Manual Lymph Drainage

of the Lower Extremities

Manual Lymph Drainage (MLD) for
the Upper Body
This book was created to help guide you in your lymphedema treatment plan. Your plan may include
other treatments along with manual lymph drainage (MLD). Your therapist will create a plan with you.
If you have any questions or concerns, please talk with your therapist.

Therapist Name: ________________________________________________________________

Phone Number: _________________________________________________________________

What is the Lymph System?

The lymph system is a network of lymph vessels, tissues, and organs that carry lymph throughout the body.
The parts of the lymph system that lay a direct part in lymphedema include the following:
• Lymph: Colorless, watery fluid that travels through the lymph vessels and carries lymphocytes.
Lymphocytes are a type of white blood cell.
• Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return
it to the bloodstream.
• Lymph nodes: Small, bean shaped structures that filter lymph and store white blood cells that help
fight infection and disease. Lymph nodes are found along a network of lymph vessels throughout the
body. Groups of lymph nodes are found in the neck, underarm, groin, and other areas.

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 What Is Lymphedema?
Lymphedema is the buildup of protein rich fluid the body cannot absorb which can cause swelling. When
the lymph system is working as it should, lymph flows through the body and is returned to the bloodstream.
When part of the lymph system is damaged or blocked, fluid cannot drain from nearby body tissues.
Fluid builds up in the tissues and causes swelling. The swelling is lymphedema.

What Is Manual Lymph Drainage (MLD)?

To help understand the process, think of a traffic jam. The fluid needs to change direction to help with
the flow. You will work your way back towards the jam to get the fluid to move. Once the traffic jam is
removed, the fluid can move back into the blood stream.
You will learn how to stretch and move your skin in a way that helps the lymph fluid drain away from
the swollen areas. Moving the lymph fluid towards an unaffected (undamaged) area allows it to reabsorb
into your blood stream in another part of your body.
For example, if your underarm lymph nodes were affected by breast cancer treatment, you will notice
swelling in your affected arm, breast, or chest wall. You can use MLD to move the fluid towards the lymph
nodes in your other arm, neck, or groin.
Terms to know:
• Affected: The side that had treatment, surgery, or has swelling.
• Unaffected: The side that did not have treatment, surgery, or has swelling.
If you have questions about which is the affected and unaffected side, please ask your therapist. The directions
in this book will have you place your fingers or hand on the affected side or unaffected side in the steps.

When to Do MLD
You can do MLD every day. MLD can be done while you are sitting, standing, or lying down. Some ways
you can add MLD to your daily routines:
• While watching TV • As part of a relaxation routine before bed
• During your meditation or prayer • Time during self-care

When Not to Do MLD

Your therapist will review your medical history and talk with your doctor if there are any concerns.
Do not do MLD:
• Directly over an implanted device such as a port or pacemaker
• In an area where it causes pain
• If you have an infection or open skin in that area
Some people have chronic health problems that make it unsafe to do MLD, these include:
• Heart failure • Liver problems
• History of blood clots or stroke • Kidney problems
Scars
You may be able to perform lymph drainage over a scar. Your therapist will let you know if you can follow
the same path in this book over a scar or if you have to change paths.
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How to do Manual Lymph Drainage
Stages of MLD
There are 2 stages of MLD. The steps need to be done in the correct order.
• Draining: Drain the lymph fluid that is currently in the lymph vessels and nodes to make room for
more fluid.
• Moving: Move the fluid in the tissues (seen as swelling) to the area of the body where the lymph is
better flowing.

Deep Breathing
Before you start, you need to do deep breathing exercises.
This is important to help the lymph flow. You can do this
anytime and anywhere.
1. Sit up straight in a chair or lie down with your knees bent.
2. Place your hands flat on your belly.
3. Breath out normally.
4. Breath in deeply and slowly through your nose. You
should feel your belly and chest expand.
5. Pucker your lips and breathe out through your mouth.
You should feel your belly flatten and your chest go down.
6. Rest for a few seconds before starting the MLD technique.

