Lymphatic drainage


The manual lymph drainage is a form of physical therapy and above all serves the Edema and decongestive therapywhich can arise after operations or trauma. This therapy is particularly common after a Tumor treatment or Removal of lymph nodes applied.

History and departments for application

Manual lymph drainage therapy, largely developed by Emil Vodder, has been established since 1960. Since then she has been taught in German massage and physiotherapy schools. The executing people are above all Masseurs and physiotherapists.
Since manual lymph drainage therapy requires practice and special training, therapy is only permitted for trained specialists. The training is a 4-week additional training and is specified in the guidelines of the IKK. While lymphatic drainage is very widespread in Austria and Germany, it is used much less in the USA.

Application technology

Emil Vodder describes lymph drainage in his technique four basic concepts:

  • standing circle
  • Pump handle
  • Scoop handle
  • Twist grip

These different handles are adapted to the corresponding body regions. This is supposed to Activated lymphatic system be, whereby especially the Improves the pumping capacity of the lymph vessels becomes. The frequency of this pumping power is 10 to 12 contractions per minute under rest conditions. This can be increased to up to 20 contractions. The therapist creates a stimulus for the tissue through the handles and the changing pressure. The smooth muscle cells the lymph vessels respond to this stimulus with an increased pumping frequency. Repeating these grips many times results in a increased flow rate. The direction of pressure is adapted to the accessible lymph vessels and must always towards the extremity root (poor, legs) or to the end point of a lymphatic vessel. This unites in two large ones Veins, the subclavian vein and the internal jugular vein, which are located in the area of ​​the Heart, or under the Collarbone (Clavicle) lie.
This directs the lymph towards the large lymphatic strains. In addition, the therapist can move protein-rich lymph from the superficial lymphatic system, which covers the entire body like a network, via the so-called watersheds into a healthy area. There the accumulated lymph can then be transported away.
In all of these applications, in contrast to classic massage, lymphatic drainage does not increase the blood flow to the tissue. If the congestion is very pronounced, manual lymphatic drainage can also be used Compression bandages, Exercise therapy and Skin care be combined.

Area of ​​application for lymphatic drainage

Manual lymph drainage is mainly used for treatment lymphostatic edema used.
These arise due to insufficient transport capacity of the Lymphatic vessels but with a normal amount of lymph.
These include primary and secondary lymphedema.
A typical secondary lymphedema would be arm edema after one Breast cancer surgery with removal of the axillary lymph nodes. Besides this decongestant effect, the lymphatic drainage also shows one analgesic and sympatholytic effect.
The patients become calmer Gastrointestinal tract is stimulated and the Skeletal muscle tone sinks. The decongestion before and after operations can relieve pain and, in some cases, significantly reduce the need for pain medication. In addition, the healing process can be faster.
Further indications are all orthopedic and traumatological diseases that are associated with swelling. And also with Burns, migraine or Whiplash Lymph drainage is often used. In the Scar treatment Lymphatic drainage improves the mobility of the scar and the formation of new lymphatic vessels after the vessels have been severed.

Lymphatic drainage on the face

In this day and age the skin exposed to particular loads. Regardless of whether Environmental factors or stress in everyday life, the skin is called largest human organ heavily used and therefore requires special care. This particularly concerns the Facial skinthat often appears dull and exhausted. The reason for this is often insufficient removal of harmful environmental substances via the lymph. From this a secretion build-up develops, which is caused by a Swelling of the lymph nodes can make the skin noticeable and then make the skin appear dull and dull, often also reddened. With a Lymphatic drainage one can try to improve this skin condition. The effect of lymphatic drainage on the face is based on the Method of massage. With gentle pressure and stroking movements on the skin, this becomes Lymphatic system stimulated and an existing lymph blockage can be released. The intent of facial lymphatic drainage is to get the Transport of pollutants in the next Lymph nodes and by stimulating the surrounding area Connective tissue and the Muscles the Blood circulation to improve in the massaged area.

The lymphatic drainage should always be done by one trained Therapists be carried out. You can also try out simple steps yourself. However, this happens in any case at your own risk.

