This is a professional evaluation of a 50-minute lymphatic drainage session at the Four Seasons Hotel, George V in Paris, France. This is one of my favorite spas in the world, which was refurbished during COVID. I will write a separate article about this newly updated establishment at a later date.
Their
manual lymphatic drainage aka MLD was offered as either a 50 or 80 minute service. Manual lymphatic drainage is typically applied to reduce swelling which can produce various health benefits. I do not have any swelling or lymphedema, so I simply scheduled a 50-minute service to evaluate their manual application. What I found is their manual lymphatic drainage strokes and techniques are quite different from what is practiced in the United States, whether it's our evidence-based approach, Chikly, Vodder or other "types" of MLD. Just because something's different, doesn't mean it's less effective. Similar results can be achieved with different approaches, and this establishment had a very different approach.
At this spa establishment where MLD is not being offered in a medical setting, they automatically include both facial and body treatment with their lymphatic drainage appointments. In the US, we usually separate MLD application as a facial treatment, body treatment or if a client wants both facial and body MLD treatment, they would have to specify wanting both when scheduling the appointment, so that an appropriate amount of time can be scheduled for the desired services.
The 50-minute lymphatic drainage treatment began with the service provider using hot towels to wipe both the hands and feet in a private treatment room. This is not the customary start for MLD, but it is good for sanitation and a really nice way to open any type of massage or bodywork service. The lymphatic system work then began with repeatedly pumping of the lymphatic terminus. Her pumping of the terminus was faster than what we teach. The pumping was almost as rapid as a heart beat, with on average one pump per second. I have recently seen greater research that shows this faster pumping technique while we like to teach pumping techniques with client's inhaling and exhaling.
The therapist then moved on to some submandibular work. She worked from the midline laterally on the submandibular area, then moved up to the hairline at the forehead. As she moved onto each new area on the face, she alternated lymphatic terminus pumping in between. Then from the forehead she continued inferiorly along the hairline to work anteriorly to the ears and back to the lymphatic terminus for more pumping.
Abdominal lymphatic drainage was immediately provided after facial work and repeated pumping of the lymphatic terminus. My breast area was draped by a towel while a sheet covered my lower body to expose the abdomen. Very light work was started at four corners around my abdomen, as well as some initial sweeping strokes throughout the abdomen. Then, deeper techniques were applied in the same areas where the lighter techniques at the four corners began. The intensity of pressure gradually increased and the work was primarily provided towards the navel as the pressure was increased. All pressure applied was comfortable and tolerable throughout the entire appointment, including the facial and bodywork. The whole session could be described as light to lightly moderate pressure.
After her finishing strokes on the abdomen, she covered my upper body with the sheet, and then moved to undrape one full lower extremity. The service provider worked proximal to distal on the leg, which is a fairly standard MLD approach when starting extremity work. She manually pumped slightly inferior to the inguinal lymph nodes, then continued her MLD manual techniques inferiorly from the hip towards the foot. She only kept me in supinated position for the entire 50-minute appointment. Once the anterior lower extremity work was completed, she flexed my knee with my foot flat on the table, and reached underneath my leg, starting MLD techniques at the hamstring attachments of the ischial tuberosity, working inferiorly under the leg towards the popliteal fossa. She continued pumping techniques in the popliteal fossa and then worked her way down the calf until she reached the foot again. This was repeated on the other leg.
Once she completed identical work on both legs, she moved back up to my head for more lymphatic terminus pumping and what felt like a general and gentle session closure application. She finished her treatment with a repeated hot towel wiping of my hands and feet, despite not using any lubricant during this dry hands-on application. This is very good practice and may be a required business policy to finish every body treatment, so that there's less liability for the client to slip while dismounting the treatment table. The reason why hands would be wiped is because if the hands are oily and you reach out to prevent a fall, your oily hand may slip on any grabbed surface, so that is why it's good business to wipe both the hands and feet during table dismount.
She washed her hands before starting the hands-on bodywork and again, after she completed it. The therapist did not include the upper extremities during this 50-minute treatment. The upper extremities would likely be included if I had scheduled the longer 80-minute MLD session instead.
After washing her hands, the table was inclined electrically at the superior end which is more good practice, to allow a client to reestablish normal blood pressure in a seated upright position instead of attempting to go from fully supinated to standing after an hour of relaxation, which could end in orthostatic hypotension, which would put a client at other risk during table dismount.
While this MLD session was extremely different from anything I've received before, I wouldn't be able to attest to its effectiveness due to the fact that I do not have any swelling. What I can attest to is that it felt wonderful and was very sanitary and relaxing.
Despite the alternative approach to what we practice or teach for MLD in the US, there was one error made with this MLD service. I had asked the therapist to elevate my legs while supinated on the treatment table, and she initially refused saying that would negatively affect drainage. Unfortunately we shared a language barrier where I was unable to explain that elevating the legs would actually improve drainage instead of hurt it as she had implied. When she did eventually use the electrical table to lift my knees, she further showed that the drainage on my lower legs was now opposite of where we needed it to drain. She is correct that lifting the knees during MLD would promote drainage towards the ankles which is undesired. However, this can be EASILY improved by placing a pillow under the ankles which will create extremely desirable postural drainage for the entire leg. So in this establishment , they are not applying postural drainage techniques that should be used with MLD to make the treatment more effective and achieve greater drainage. Lifting the legs while a client is supinated also has the added benefit of relieving stress on the low back as well.
Overall, aside from not providing appropriate positional drainage with the MLD appointment, in addition to the fact that it was quite different from any MLD I have experienced in the past, I still found it to be an excellent application by a highly skilled practitioner which was enjoyable and quite nice.
