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Lymphatic watersheds

Diagramatic representation of lymphatic watersheds used in lymphatic drainage massage.

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(Manual Lymphatic Drainage)

Specific massage techniques are used to enhance the efficiency of a sluggish lymphatic system and to move fluid from areas of lymph (fluid) build up to unaffected areas of the trunk and limbs. This fluid can then be transported into the deeper lymphatic system of vessels which is then eventually returned back into the cardiovascular system via larger vessels near the heart as part of the normal lymphatic flow cycle.


Fibrotic (hardened) tissues can also be softened and improvement maintained with repeated massage sessions or self massage techniques at home.


The principle of any manual lymphatic massage is based on light pressure to stretch the skin and stimulate initial lymph vessels under the skin to take up more fluid and to pump more frequently.


Areas (known as watersheds) adjacent to the affected limb are massaged first to drain or ‘clear’ lymph and provide a reservoir for incoming fluid from the affected area.


Only appropriately qualified therapists should provide lymphatic massage as some forms of massage could exacerbate lymphoedema.


Our patients are also shown simple lymphatic drainage techniques to use at home as part of our home management regime. If appropriate, a partner or family member can be a part of this education process to assist with massage at home.


Our clinical sessions uniquely combine one hour sessions of manual lymphatic drainage (MLD) and/or low level laser therapy (depending on an individual’s needs) as the basis of our treatment plan.


Williams AF, et al (2002) A randomised controlled crossover study of women with breast cancer related lymphoedema European J of Cancer Care 11(4):254-261

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