Instructions for lymphatic drainage on the face:
First, you run your fingers along one Neck side (left or right) and then goes over the middle to the other side of the neck. The Massage direction is always from the collarbone to the chin. Then move your index fingers below the nostrils and the middle fingers below the bottom lip on both sides at the same time from the middle towards the ear. Now you put your ring finger on the Nostrils and here, too, moves towards the ear with a gentle, stroking movement. In the fourth step, the index finger is on the eyebrows and then with a little pressure to the Ears and from there below the eyes to nose guided. The last step is to lay the Palms on the faceso that only the nose remains free. Now apply strong pressure on the face for about 5 seconds. With regular repetition of the Lymphatic drainage on the face you can achieve a fresher and more even complexion.

Lymph drainage on the leg

Lots of people know the problem that after long periods of standing / sitting or in hot weather the Legs swollen in the evening are. This is mainly due to the fact that people are no longer on all fours, but rather in an upright gait. That's how it gathers Water in the deeper parts of the body and can there too Swelling to lead. In most cases, this condition returns to normal overnight. If it works incorrectly Lymphatic system the water is no longer completely heading heart transported. The cause of this can be too many substances that have to be transported, which leads to an overload of the system or even one Destruction of the lymphatic system by e.g. Operations. This consequently leads to swelling, which for the reasons mentioned above often occurs on the legs.

The lymphatic drainage on the leg stimulates the lymphatic system to absorb and transport the tissue fluid again with light pressure, which is always exerted in the same direction. First, the leg is massaged from the ankle upwards with stroking movements. Then make circular movements on the thigh from the knee up towards the groin. The different handles can be used in different numbers and locations. Here, too, you should never feel pain during the treatment, as the sensitive lymphatic tracts are then exposed to too much pressure. Usually, however, the treatment is perceived as extremely pleasant. You can also have your doctor prescribe lymphatic drainage on the leg. Usually several sessions are necessary at regular intervals to completely remove the swelling.

Lymph drainage on the knee

Especially after injuries or operations in the Knee region can the sensitive Lymphatics be harmed. The lymph is then no longer completely removed and collects in the Knee-, Thigh- and Lower leg area on. Here can the Lymphatic drainage To remedy the situation. You should be at the beginning of one Physiotherapists can be taken over, but can also be carried out independently by the patient after some time and with appropriate instructions. Lymph drainage on the knee is always based on anatomical course of the Lymphatic vessels and always takes place in the direction of discharge. Should be avoided too high pressures, because the lymph vessels are very thin and already damaged by the operation / injury.

Instructions for lymphatic drainage on the knee:
First you put both hands on top of each other and massaged with gentle pressure circular the swelling as well as the surrounding area. Now lead upwards from the knee towards strip Pull out hand movements with little pressure and repeat the whole thing for example five to ten times. For lymph drainage on Lower leg one begins at the level of the ankle and here first encompasses the entire lower leg with both hands for a few seconds. Then loosen the grip again and encircle the lower leg again. After about three times firm squeezing of the lower leg, you begin in the same way a little further up. Continue this until you reach the Knees has arrived.
Lymph drainage in its own way aims to Tissue water to start moving and heading Lymph nodes to transport. It is, however never a substitute for qualified treatment by a physiotherapist. With complaints during lymphatic drainage on your knee, you should immediately receive your doctor seek out.

Lymph drainage on the foot

Just like the legs, the feet are considered to be predisposed body part for lymphatic congestion. That's because the lymph is the Gravity following at the lowest point of the body, i.e. the feet, sags. With the help of manual lymphatic drainage An effective decongestion therapy can reduce the local symptoms so that painful swellings on the foot owing to Lymph drainage disorders regress. Evidence of lymphedema on the foot can be clinically diagnosed relatively easily and differentiated from edema of other origins. In contrast to venous edema, for example, the toes are also swollen and are called "Box toes" designated. The naming is explained by the fact that when pressure is exerted on the toes, they have a box or. take on a rectangular shape. Besides, this is Stemmer sign positive. Here you check them Withdrawability the skin over the second toe by a light Pinching motion. If you have lymphedema, you cannot lift the skin, so the sign is positive.

For the treatment of lymphedema on the foot, the typical Gripping techniques of manual lymphatic drainage be applied. Basically, it must be ensured that the pressure on the tissue should be effective but not painful and that the lymph fluid is transported through to the next lymph node region correct execution the handles is possible.

