluid. Before you begin, it’s essential to “prime” the main lymph nodes to facilitate drainage during the massage. This step ensures that your lymph nodes are ready to receive fluid from the rest of the body.
• Neck (cervical) lymph nodes
◦ Location — Both sides of your neck, under your jawline.
◦ How to stimulate
▪ Place your fingers on either side of your neck, just below your ears.
▪ Using light pressure, gently stroke downward toward your collarbones.
▪ Perform five to 10 strokes on each side.
• Armpits (axillary) lymph nodes
◦ Location — In the armpit region.
◦ How to stimulate
▪ Place your hand flat under your armpit.
▪ Gently press upward toward your shoulder with light circular motions.
▪ Perform five to 10 circles in each armpit.
• Groin (inguinal) lymph nodes
◦ Location — In the crease where your thighs meet your lower abdomen.
◦ How to stimulate
▪ Place your fingers on either side of your groin area.
▪ Gently press inward and upward with circular or sweeping motions.
▪ Perform five to 10 circles on each side.
Next, focus on your face and neck. Lymphatic drainage in this area helps reduce puffiness and improve circulation. Start by placing your fingers in the center of your forehead, then gently sweep outward toward your temples. Continue moving downward, sweeping along the sides of your face and jawline, guiding the fluid toward your neck. Perform five to 10 strokes on each section of your face.
Then, place your hands flat on either side of your neck. Gently stroke downward from your jawline to your collarbones. Perform 10 to 15 strokes.
When working on your arms, begin at your upper arm, near your shoulder. Use your hand to gently stroke down toward the armpit, where the axillary lymph nodes are located. Repeat this 10 to 15 times on each arm. Then move to your lower arm, starting at your wrist and stroking upward toward your elbow. This process encourages fluid to drain from your arms toward the axillary lymph nodes.
To address your legs, start at the upper thighs, just below your hip, and gently stroke upward toward your groin, where the inguinal lymph nodes are located. Repeat 10 to 15 times on each leg. Move down to your lower legs and repeat the same process, starting at your ankles and stroking upward toward your knees. This will help reduce any swelling in your legs and promote the movement of lymph fluid back toward your heart.
Once you’ve completed the MLD session, drink another glass of water to help flush toxins and waste from your body. Light activity, such as walking or gentle stretching, further promotes lymphatic flow and enhance the benefits of the drainage.
How to Perform Manual Lymphatic Drainage on Your Abdomen and Pelvic Region
For your abdomen, focus on the area around the cisterna chyli, which collects lymph from your lower limbs, intestines and pelvis before draining into the thoracic duct. While you cannot directly feel or access it due to its deep anatomical position, you can stimulate lymphatic flow toward this structure using MLD techniques. Here’s how to locate its approximate position and perform a lymphatic drainage massage effectively:
• MLD for the cisterna chyli
◦ Position — The cisterna chyli lies deep in your abdomen, located just in front of the first and second lumbar vertebrae (L1 and L2). It is positioned near the lower end of the thoracic duct, close to the abdominal aorta.
◦ How to find the area — To locate it conceptually, place your hand at the center of your abdomen, just below your ribcage and above your belly button. The cisterna chyli is located deep inside your body behind the stomach and in front of your spine, near this region.
Place your hands just below your ribcage and use soft, circular motions to massage the area. This will help stimulate lymphatic drainage from the lower body into the cisterna chyli, where it can be processed and moved upward.
◦ Massage technique — Although you can’t directly access the cisterna chyli, gentle massage of the abdominal area stimulates lymphatic flow toward this structure, helping to drain lymph from the lower body and improve circulation. Perform 10 to 15 circular motions.
You can also use MLD to enhance lymphatic drainage in other parts of your abdomen, as follows:
• MLD for your celiac lymph nodes (upper abdomen)
◦ Position — Located near your celiac trunk, just below your diaphragm.
◦ How to find the area — Place your hands just below your ribcage in the center of your upper abdomen. This is where your stomach and liver are located.
◦ Massage technique — Use light, circular motions, gently pressing inward and upward toward the diaphragm. Think of moving fluid toward your heart as you massage this area. Start with one hand just below your ribcage, slowly sweeping outward toward the sides.
• MLD for your superior mesenteric lymph nodes (central abdomen)
◦ Position — These nodes are found in the middle of your abdomen, around your belly button (navel), and are associated with the small intestines.
◦ How to find the area — Place your hands around your belly button area, extending outward slightly.
◦ Massage technique — Using gentle pressure, make slow, circular strokes around your navel. Massage in a clockwise direction (following the path of digestion) to encourage movement of lymph fluid. Start with small circles close to your belly button and gradually work outward toward your flanks.