The Basic MLD Technique

Lymph flows right under your skin. To move the lymph fluid, you need to use gentle, light pressure to
stretch the skin. Firm and deep pressure like a massage does not work which will block the flow of fluid.
The stretch and release movements should become a rhythmic motion.
1. Keep your hand open and relaxed. You will use the pads of your fingers to gently help the fluid move.
2. Gently stretch the skin as far as it naturally goes in the direction that you want the lymph to flow.
Hold for 3 seconds.
3. Then release the pressure and let your skin return to the relaxed state before repeating the movement.
4. You will repeat all these steps 10 times.

Scan the QR code to watch a video on manual lymph drainage.

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 Neck and Shoulder
Drain Your Neck
Using a very light touch and relaxed hand:
1. Place 3 or 4 fingers flatly on one side of your neck, just under
your ears.
2. Gently stretch your skin to the back and down.
Hold for 3 seconds.
3. Release skin.
4. Start stretching your skin near your ear then move down your
neck and repeat. Move down your neck in this way until you
reach your shoulder.
5. Repeat all these steps 10 times.
Repeat steps 1 through 4 on the other side. You may be able to do
both sides at the same time.

Drain the Top of the Shoulder

Using a very light touch and relaxed hand:
1. Place the pads of 2 or 3 fingers at the side of your neck, just
above your collarbone.
2. Gently stretch your skin down and in towards your collarbone
while keeping your fingers above your collarbone.
Hold for 3 seconds.
3. Release the skin.
4. Repeat all these steps 10 times.
Repeat steps 1 through 4 on the other side.

Drain the Shoulder

Using a very light touch and relaxed hand:
1. Place the flat of your hand at the outside of your shoulder on
your affected side.
2. Gently stretch your skin away from your neck.
Hold for 3 seconds.
3. Release skin.
4. Move your hand closer to your neck and repeat steps
2 and 3.
5. Repeat all these steps 10 times.
If you are able, you can drain the back of your shoulder following the
same steps 1 through 5.

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Drain the Affected Underarm
This is to make room for the lymph nodes in your under arm to take
in lymph fluid from your belly or upper leg. Do this on the affected
side. Using a very light touch and relaxed hand:
1. Raise your affected arm.
2. Place your hand flat against your underarm. Gently pull the skin
up and in toward your body. Hold for 3 seconds.
3. Release skin.
4. Move your hand closer to your neck and repeat step 2.
5. Repeat all these steps 10 times.

Drain the Groin Area

Drain the lymph fluid from the groin area lymph nodes toward
your belly. Do this on the affected side first. Then you will drain the
unaffected side.
1. Place the flat of your hand along the crease at the top of your leg
– at your panty line. 1
2. Gently press into your body using a pumping pressure.
3. Roll the gentle pressure in your hand from the pinky to the 2
thumb side. Your hand will stay in one place. Gentle scoop 1
upwards. Make the letter j with your hand. 2
4. Repeat 10 to 15 times.

Stomach to Underarm
Using a very light touch and relaxed hand:
1. Place your flat hand or flattened fingers on the
side of the stomach 1 .
2. Gently stretch your skin towards your groin.
Hold for 3 seconds.
3. Release skin.
3
4. Move your hand to your rib 2 on the same
side. Repeat steps 2 and 3. 2
5. Move your hand to your underarm 3 on the 1
same side. Repeat steps 2 and 3.
6. Repeat all these steps 10 times.

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 Drain Lymph From Your Hip to Your Underarm
1. Start at the top of your leg.
2. Place one hand on the inside of your leg and one hand on the back of your leg. 1
3. Gently stretch and release skin from the inside of your leg towards the outside of your leg and up
towards your hip.
4. Move down your leg and repeat. 2 and 3
5. Next place both hands on the outside of your knee. Switching between the left and right hands,
stretch the skin in an upward motion towards your underarm 4 or opposite groin. 5
6. Repeat each section 10 to 15 times.

