What Is Lymphatic Drainage, and Is It Real? The Evidence

Lymphatic drainage means two things. The first is a process your body runs all day: fluid leaks out of your smallest blood vessels into the tissues, and a second network of vessels, the lymph system, collects it, filters it through lymph nodes and returns it to your blood. The second is a treatment that pushes that fluid along from outside, with a therapist's hands or with an air compression garment. The process is real and measurable. The treatment has solid evidence in lymphoedema, where the system is damaged, and small, short-lived effects in healthy people. No trial shows that it removes toxins or fat.

Your body drains about four litres a day

Blood pressure in your capillaries pushes water and protein out between the cells. That fluid feeds and hydrates the tissue, and it has to go somewhere afterwards. Physiologists estimate about 8 litres a day enter the lymph vessels. Lymph nodes along the way absorb about half of that water, and about 4 litres a day reach your blood through two junctions with the veins under your collarbones. The thoracic duct, the largest lymph vessel, measures about 2.2 mm across and carries about three quarters of the total.

Older textbooks taught that most of the leaked fluid flows back into the capillaries at their far end. A 2010 review of the measurements found that in most tissues that reabsorption lasts a short time, and slight leakage continues in the steady state. The lymph vessels carry the balance back.

How lymph travels uphill

Fluid between your cells often sits below atmospheric pressure, and the veins it drains into sit at about 20 cm of water. Lymph has to climb that gap. The larger lymph vessels manage it in two ways.

• Their own pumping. Each vessel comes in short segments with a one-way valve at each end. The muscle in the wall contracts about ten times a minute, pushing lymph into the next segment, and the valves stop it flowing back.
• Outside squeezing. Your calf and thigh muscles press on the vessels each time you walk, and breathing changes the pressure in your chest and belly.

A day standing behind a counter or sitting at a desk takes away most of that outside squeezing. Fluid then pools around your ankles, and your shoes feel tighter by evening. That swelling is normal, and it drains when you move or lie down.

The treatment called lymphatic drainage

Clinics use the name for two methods. In manual lymphatic drainage, a trained therapist uses slow, light strokes that stretch the skin toward working lymph nodes. In pressotherapy, you lie in a garment whose air chambers inflate and deflate in sequence, so the squeeze travels the way lymph flows. Our comparison of lymphatic drainage massage and pressotherapy sets the two side by side, trial by trial. At our Makati clinic we offer pressotherapy, and you can reserve a pressotherapy slot in Makati.

Is lymphatic drainage real?

Three questions sit inside this one, and they have different answers.

Can anyone see a treatment move lymph? Yes. Researchers inject a fluorescent dye under the skin and film it with near-infrared cameras. In one such study, lymph moved 23% to 28% faster right after a manual session, in healthy limbs and in limbs with lymphoedema. In four people with leg lymphoedema, the dye moved during an hour of pneumatic compression, and the vessels contracted in time with the pump.

Does it help when drainage is broken? Yes, as part of a package. Bandages on their own shrank the extra arm volume by 30 to 38.6 percent in a Cochrane review, and manual drainage on top of them added about 7 points. Across 14 trials of pneumatic compression, lymphoedema appeared about one third as often in women who used a pump after breast cancer surgery as in women who did not.

Does a healthy body need it? Not unless the system is damaged. From UCLA Health: "Your lymphatic system does not necessarily need your help unless it's not working well." The same article found no substantial evidence that the treatment detoxifies the body, boosts immunity or causes weight loss. In healthy people, trials measure less aching over the next hour or so. Your liver and kidneys clear waste from your blood, and the lymph system returns its four litres a day whether or not anyone massages it.

When drainage fails: lymphoedema

Lymphoedema is swelling that stays because the lymph system cannot keep up. The NHS describes two kinds: primary, from genes that shape how the vessels develop, and secondary, from damage to the system, such as surgery or radiation for cancer. Along with swelling, you may notice a heavy, aching limb, skin infections that keep returning, and skin that turns hard and thick.

Researchers have measured the risk after breast cancer treatment. Across 72 studies, 16.6% of women developed arm lymphoedema after breast cancer, and 21.4% in the studies that followed women forward from diagnosis. Removing the lymph nodes from the armpit raised the rate to 19.9%, against 5.6% after a sentinel node biopsy. Lymphoedema has no cure. Compression, skin care, exercise and manual drainage keep it under control. Leave it to a lymphoedema therapist; a beauty clinic should not manage it.

Helping your own drainage

You already own the main pump. Walking works your calf muscles, and breathing shifts pressure in your chest and belly. Raising your legs lets gravity help. In a study of 20 workers after an eight-hour standing shift, 30 minutes lying flat cut leg volume by 95 mL. A pneumatic pump cut it by 133 mL, and the gap between the two was too small to count as a difference.

If your face or feet puff up after a salty meal, a hot day, the days before your period or a flight, read why the face and legs hold water.

When to see a doctor first

Get medical advice before any treatment if:

• one leg swells without a reason you know, or the area turns red or hot;
• swelling comes with breathlessness or chest pain, which needs emergency care;
• both legs stay swollen after you have tried raising them and walking;
• you have heart, kidney, liver or thyroid disease, or swelling in an arm after cancer treatment.

US Veterans Affairs guidance rules out pneumatic compression with deep vein thrombosis, uncontrolled heart failure, acute kidney failure or a skin infection, and rules out trunk garments in pregnancy. If you are pregnant, ask your doctor before pressotherapy.

Pressotherapy at The Peninsula Manila

Our clinic runs lymphatic drainage as pressotherapy, on a device ICONIQUE owns. The garment fills and empties its air chambers one after another to support drainage and circulation. It is restful, and the garment fits any body type. Plan on 45 to 60 minutes, consultation included. We do not offer manual lymphatic drainage massage, and we make no promise of weight loss or detox.

The clinic occupies the lobby level of The Peninsula Manila, at the junction of Ayala and Makati Avenues, a four-minute walk from Ayala Triangle. For opening times and how to find the door, see our guide to lymphatic drainage in Makati, and you can book a session for today's price.

Frequently Asked Questions

What is lymphatic drainage?

Your body's process of collecting fluid from the tissues and returning it to the blood, about 4 litres a day. The same name covers treatments that push that fluid along by hand or with an air compression garment.

Is lymphatic drainage real?

The lymph system and its drainage are real and show up on imaging. Treatments have trial evidence in lymphoedema, where manual drainage added about 7 percentage points to the swelling reduction from bandaging. In healthy people the trials measured effects for up to an hour.

Does lymphatic drainage remove toxins?

No. UCLA Health saw no substantial evidence that the treatment detoxifies anything. The liver and kidneys filter waste out of your blood, and lymph reaches the blood with or without a treatment.

How can I drain my lymph myself?

Walk, keep your calves working, and raise your legs. In one study, 30 minutes lying flat after an eight-hour standing shift cut leg volume by 95 mL.

How do I know if I need lymphatic drainage?

Swelling that stays in one arm or leg, heaviness, hard skin or repeated skin infections point to lymphoedema; see a doctor or a lymphoedema therapist. Swelling in one leg with pain, or swelling with breathlessness, needs a doctor before any treatment.