Effects of Massage Therapy on the Skin of Lymphedema Patients

The difference between normal massage techniques and manual lymph drainage techniques is that strokes that are used in normal massage therapy are applied with a bit more pressure than are strokes of manual lymph drainage therapy. The basic strokes that are used in normal massage therapy are petrissage, effleurage, tapotement, vibration and friction.

It should be noted that massage stroke effects are not limited to suprafascial tissues like the skin. These strokes also cause reactions in subfascial areas. Subfascial tissues are muscles, tendons and ligaments.
It is possible that local arterial blood flow is increased by massage strokes and there is venous and lymphatic return. Normal massage strokes can loosen subcutaneous adhesions as well.

There are various massage therapy publications that list edema as one of the indications of these techniques. This is a correct statement but it is also in a way misleading if one does not establish or clarify the distinction between edema and lymphedema.

Edema is actually related to suprafascial tissues and can be the result of various problems like inflammation or impaired venous return. Examples of impaired venous return are valvular insufficiency, pregnancy, or prolonged sitting and/or standing.

In edema, the lymphatic system is overloaded but remains intact. This results in water getting accumulated in the tissues. This condition is called dynamic insufficiency.

It is possible that massage therapy benefits some forms of edema but is contraindicated for others. This is why normal massage therapy should not be used in patients with edema without prior consultation with a physician.

Lymphedema on the other hand is always a result of mechanical insufficiency of the lymphatic system. This in turn ends with water and protein accumulating in tissues. When the lymphatic system becomes mechanically insufficient the transport capacity of the system decreases below the required physiological level of water and protein load. The system is not capable then of properly responding to an increase in lymphatic load.

There are also several negative effects of massage therapy on lymphedema. As mentioned before, massage strokes usually lead to an increase in arterial blood flow (also called active hyperemia) in skin areas to which normal massage techniques are applied. This active hyperemia is escorted by an increase in blood capillary pressure. This leads to a subsequent increase in ultrafiltration of water in the blood capillaries area. The result of this process is that more water accumulates in the interstitial spaces. As the lymphatic system is mechanical insufficient the lymphatic system is not able to manage this additional water load and there is an increase in swelling.