The two dynamic handles, the Scoop- and Pump handle, as these are used primarily on the peripheral parts of the body of the extremities (i.e. hands and feet or forearms and lower legs). The pressure massage is usually carried out from the periphery, i.e. the toes towards the ankles. If the foot is extremely swollen, the Twist grip to decongest the lymphatic vessels. It is important that despite the localization of the complaint in the foot other areas of the body treated with become. The order and selection of the body parts to be included varies depending on the severity of the symptoms and clinical picture.

Finally, it makes sense to go along with lymphatic drainage if you have problems with your feet Compression stockings to wear and on sufficient exercise to pay attention.

Lymph drainage on the arm

Lymphedema on the arm is indicated by swelling of the arm. The arm sometimes feels heavy, and tingling sensations can occur. With the arms, as with lymphatic drainage in the trunk area, due to the positional relationship to the heart, explicit attention must be paid to possible contraindications. These so-called contraindications include, for example, advanced heart failure, active cancer, thrombosis and infections.

The exact indication should always be made in consultation with the patient's doctor. The lymphatic drainage treatment process is based on the same criteria as those for lymphatic drainage on the foot, since the arm is also an extremity.

It is therefore important to ensure that the pressure massage is carried out from the hands towards the shoulder, i.e. from the periphery towards the center of the body. The lymph drainage is stimulated with gentle stroking movements. The therapist usually starts on the forearm and slowly strokes and kneads in the direction of the upper arm up to the armpit lymph nodes. Here the lymph is then transported into the other lymphatic system.

Before treating the edematous swollen region, however, more centrally located and symptom-free areas of the body should be included in the decongestion massage. This includes the neck, chest and trunk area. Depending on the intensity of the symptoms, dynamic movements of the lymphatic drainage techniques can be used. This includes the scoop and pump handle. As with the foot, the twist grip can also be used in cases of extreme swelling, which is actually more suitable for lymphatic drainage on the trunk of the body. In the arms, in addition to primary lymphedema, secondary edema formation or drainage obstruction after trauma with surgical or conservative care are often indicative of lymphatic drainage.

Lymphedema appears on the arm, for example after an operation. In particular, patients who had to undergo surgery for breast cancer (breast cancer) and from whom lymph nodes in the armpit area had to be removed are affected by such edema.

The duration of the lymphatic drainage on the arm is determined by the treating therapist and the prescribing doctor; it usually lasts 30 to 60 minutes. The frequency of lymphatic drainage also depends on the disease, it can be done once or several times a week. Lymphatic drainage must not be carried out on the arm in certain diseases.

Read about this too Lymphedema of the arms


There are several reasons why manual lymphatic drainage should not be used. One differentiates absolute from relative contraindications.

To the absolute contraindications counting untreated skin tumors (Malignancies), Thrombosis, or thromboembolism, acute septic inflammation and a decompensated heart failure (NYHA III or IV).

Relative contraindications are chronic inflammation, previous thromboses, Hypotension (Hypotension), Thyroid dysfunction or bronchial asthma.
In these cases, manual lymphatic drainage can be used, but should be adapted to the previous illnesses and certain precautionary measures should be observed.

Do lymphatic drainage yourself

In general, the Lymphatic drainage should only be performed by qualified persons. Is massaged in the wrong direction, for example, so that the tissue fluid does not move out of the affected area Lymph nodes, but transported into the area so it can too Damage to vessels and annoy come and the actual disease will be made worse. If you still want to try out the individual grips on yourself or your partner, try to strong pressure to avoid. It will always be that Subcutaneous fatty tissue massaged with light pressure, so you shouldn't try to "push away" swelling. Usually begins one the Lymph drainage on the neck. One should keep the movements circular then run towards upper body work ahead. As well on leg you can try the lymphatic drainage yourself. Should the legs once in summer or after long periods of standing / sitting swollen it is usually felt to be very pleasant when you go through light stroking from bottom to top (and never the other way around) the Lymph fluid transported back towards the lymph nodes.

