Overview
A manual technique used to reduce edema (swelling) by gently pushing fluid distal to proximal
Involves using a gentle pressured stroking action to the skin
Is used when there is edema present
Often referred to as retrograde massage
Usually performed for 5-10 minutes
Manual lymphatic drainage techniques that require compression bandaging or more complex manual lymphatic drainage should only be performed by someone with specialized training in lymphedema care
Patient can be referred to a certified lymphedema therapist
When to Use
When there is edema present, such as in:
Post-operative surgery
Post-injury swelling
Lymphedema
Some cases of complex regional pain syndrome
What is Edema?
An abnormal accumulation of fluid in the tissues that causes swelling
Can result from injury, surgery, inflammation, or poor circulation
Is often a natural, protective reaction from the body
Damage to a body part results in increased blood flow and fluid leaks from the blood vessels into the surrounding tissues
Delivers immune cells to the area
If edema persists, it can impact:
Range of motion
Soft tissue mobility
Quality of scar tissue formation
Function
Strength
Recovery time
Precautions
Avoid pressing too hard (too much force can make edema worse)
Avoid massaging over any open wounds
Can still perform edema massage, just do not touch the area on or around the open wound
Contraindications
Active infection in the area
Blood clots in the area
Other Edema Management Techniques
Ice: The vasoconstriction can limit the leakage of fluid into tissues
Compression: The external pressure helps flush fluid out of the area
Elevation: Promotes fluid flush out of the area by using gravity to reduce blood and lymphatic accumulation in the area
Kinesiotape: Can help gently lift the skin to create more space for increased lymphatic flow
Patient Education
Patients are often taught the following edema reduction techniques as part of their home program:
Self-edema massage using their other hand
Perform 3 times a day for 5-10 minutes at a time
Elevation (put the area of swelling above the heart)
Elevate area for 30 minutes to an hour, several times a day
Compression garments can be purchased, such as a glove
Coban wrap can be applied to the area, applying distal to proximal
References
Chamberlain, M., & Miranda, G. (n.d.). Retrograde Massage 101 for Occupational Therapists. OT Flourish. https://otflourish.com/retrograde-massage-101-for-occupational-therapists/
Ingwaldson, A. (2019). Article Review: Best Edema Management Techniques in Hand Therapy. Hand Therapy Academy. https://www.handtherapyacademy.com/treatments/best-edema-management-techniques-in-hand-therapy/