1 2 3 4 5

Drain the Groin Along the Pubic Line

Start on the side that is affected and go across to the unaffected side. Using a very light touch and a
relaxed hand:
1. Place your flat hand along the public line (crease of your legs) on the affected side 1 .
2. Gentle stretch the skin across to the unaffected side 2 .
3. Release skin.
4. Move your hand to the middle of your pubic line 2 . Repeat steps 2 and 3.
5. Move your hand to the unaffected side 3 . Repeat steps 2 and 3.
6. Repeat all the steps 10 times.

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Leg Sequence
Drain Lymph From Your Thigh to Your Underarm
You will drain the affected side. If both sides are affected, follow these steps on both legs. With a light
touch and relaxed hand:

Drain Groin
1. Place your hand on the groin area of your underwear line.
1
2. Stretch the skin up to the stomach 1 . Hold for 3 seconds.
3. Release skin.
4. Repeat all these steps 10 times. 4
2

Drain Inner Thigh 5

1. Place your hand on the inner thigh . 2 3

2. Stretch the skin up to the stomach. Hold for 3 seconds.

3. Release skin.
4. Place your lower on the inner thigh 3 and repeat steps 2 and 3.
5. Repeat all steps 10 times.

Drain Front of Thigh

1. Place your hand on the front of the thigh 4 .
2. Stretch the skin up to the stomach. Hold for 3 seconds.
3. Release skin.
4. Place your lower on the front of the thigh 5 and repeat steps 2 and 3.
5. Repeat all steps 10 times.

Knee Sequence
You will drain the affected side. If both sides are affected, follow these steps on both legs. With a light
touch and relaxed hand:

Drain Inner Side of Knee

1. Place hands on the inner side of your knee just below the
knee bend.
2. Stretch the skin up towards the thigh. Hold for 3 seconds.
3. Release skin.
4. Repeat all steps 10 times.

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 Drain Lymph From Your Hip to Your Underarm
1. Start at the top of your leg.
2. Place one hand on the inside of your leg and one hand on the back of your leg. 1
3. Gently stretch and release skin from the inside of your leg towards the outside of your leg and up
towards your hip.
4. Move down your leg and repeat. 2 and 3
5. Next place both hands on the outside of your knee. Switching between the left and right hands,
stretch the skin in an upward motion towards your underarm ( 4 ) or opposite groin. 5
6. Repeat each section 10 to 15 times.

1 2 3 4 5

Move the Lymph Fluid From Your Lower Leg

Using a very light touch and relaxed hand:
1. Place on hand behind the leg and one in front. 1
2. Gently pull the skin up to the thigh. Hold for 3 seconds.
3. Release skin.
4. Move your hands down your lower leg. 2 Repeat steps 2 and 3.
5. Move your hands above your ankles. 3 Repeat steps 2 and 3.
Repeat all steps 10 times.

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Move the Lymph Fluid From Your Ankle, Foot, and Toes
Using a very light touch and relaxed hand:
1. Place you hands under the ankle bones on the back. 1 Stretch the skin gently up towards your leg.
Hold for 3 seconds and release skin.
2. Place your hands on top of your foot close to your toes. 2 Stretch the skin towards the ankle. Hold
for seconds and release skin.
3. Please fingers around one toe at time. 3 Gently pull the skin towards your ankle. Hold for 3 seconds
and release skin. Complete this on each toe.
Complete all steps 10 times.

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Copyright©2024Sanford.
This information is not intended as a substitute for professional medical care.
Always follow your health care provider’s instructions.

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 To learn more, visit us online:

good-sam.com sanfordhealth.org

The Good Samaritan Society is an affiliate of Sanford Health.

019051-00441 PE 12/24