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Lymphedema is the build-up of a protein-rich fluid in your arms or legs due to a disturbance in your lymphatic system.  

Worldwide, its most common cause is an internal parasite transmitted by mosquitoes. Very rarely, it can be due to a birth defect. But in the United States, lymphedema is usually the result of surgery, radiation therapy and certain types of chemotherapy or immunotherapy used to treat breast cancer. 

Manual lymph drainage (MLD, sometimes mistakenly called ¡°massage¡±) is a tool that physical therapists use to give patients with lymphedema some relief. MLD redirects the excess fluid out of swollen limbs and into an area of the body that has not been affected, so it can be filtered out and excreted properly. There are also some exercises you can do on your own to help remove this fluid. 

But which techniques are considered the best for lymphatic drainage? How often should you do them? And, are all exercises and MLD techniques safe for every cancer patient?  

Read on for answers. 

How do I know if I need lymphatic drainage?

Not everyone who undergoes cancer treatment or has lymph nodes removed or a biopsy will develop lymphedema. You can have a compromised lymphatic system but still have the reserve capacity to compensate for the loss. You only start seeing symptoms when your body exceeds that capacity.  

Here are the early warning signs we talk to our patients about: 

• Feelings of heaviness in your arms or legs  
• Feeling like your arm or leg is swollen, even if it¡¯s not visible 
• Seeing swelling while looking in a mirror 
• Noticing that your clothes don¡¯t fit right (e.g., one sleeve is tighter than the other) 
• Noticing that your rings don¡¯t fit anymore 
• Having to loosen up or add links to your watch or wristband 

When should I see a doctor about lymphedema?

It¡¯s much easier to treat lymphedema in its earlier stages than it is in its later stages. So, if you notice any of these issues, let your care team know immediately. Once lymphedema is very advanced, some damage may be irreversible. 

Which exercise is the best for lymphatic drainage?

There¡¯s no one-size-fits-all answer because no one thing works well for everybody. Both the manual lymph drainage techniques we use and the exercises we give to patients to do on their own are highly customized.  

Physical therapists here at MD Anderson have a list of 18 distinct steps we can take to relieve lymphedema through MLD. But we don¡¯t necessarily use all of them every time because each patient is different. Sometimes, patients can¡¯t do certain steps, whether due to scarring or a limited range of motion. Others might have a particular condition that would cause additional issues if we took a particular step. So, we create individualized plans for every patient. 

That¡¯s why I highly recommend contacting your MD Anderson care team and asking for a referral to Physical Therapy as soon as you notice any of these symptoms. 

Can I drain excess lymph myself?

We do sometimes teach people how to do this themselves. But again, any exercises we might recommend would be highly customized to you. There¡¯s nothing universal we can share. 

What happens to your body after manual lymph drainage or exercise?

Both of these activities redirect excess fluid into an area that can safely return it to the body. So, if you followed a drop of that fluid from, say, the end of your fingertip to its final destination, it would travel up your arm and into what¡¯s known as a terminus in your neck. From there, it would enter your circulatory system, and either be carried along in the bloodstream until it was no longer needed or sent to your kidney for immediate excretion.