• MLD for your inferior mesenteric lymph nodes (lower abdomen)
◦ Position — These lymph nodes are located in your lower abdomen, typically on the left side, near your lower colon.
◦ How to find the area — Place your hands on the lower left side of your abdomen, between your belly button and the top of your pelvis, slightly inward.
◦ Massage technique — Use soft, circular or sweeping motions across this area, moving upward toward your belly button. Imagine directing the lymph flow toward the central part of your abdomen and then upward.
• MLD for your iliac lymph nodes (pelvic region)
◦ Position — Found along the iliac arteries in your lower abdomen and pelvic area, close to your hips.
◦ How to find the area — Place your hands on both sides of your lower abdomen, just above your groin and inside your pelvic bones.
◦ Massage technique — Apply gentle pressure in circular motions in this area, working from the outer edges near your pelvis inward toward your belly button. Again, focus on encouraging the lymph to move upward and inward. Use light, upward strokes toward your navel, imagining pulling fluid up from your legs and pelvis.
5 Steps for Performing Manual Lymphatic Drainage
The steps that follow will help you get started with MLD at home. Even though you can’t feel the lymph nodes directly, it can help to visualize the lymph fluid being pushed through the lymphatic system. Imagine any stagnant fluid or waste being cleared out of the abdominal tissues and flowing up toward the chest, where the lymph eventually drains into the bloodstream.
This combination of light touch, gentle pressure and mindful breathing stimulates lymphatic circulation and improves overall detoxification, even though the abdominal lymph nodes are located deep inside your body.
Next, use the five steps below to begin. You can perform this massage once or twice a day for general lymphatic health, especially if you feel bloated or have issues with fluid retention. Remember, staying hydrated supports lymphatic flow, so drink water before and after performing lymphatic drainage massage to aid the process.
• Step 1: Stimulate your diaphragm — Place your hands on your upper abdomen, just below your ribcage. Using gentle, circular motions with your fingertips, massage this area with light pressure. Focus on stimulating your diaphragm’s movement. This motion helps stimulate lymph flow from the abdomen and lower body into the cisterna chyli. Perform this for one to two minutes using slow, circular strokes.
• Step 2: Abdominal sweep massage — Place your hands on your abdomen, directly over your belly button. Using both hands, sweep your palms upward toward the center of your ribcage in a gentle motion. Start near your belly button and move upward in a slow, sweeping motion, imagining you’re guiding lymph fluid toward the cisterna chyli.
The pressure should be light and rhythmic, not deep or forceful. This encourages lymph to move from the lower abdomen and pelvis toward the central lymphatic system. Repeat this movement for two to three minutes, continuing to use gentle pressure.
• Step 3: Lower abdominal massage — Place your hands on your lower abdomen, below your belly button. Use your fingertips to perform soft, circular massage motions in this area, moving in a clockwise direction (the direction of your intestines). Gently guide lymph from your lower abdomen upward toward the belly button.
This area covers lymph flow from your legs and pelvis, and massaging here helps move lymph toward the cisterna chyli. Massage in this area for one to two minutes using light, circular strokes.
• Step 4: Side-to-side sweeping motion — Place one hand on the left side of your abdomen and one hand on the right side, just above your hip bones. Sweep both hands gently toward the center of your abdomen, meeting near the belly button, then move your hands back out to the sides. This motion helps guide lymph from the flanks toward the center where your cisterna chyli is located. Perform this motion for two to three minutes using a gentle, sweeping motion.
• Step 5: Combine with deep breathing — After performing the massage, spend a few minutes combining the abdominal massage with diaphragmatic breathing. Take deep breaths, expanding your belly with each inhale and allowing it to fall with each exhale. This natural movement of your diaphragm further assists in moving lymph toward the cisterna chyli.
More Tips for Effective Manual Lymphatic Drainage
To maximize the benefits of manual lymphatic drainage, it’s important to keep a few key points in mind. The following tips will ensure you’re performing MLD correctly and getting the most out of each session.
1. Frequency — For best results, perform MLD two to three times per week or as recommended by a health care professional.
2. Duration — Each session should last between 10 and 30 minutes, depending on the areas treated.
3. Stay hydrated — Drinking water before and after MLD flushes toxins and waste products from the lymphatic system.
4. Consistency — Regular practice of MLD helps maintain healthy lymphatic function.
There are some cases when you should avoid MLD, however. Do not perform MLD if you have:
- Infections, such as cellulitis
- Congestive heart failure or other heart-related problems
- Deep vein thrombosis or a history of blood clots
Incorporating gentle exercise into your routine, such as walking or yoga, will further improve lymphatic flow and enhance the benefits of MLD. By taking care of your lymphatic system with MLD and other healthy habits, you’ll improve your body’s detoxification processes, reduce swelling and support your immune function, all while promoting relaxation and well-being.