Add This Easy 6-Step Lymphatic Balancing Approach to Massage - Massage Magazine

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Many massage therapists believe that lymphatic drainage requires a specialized set of techniques that don’t factor into the daily practice of massage.


This common misperception extends to believing that these specialized lymphatic techniques apply only to clients with lymphedema, or that they involve extensive taping or complicated draping.

These beliefs may have prevented many massage therapists from incorporating specialized lymphatic work into treatments.

However, adding a principle-based approach to balancing the lymphatic system is easier than a massage therapist might think—and may be the key to getting lasting results for those difficult clients who are not responding to current treatment protocol.

The Lymphatic System


In osteopathic medicine, one basic tenet in the hierarchy of healing is that movement of fluids is essential to the maintenance of health. More importantly, however, drainage must precede supply.

Specifically, a supply of oxygen and nutrient-rich blood is vital for all cells and tissues to function correctly. For cells and tissues to receive this nutrition, normal metabolic waste products must first be drained. The system responsible for providing this drainage pathway is the lymphatic system.

The lymphatic system is made up of a network of thin tubes, or lymph vessels, that run throughout the body, and oval-shaped organs, or lymph nodes, that collect and filter lymph. Daily, approximately 30 liters of fluid filled with oxygen and nutrition filters out of the capillaries and into the interstitial spaces.

Of that, about 27 liters return to circulation, and after cleaning the extracellular spaces of particulate matter, exudates and bacteria, the remaining three liters drain into the capillaries of the lymphatic system.

Lymph vessels collect and filter this fluid, now called lymph, through lymph nodes before directing it toward blood vessels near the heart, where the fluid re-enters blood circulation. This process helps maintain normal blood volume and pressure and prevents excess accumulation of fluid, also called edema or swelling, around tissues.

A properly functioning lymphatic system is critical for the body to detoxify and regenerate tissues. The lymphatic system filters out metabolic waste, toxins and foreign substances from the tissues. It also recovers crucial substances that have escaped from the blood, it and helps maintain a healthy immune system.

When fluid outflow is restricted due to injury or infection, waste products, acids and toxins accumulate in the tissues, which significantly compromises cellular metabolism and causes pain, tension and edema.

Because drainage precedes supply, a congested or impaired drainage (lymphatic) system makes it difficult for the injured tissue to receive the nutrients and building blocks needed for repair. To promote proper tissue healing and restore full pain-free movement, the accumulated edema and waste products must be removed quickly from the interstitial tissues.

Massage Removes Barriers


One of the many positive outcomes of massage therapy is the removal of barriers that are usually caused by restrictions or imbalances in muscle, joint or fascia. Commonly found in the injured orthopedic patient, these musculoskeletal barriers limit and restrict fluid flow in the involved tissues.

Thus, having the ability to remove barriers puts massage therapists in a unique position to be the provider of choice to utilize these specialized manual lymphatic drainage techniques. These techniques create a better environment for the drainage of metabolic toxins and aid in the re-oxygenation of an injured area to promote quicker healing.

Lymphatic Balancing is a curriculum I designed that applies specialized manual lymphatic drainage techniques, originally designed to treat lymphedema, to the orthopedic client.

Lymphatic Balancing expands on the philosophical approach to lymphedema with the addition of traditional osteopathic lymphatic pumping techniques, making it more applicable to a wide range of clientele within the orthopedic community.

Lymphatic Balancing can be used to address excess fluid, swelling or lymphatic stagnation in the cranium, spine, thorax, abdomen, visceral system, and upper and lower extremities. Additionally, this gentle, hands-on approach is effective in treating back-and-neck pain, sciatica, headaches, thorax-and-rib pain, upper-and-lower extremity orthopedic dysfunctions, and postural asymmetry.

The Lymphatic Balancing procedure involves both short- and long-lever manual pumping techniques to simulate gentle, specific, wave-like movements that stimulate fluid motion and aid in the re-circulation of the venous and lymphatic flow. These subtle manual maneuvers activate lymph and interstitial fluid circulation, as well as stimulate the immune system and balance the autonomic nervous system, leading to an overall reduction of fluid in an area.

Outcomes include restoration of proper joint biomechanics, improved functional range of motion and optimal postural alignment.

The 6-Step Lymphatic Balancing Approach


1. Perform a total body evaluation. Always start the session with a total body evaluation to determine if there are lines of tension in the body that are creating restrictive barriers to lymphatic flow.

If lines of tension are found, then treat with a total body balancing technique. Such a technique helps release lines of tension in the upper and lower extremities, cranium, spine, thorax, abdomen and pelvis that could be compromising the drainage pathway of the primary area of complaint.

2. Balance the four transverse diaphragms. The transverse diaphragms (pelvic floor, respiratory diaphragm, thoracic inlet and tentorium cerebelli) are all oriented horizontally and, when restricted, can impede lymph flow, as well as other vital structures that impact blood (artery or vein), nerve and energy flow. To ensure unimpeded fluid flow, it is imperative to make sure these diaphragms are functioning correctly.

3. Balance the autonomic nervous system. The autonomic nervous system comprises the sympathetic and parasympathetic nervous systems. Both systems involuntarily regulate internal body functions, but have opposite effects on the functions regulated.

With fluid flow, the autonomic nervous system controls microcirculation through vasoconstriction and vasodilation of the lymph and blood vessels. Since most people tend to be on sympathetic overload, it is important to balance the autonomic nervous system prior to any treatment.

4. Balance local restrictions. Evaluate and treat any local restrictions in the primary area of complaint that may be interfering with the flow of lymph before performing Lymphatic Balancing techniques. Local muscle, joint or fascia restrictions can create barriers to the local flow of lymph and blood, and need to be removed.

5. Promote lymphatic flow. Perform the appropriate Lymphatic Balancing techniques to promote lymphatic flow in the area. When performing Lymphatic Balancing, treatment sequence is important. Fluid moves from high to low pressure; therefore, treatment must start and end with creating a space for the fluid to flow.

Treatment begins by opening the proximal nodes. Once the nodes are open, treatment continues proximal to distal (to the site of swelling) by using effleurage and short-lever pump techniques to open the lymphatic drainage pathway. At the site of swelling, short- lever drainage and local pump techniques are used to bring the deeper swelling more superficial, aiding in its removal.

At this point in the sequence, focus shifts to moving the fluid distal to proximal by using short-lever pump techniques along the pathway toward the proximal nodes. Treatment then ends by opening the proximal nodes to further promote continued drainage.

6. Perform supportive techniques. These techniques are used to enhance and lengthen the Lymphatic Balancing treatment effects. Active lymphatic pump exercises can be suggested as a home program to further address swelling and improve deep circulation. Additionally, basic lymphatic taping can be used to provide ongoing support and encourage continued drainage to the treatment area.

About the Author:

Kerry D’Ambrogio, DOM, AP, PT, DO-MTP, is a physical therapist, osteopath, board-certified acupuncture physician, and author of Positional Release Therapy. Information on his manual therapy techniques and continuing education courses offered by the D’Ambrogio Institute (DAI) are available on the institute’s website.

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