Branislava Ilic - Branka Specialist Manual Lymphatic Drainage and Lymphoedema Management
Harley Street / Central London / SW London

Lymphatic System

The best way of clearly understand lymphoedema, it may be helpful to have basic knowledge about the lymphatic system.

The lymphatic system form part of your immune system, helping to deal with infection at a local level but just as importantly, they are responsible for cleansing your tissues and maintaining a balance of fluids in your body.
It can be likened to a waste disposal system, taking tissue fluid, bacteria, proteins and waste products away from the tissues around skin, fat, muscle and bone.

Lymph fluid passes through lymph nodes which are connected by a network of lymph vessels. The nodes are found throughout the whole body.

Main function of lymph systems are:

acts as a one-way drainage system transporting fluid from body tissues into the blood circulation

contains white blood cells called lymphocytes, which fight infection

gets rid of waste products produced by cells.

Lymph fluid

Lymph flows constantly through the lymph vessels and is filtered through the lymph nodes. The fluid then drains back into the bloodstream.

This is a colourless fluid that forms in our body and surrounds all our body’s tissues ant it contains many white blood cells. Extra fluid that comes from the body’s tissues drains into small lymph vessels.
Once inside the lymphatic vessels (not visible just under the surface of the skin) the tissue fluid becomes known as 'lymph' and it is then transported in one direction, by increasingly larger and deeper lymphatic vessels.
Movement of lymph depends on muscle movement (exercise) and the contraction of the vessels themselves. Gentle massage known as Manual Lymphatic Drainage (MLD) and deep breathing can also help to move the lymph more effectively.

Lymph nodes

A human has between 500 to 1500 lymph nodes, which are mainly located in the head and neck region, armpits, chest, abdomen, pelvis, and groin.
They filter and break down bacteria (germs) or other harmful cells from the lymph fluid.

Lymph nodes vary in size. Some are as small as a pinhead and others are about the size of a baked bean. The number of lymph nodes in the body differs from person to person.

Lymph vessels

Lymph vessels are a network of tubes that connect to groups of lymph nodes throughout the body. Some vessels are just under the skin and can easily be damaged if the skin is broken.

Lymphatic vessels carry lymph into the nodes where waste products are filtered out.

Lymphatic vessels are located near the veins and have valves to prevent backward flow.

How the lymphatic system works

Lymph fluid normally flows through the network of lymph vessels that connect to a group of lymph nodes. The nodes act as a filter, destroying or trapping anything harmful that the body doesn’t need. The lymph nodes contain white blood cells (lymphocytes), which attack and break down bacteria, viruses, damaged cells or cancer cells.

Waste products and the destroyed bacteria are then carried in the lymph fluid back into the bloodstream and are eventually removed from the body as urine through the kidneys with other body waste.

Lymph nodes sometimes trap bacteria or viruses that they cannot destroy straight away. When you have an infection, lymph nodes often swell and become tender and sore to touch as they fight infection.

90% of the tissue fluid returns to the cellular beds to become plasma again and continue its journey as a part of the blood circulation.

The other 10% is lymph and is left behind. The amount of lymph left behind circulating through the body accounts for one to three percent of the total body weight.

When lymphatic tissue or lymph nodes are destroyed, disturbed, or removed, the lymph cannot drain areas properly. Access lymph now accumulates, resulting in swellings, which is one of the main characteristics of lymphoedema.

 Lymphoedema & Lipoedema Management. lymphatic system image3


Lymphoedema is swelling that develops because of a build-up of fluid in the body’s tissues. This happens when the lymphatic system, which normally drains the fluid away, isn't working properly. It can occur in any part of the body, but is most likely to affect an arm or a leg.

Lymphoedema is a chronic swelling. That means it is a condition that never goes away because the causes can’t be reversed. However, it can be reduced in most people, and the swelling can often be kept to a minimum, particularly when it’s diagnosed early.
Specialist Lymphoedema Practitioner can assess and treat lymphoedema. They can also teach you how to manage it yourself.

There are two main types of Lymphoedema:

Primary Lymphoedema usually determined from birth and arises due to some failure of the lymphatic system itself - usually with the underdevelopment of the lymphatic system. It may develop without any obvious cause at different stages in life, but particularly at puberty.

Secondary Lymphoedema is the result of some problem outside of the lymphatic system that prevents it working properly. Example Surgery, radiotherapy, Accidental trauma/injury or infection, educed mobility/paralysis, Problems with veins not working very well (varicose veins/after deep vein thrombosis), Cancer itself


Decongestive Lymphatic therapy (DLT) is recommended treatment for lymphoedema

...DLT usually begins with an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part.
This is followed by the second phase, known as the maintenance phase. During this, you will be encouraged to take over your own care by carrying out simple self-massage techniques, wearing compression garments and continuing to exercise. This phase of treatment aims to maintain the reduced size of the affected body part.
You may then have reviews every few months to check how your treatment is progressing...

There are 4 main components when treating Lymphoedema:

 Lymphoedema & Lipoedema Management. Leg MLD

1. Manual lymphatic drainage (MLD)

Specialised massages carried out by a specialist therapist – to move fluid from the swollen areas into working lymph nodes, where it can be drained.
Specialist lymphoedema therapist will also teach you a range of simpler massage techniques that you can use during the maintenance phase of treatment, to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD).

 Lymphoedema & Lipoedema Management. Compression garment

2. Compression bandages and garments

If you have lymphoedema, you will have special bandages or garments (such as sleeves, gloves, stockings or tights) fitted over any affected limbs. These will support the affected muscles during exercise and encourage them to move fluid out of the affected limb.
These may also be applied after a session of MLD, to prevent fluid accumulating in the limb again. This use of compression bandages and garments is known as multilayer lymphoedema bandaging.
You will be taught how to correctly apply your own bandages and compression garments, so you can continue to use them during the maintenance period.

3. Skin care

Taking good care of your skin is important, because it will reduce your risk of developing possible complications such as infection, cellulitis. It is important to keep your skin and tissue in healthy and good texture

4) Exercises

Maximise lymph drainage without over exertion (this would cause the swelling to worsen)

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