The body’s immune system is made up of individual parts which work together to find and destroy pathogenic bacteria, viruses, fungi, and cancerous cells. Each part of the immune system must be functioning properly in order to detect and differentiate the unhealthy organisms from healthy tissues. 

The lymphatic system is a vital part of the immune system, comprising a network of lymphatic vessels that carry a clear fluid called lymph (from Latin, lympha meaning water) directionally towards the heart.  One of the main functions of the lymph system is to provide an accessory return route to the blood for the surplus three liters. The other main function is that of defense in the immune system. Lymph is very similar to blood plasma: it contains lymphocytes and other white blood cells.  It also contains waste products and cellular debris together with bacteria and proteins. Associated organs composed of lymphoid tissue are the sites of lymphocyte production.

Lymph nodes are part of the lymphatic system that can be found widely distributed throughout the entire body. They are responsible for trapping foreign particles and filtering pathogens found within the body. A lymph node is an organized collection of lymphoid tissue, through which the lymph passes on its way back to the blood.

Lymph nodes are located at intervals along the lymphatic system. Several afferent lymph vessels bring in lymph, which percolates through the substance of the lymph node, and is then drained out by an efferent lymph vessel. There are between five and six hundred lymph nodes in the human body, many of which are grouped in clusters in different regions as in the underarm and abdominal areas. Lymph node clusters are commonly found at the base of limbs (groin, armpits) and in the neck, where lymph is collected from regions of the body likely to sustain pathogen contamination or environmental toxins.

While the heart continuously pumps blood through the blood vessels, the lymphatic system relies on the movement of smooth muscles to transport fluid through the lymph vessels. Certain health conditions can interrupt the normal flow of lymph, causing lymph fluid to build up in an area of the body, often in the arms or legs, where it can cause swelling. This condition is called lymphedema. People can develop lymphedema as a result of infections, cancer treatments that involve the removal of lymph nodes, and any condition that damages the lymphatic system.

There are numerous therapies and bioregulatory remedies that assist lymphatic flow and can reduce swelling and improve circulation throughout the lymphatic system. One of the most utilized is lymphatic massage. The following are selected articles on lymph system regulation and dynamics including lymphatic therapies.

Lymphatic Drainage – Lymphatic Massage

Bayrakci Tunay, V., T. Akbayrak, Y. Bakar, H. Kayihan, and N. Ergun. “Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite.” Journal of the European Academy of Dermatology and Venereology 24, no. 2 (2010): 138-142.

Devoogdt, Nele, Marie-Rose Christiaens, Inge Geraerts, Steven Truijen, Ann Smeets, Karin Leunen, Patrick Neven, and Marijke Van Kampen. “Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomized controlled trial.”Bmj 343 (2011): d5326.

Ebert, Jay R., Brendan Joss, Berit Jardine, and David J. Wood. “Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty.” Archives of physical medicine and rehabilitation 94, no. 11 (2013): 2103-2111.

Ernst, E. “The safety of massage therapy.” Rheumatology 42, no. 9 (2003): 1101-1106.

Estourgie, Susanne H., Omgo E. Nieweg, Renato A. Valdés Olmos, Emiel J. Th Rutgers, and Bin BR Kroon. “Lymphatic drainage patterns from the breast.” Annals of surgery 239, no. 2 (2004): 232.

Földi, Ethel. “The treatment of lymphedema.” Cancer: Interdisciplinary International Journal of the American Cancer Society 83, no. S12B 12B (1998): 2833-2834.

Huang, Tsai-Wei, Sung-Hui Tseng, Chia-Chin Lin, Chyi-Huey Bai, Ching-Shyang Chen, Chin-Sheng Hung, Chih-Hsiung Wu, and Ka-Wai Tam. “Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials.” World journal of surgical oncology 11, no. 1 (2013): 15.

Majewski-Schrage, Tricia, and Kelli Snyder. “The effectiveness of manual lymphatic drainage in patients with orthopedic injuries.” Journal of sport rehabilitation 25, no. 1 (2016): 91-97.

Molski, Pawel, Jacek Kruczyński, Andrzej Molski, and Stanislaw Molski. “Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial.” Archives of medical science: AMS 9, no. 3 (2013): 452.

Vairo, Giampietro L., Sayers John Miller, NM Cb Icolem Rier, and WB Illiame Uckley. “Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach.” Journal of Manual & Manipulative Therapy 17, no. 3 (2009): 80E-89E.

Williams, Anne. “Manual lymphatic drainage: exploring the history and evidence base.” British Journal of Community Nursing 15, no. Sup3 (2010): S18-S24.