A compression can have a supporting effect, for example special stockings or wraps and thus facilitate the transport of the lymph fluid via the lymph vessels. Exercise also helps as it compresses the muscles in your legs, which also affects the thin ones Lymphatic vessels affects and so the tissue fluid can be transported more easily "up" to the next lymph node. So you shouldn't get up in the case of swollen legs either sufficient exercise dispense. What you should definitely refrain from is because of swelling in the body less water to take in or even Tablets for drainage to take. This will damage your body even more. In no case should people with a malicious Tumor disease, one Blood clots in the vascular system (thrombosis/embolism) or one Thyroid disease receive lymphatic drainage. It should also be used in acute Inflammation or Infections (with / without fever).

Lymph drainage for cellulite

Cellulite is caused by a weak connective tissue structure, through which, among other things, tissue fluid can be deposited, which is then mostly in the Thigh- or Butt area accumulate. This is caused, among other things, by a clogged Lymphatic system, which means that the water can no longer be properly transported away. The cause of this constipation can Sedentary lifestyle, wrong eating habits or changes in the Endocrine system be. Consequently, there is an increased binding of water by the Fat cells, whereby this is retained in the body and excreted more poorly. Usually this liquid is caused by the Lymphatic system transported away. If this no longer works properly, lymphatic drainage can help. The idea behind this assumption is that by being gentle Massage techniques the stored water can be better transported away and the lymphatics are freed. Not only those from the Cellulite affected areas are supplied by lymphatic drainage, but the entire lymphatic system. One study found that when treated for several weeks, the Orange peel was decreased in the participating women. Usually one recommends about ten treatments. However, after the end of the lymphatic drainage, water can again collect in the tissue and the therapy may be necessary again. Under no circumstances should the lymphatic drainage cause pain, as the handles will then be applied too tightly. Most women find it very pleasant. The lymphatic drainage should be from specially trained therapists (Physiotherapist etc.) and you should plan around 40 € for 40 minutes.

Cost of lymphatic drainage

Lymph drainage is a physical applicationthat can be prescribed by a doctor. As soon as those affected receive a prescription for lymphatic drainage, they come Health insurance companies for the costs.

However, this depends on which indication is present and whether they are prescribed by the doctor has been. If you have to pay for the lymphatic drainage yourself, the costs vary. There come about 10 euros per 10 minutes Treatment towards the sufferer. The prices can be requested from the respective institution (e.g. a physiotherapy practice).

Depending on the insurance, the cost coverage varies in detail. Private insurance stipulates that the patient must initially bear the costs. After that, however, an invoice can be submitted for the costs of the lymphatic drainage, which will then be paid by the health insurance. In the case of statutory insurance, the health insurance company pays immediately, however, depending on the presence or absence of additional insurance Co-payments attack.

In general, you can use Costs between € 15 and € 37 go out. It should be borne in mind that the price depends on both the Duration of therapy as well as from Practice location is dependent. Usually, depending on the severity of the symptoms, there is one multiple use necessary so that the costs add up. Even if lymphatic drainage is a chargeable therapeutic measure, you should not shy away from costs and the treatment to professionals, either Physiotherapists or Masseurs, leave. Because both the implementation and the decision as to whether lymphatic drainage is allowed or helpful for those affected should not in the hands of a layperson fall.


Lymphatic drainage provides a good treatment option for chronic or acute edema represent.
By special ways of applying pressure and Distribution of the lymph towards the main drainage areas edema can be significantly reduced and the patient's symptoms alleviated. Besides the decrease in edema you can also Relieved pain and the Relaxation of the patient clearly promoted.
The manual lymphatic drainage is mainly used in Germany and Austria Physiotherapists and masseurs carried out.
In order to be able to use this therapy, a 4-week additional training must take place.
In the acute case of edema, lymphatic drainage can lead to a significant improvement after just a few applications. In the case of chronic diseases with edema formation, very regular and ongoing therapies are required to achieve success.
Since the lymphatic drainage also has an effect on the entire organism and promotes the transport of substances in the tissue, there is some contraindications.
So should patients with a acute thrombosis, one Skin tumor or one severe heart failure cannot be treated with manual lymphatic drainage. The risk of thrombus loosening, tumor ulceration or excessive use of the cardiac output would be too great. Other contraindications such as Thyroid disease, previous thromboses or pregnancy make special demands on therapy, but can be treated with manual lymphatic drainage, taking precautionary measures.