Massage Therapy Modalities: Lymphatic Massage
Lymphatic massage is a manual therapy technique with a long history of usage in treating specific medical conditions. It was developed by Emil Vodder in the 1930s. The Vodder method is still in wide usage. It uses four basic motions to stretch the skin and encourage the flow of lymphatic fluid. Different motions are appropriate for different parts of the body.
The Klose method is a well-known variant. Other methods include Foldi, Casley-Smith, and Upledger.
Lymphatic massage is often used as a treatment for post-surgery or post-traumatic edema or lipedema. It is a common treatment for post-mastectomy patients who are at risk of swelling, and it may provide symptom relief for patients with other conditions including autoimmune disorders. There is some research backing up its efficacy with fibromyalgia.
Lymphatic massage, or manual lymphatic drainage, may be provided as part of a comprehensive treatment program. However, this is not always the way it is practiced. The technique is lighter than what is employed in traditional Swedish massage, focusing on the upper subcutaneous tissue as opposed to the underlying muscular structure. Therefore it appeals to some people who are very pain-sensitive. Like other forms of bodywork, it can promote relaxation. Some individuals seek the therapy for general wellness and report feeling better after their sessions; it has been hypothesized that this is because it helps move toxins and inflammatory agents out of the body. In short, there are many reasons people may seek the therapy, though they don’t all have the same research base.
Lymphatic massage may be practiced in spa settings as well as healthcare settings. Massage therapists who work in medical settings may need to demonstrate higher levels of proficiency. However, even those in spa settings to be aware of contraindications.
Lymphatic Massage Credentialing
Practitioners must hold licenses that qualify them to use touch therapies. They will need enough training in the modality that they can utilize it competently. Dr. Andrew Weil cites the Lymphology Association of North America as the standard setter with regard to training (https://www.drweil.com/health-wellness/balanced-living/wellness-therapies/lymphatic-massage-therapy/).
Certification in lymphatic massage is one indicator of competency. Massage Magazine notes that certification in lymphatic massage can mean healthcare referrals. Licensed massage therapists are among the healthcare practitioners who may seek certification to practice lymphatic massage. Others include RNs, physical and occupational therapists, and physical therapy assistants.
The first step, if one is not licensed as a healthcare provider and is primarily interested in massage modalities, is to work toward achieving a massage therapy license. The individual will enroll in an approved massage therapy program and take a massage therapy licensing examination. 650 – 700 hours is typical, though requirements for program length vary from state to state. The program will cover topics such as pathophysiology and professional responsibility in addition to basic massage techniques and massage modalities. Programs in Western massage tend to emphasize Swedish massage, though they provide some exposure to multiple modalities. The student may have some electives. The practitioner may wish to seek Board certification; this will entail passing a more advanced examination than the one typically required for licensure.
Massage therapists may take courses in lymphatic massage or manual massage drainage. They will learn about the anatomy and physiology of the lymph system, its physiological and pathophysiological functions, and the indications and contraindications of lymphatic massage. They will learn the techniques and the provision of lymphatic massage to particular population (e.g. women who have had breast cancer surgery). Hands-on practice will allow the therapist to master the techniques, the lightness of touch, and the timing.
The number of hours varies. The course may be completed in as little as a week. There are introductory courses that are even shorter. Some providers offer multiple courses in lymphatic massage. The practitioner may complete his or her training in stages.
Therapists may look for some validation of legitimacy even when pursuing short courses. Approval by the National Certification Board for Massage and Therapeutic Massage and Bodywork is one form.
Comprehensive certification as a Certified Lymphedema Therapist (CLT) through the Lymphology Association of North America is a time investment: The requirement is 135 hours of focused training (1/3, theoretical, 2/3 hands-on). Healthcare professionals whose sole qualifying credential is Licensed Massage Therapist must also demonstrate college coursework in anatomy and physiology. (This is because standards for anatomy and physiology coursework are not consistently high from state to state.)
Massage therapists are subject to the scope and practice set by their state. Local policies (for example, those of insurance carriers) can influence the number of referrals one receives from within the healthcare arena.
Research about Lymphatic Massage
Massage therapy research can have multiple uses, from informing one’s own practice to gaining legitimacy in the healthcare community. The following are sources of research about lymphatic massage:
- British Journal of Community Nursing https://www.researchgate.net/publication/44683866_Manual_lymphatic_drainage_Exploring_the_history_and_evidence_base
- PLOS One https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189176
- National Institutes of Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755111/
The National Lymphedema Network provides a directory of therapists (https://lymphnet.org/find-treatment).