The Vodder Method of Lymph Drainage

Härén, Clas Backman, Mikael Wiberg, Kathrin. “Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: a prospective clinical study.” Scandinavian journal of plastic and reconstructive surgery and hand surgery 34, no. 4 (2000): 367-372.

Kasseroller, Renato G. “The Vodder school: the Vodder method.” Cancer: Interdisciplinary International Journal of the American Cancer Society 83, no. S12B (1998): 2840-2842.

Exercise, Yoga and Weight Training for Lymphadema

Aggithaya, Madhur Guruprasad, Saravu R. Narahari, and Terence J. Ryan. “Yoga for correction of lymphedema’s impairment of gait as an adjunct to lymphatic drainage: A pilot observational study.” International journal of yoga 8, no. 1 (2015): 54.

Ahmed, Rehana L., William Thomas, Douglas Yee, and Kathryn H. Schmitz. “Randomized controlled trial of weight training and lymphedema in breast cancer survivors.” Journal of Clinical Oncology 24, no. 18 (2006): 2765-2772.

Hespe, Geoffrey E., Raghu P. Kataru, Ira L. Savetsky, Gabriela D. García Nores, Jeremy S. Torrisi, Matthew D. Nitti, Jason C. Gardenier et al. “Exercise training improves obesity‐related lymphatic dysfunction.” The Journal of physiology 594, no. 15 (2016): 4267-4282.

Lane, Kirstin, Dan Worsley, and Don McKenzie. “Exercise and the lymphatic system.” Sports medicine 35, no. 6 (2005): 461-471.

Loudon, Annette, Tony Barnett, Neil Piller, Maarten A. Immink, Denis Visentin, and Andrew D. Williams. “The effects of yoga on shoulder and spinal actions for women with breast cancer-related lymphoedema of the arm: A randomised controlled pilot study.” BMC complementary and alternative medicine 16, no. 1 (2016): 343.

Narahari, S. R., T. J. Ryan, and M. G. Aggithaya. “How does yoga work in lymphedema.” J Yoga Phys Ther 3, no. 135 (2013): 2.

Narahari, S. R., Madhur Guruprasad Aggithaya, Liselotte Thernoe, Kuthaje S. Bose, and Terence J. Ryan. “Yoga protocol for treatment of breast cancer-related lymphedema.” International journal of yoga 9, no. 2 (2016): 145.

Kinesio Tapping for Lymph Drainage

Tsai, Han-Ju, Hsiu-Chuan Hung, Jing-Lan Yang, Chiun-Sheng Huang, and Jau-Yih Tsauo. “Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study.” Supportive care in cancer 17, no. 11 (2009): 1353.

Lymphatic Phytotherapy

Dharmananda, Subhuti. “Chinese Herbs for Lymphedema.”

Ding, Shi-Ping, Ji-Cheng Li, Jian Xu, and Lian-Gen Mao. “Study on the mechanism of regulation on peritoneal lymphatic stomata with Chinese herbal medicine.” World journal of gastroenterology 8, no. 1 (2002): 188.

Douglass, Janet, Maarten Immink, Neil Piller, and Shahid Ullah. “Yoga for women with breast cancer-related lymphoedema: A preliminary 6-month study.” J Lymphoedema 7, no. 2 (2012): 30-8.

Fisher, Mary Insana, Betsy Donahoe-Fillmore, Laura Leach, Colleen O’Malley, Cheryl Paeplow, Tess Prescott, and Harold Merriman. “Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study.” Journal of bodywork and movement therapies 18, no. 4 (2014): 559-565.

Hashizume, Naoki, Minoru Yagi, Hideaki Egami, Kimio Asagiri, Suguru Fukahori, Shinji Ishii, Nobuyuki Saikusa, Motomu Yoshida, Daisuke Masui, and Yoshiaki Tanaka. “Clinical efficacy of herbal medicine for pediatric lymphatic malformations: a pilot study.” Pediatric dermatology 33, no. 2 (2016): 191-195.

Poage, Ellen G., Julia R. Rodrick, Ausanee Wanchai, Bob R. Stewart, Janice N. Cormier, and Jane M. Armer. “Exploring the usefulness of botanicals as an adjunctive treatment for lymphedema: a systematic search and review.” PM&R 7, no. 3 (2015): 296-310.

Wheat, Janelle, Geoffrey Currie, Hosen Kiat, and Kerry Bone. “Improving lymphatic drainage with herbal preparations: a potentially novel approach to management of lymphedema.” Australian Journal of Medical Herbalism 21, no. 3 (2009): 66.