CE INSTITUTE LLC BLOG

Manual lymphatic drainage (MLD) education for post-surgical conditions is a growing interest amongst our students.  But, many manual lymphatic drainage techniques were created for oncology treatment and chronic swelling conditions.  What's important to note today is that old school MLD techniques used for lymphedema should not be the same treatment for acute post-surgical MLD. Treating a client's post-surgical swelling the same as chronic lymphedema with MLD is ill-advised.

SWELLING IS A GENERAL PHYSICAL BODYWORK CONTRAINDICATION! Almost ALL chronic or acute swollen soft tissue can TEAR with inappropriate pressure and movement. As such, MLD practitioners must be extremely careful when working with swelling.  Manual lymphatic drainage techniques are designed to relieve swelling without damaging the underlying tissues when properly applied.

As such, practitioners should be using different MLD techniques and protocols to treat acute swelling versus chronic swelling.  If you are new to the MLD industry, be sure to seek education including protocols and techniques that provide both. And if you have previously trained in MLD, think about the strokes and techniques that you are using and adapt accordingly if you are able, or consider training in these new adaptions with an educational provider like us. Anyone who is practicing the same techniques for both acute and chronic swelling may have less effective treatment than a practitioner who has specific strokes, techniques and protocols for chronic versus acute medical conditions.  

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

Here's an 11-minute free manual lymphatic drainage training video that explains this concept and more:

 #MLD #manuallymphaticdrainage #lymphaticdrainage #bodywork #bodyworker #massage #massagetherapist #mt #LMT #lymphedema #postsurgical #cosmeticsurgery #plasticsurgery #swelling #edema #chronicswelling

Manual lymphatic drainage (aka MLD or simply "lymphatic drainage") is a light-touch modality that is applied to reduce swelling of the face or body through specialized skills, techniques and practices. It is often applied by massage therapists, despite being quite different from massage.

In "regular" massage, clients can request work almost anywhere they wish, in any order they wish, with a variety of pressures that can be changed from one appointment to the next. In lymphatic drainage, a specific order or routine is followed, with minimal pressure that cannot be altered without medical reasoning.

Why Massage Therapists Learn and Practice Lymphatic Drainage

Lymphatic drainage can be practiced on clients who are contraindicated for massage therapy because of swelling. A reduction of excess swelling will often decrease pain and increase healing, especially in most oncology, sports injury and post-surgical medical situations. That is why massage therapists learn and practice lymphatic drainage. Lymphatic drainage skills can provide extra appointments for clients who would be normally contraindicated for massage.

For example: A client with a strained, swollen ankle might book a full-body massage appointment because they are in pain. However, it is contraindicated to massage an acutely swollen ankle. As such, the practitioner can provide lymphatic drainage on the swollen ankle and regular massage skills throughout the rest of the body. A trained lymphatic drainage practitioner is more likely to relieve this client’s pain rather than send them home without working on the one area the client might want or need it most: their swollen ankle.

The Practice of True Lymphatic Drainage

A practitioner’s lymphatic drainage goal is to encourage excess interstitial fluid—swelling or edema—within the body’s tissues to enter the lymphatic capillaries to form lymph. When this fluid is within the body’s interstitial tissues, it is called interstitial fluid. Once the interstitial fluid enters a lymphatic capillary, it is called lymph.

This fluid transference is known as forming lymph. This newly formed lymph is then gently manipulated toward regional lymph nodes where it is filtered and then travels through progressively larger lymphatic vessels back to the cardiovascular system.

Lymphatic drainage follows different pathways than a typical Swedish massage therapy session. Massage is generally provided in one direction—toward the heart—to increase overall cardiovascular circulation through venous return. Lymphatic drainage has several different pathways that include working toward the cervical, inguinal or axillary nodes. These sophisticated pathways become complicated when a client has an obstruction due to surgery, oncology treatment, birth defect or other physical trauma. (A high-quality CE course in lymphatic drainage will explain the different directions, pressures and tissues that are manipulated and used in this highly specialized bodywork.)

Lymphatic Drainage Bodywork Pressure and Application Explained

True lymphatic drainage is commonly called capillary work because practitioners work to encourage permeable superficial lymphatic capillaries to absorb excess interstitial fluid to form lymph, with extremely light touch and highly specialized skills. Gentle techniques are then applied to encourage this newly formed lymph to travel to lymph nodes and progressively larger lymphatic vessels.

Extremely light pressure is used because applying any type of moderate-to-deep pressure around a swollen or stretched tissue could further stretch or tear the swollen tissue. Also, too much pressure bypasses the initial lymphatics where most of the interstitial fluid is collected to form lymph and reduce swelling.

Despite this fact, there are some who perform lymphatic massage, skipping the light, skilled touch of lymphatic capillary work by claiming to do greater work on larger lymphatic vessels. A lymphatic massage applies kneading or ischemic compression over the lymphatic system’s unique pathways with moderate pressure, which is not a true holistic application of lymphatic drainage, nor is it an appropriate amount of pressure to work with on swollen tissues. Some of these lymphatic massages are performed through clothing, which requires a practitioner to apply even more pressure which could harm a swollen client.

It is critical to properly advertise and provide lymphatic drainage services. In the State of Florida, a licensed massage therapist was recently served an emergency restraining order for advertising lymphatic drainage as forcibly expelling bodily fluids out of their client’s surgical incisions. In the emergency restraining order, the state focused on the fact that lymphatic drainage bodywork is a gentle application that would not include any such forceful practice.

Is Your Lymphatic Drainage Client Taking Opioids?

Many acute medical conditions that cause swelling are indicated for lymphatic drainage but contraindicated for massage. Most acute medical conditions such as surgery, sports injuries or oncology treatments can be traumatic to the body, which could result in that client’s doctor prescribing an opioid.

Lymphatic drainage is one of the lightest forms of hands-on bodywork. It is difficult for a client to feel the light touch of lymphatic drainage bodywork when they are swollen and in pain but on opioids. As such, a client on opioids may ask a practitioner for more pressure during their lymphatic drainage session so they can “feel it working.”

Unfortunately, the excessive use of opioids over the past few decades has likely led to practitioners feeling compelled to apply greater pressure in lymphatic drainage to satisfy their clients’ request to feel the work.

Instead of applying more pressure, it is a practitioner’s ethical duty to explain how lymphatic drainage works with light, skilled touch and to find different ways to show the client how their lymphatic drainage is working, especially when the client cannot feel it.

How to Show Lymphatic Drainage Therapeutic Results

Practitioners should physically show a client their tangible lymphatic drainage appointment results though pre-treatment and post-treatment measurements or pictures. This is important because some lymphatic drainage clients might not be able to feel their lymphatic drainage bodywork for various reasons. Cloth-type measuring tapes can be used to measure a swollen extremity and photos are the best option to review any reduction of swelling or puffiness in the face.

To conclude, almost the only thing in common between massage and lymphatic drainage is it can be offered by a massage therapist on a standard massage therapy table. Beyond the practitioner and table, these two modalities are extremely different for important therapeutic reasons, which becomes increasingly apparent with greater lymphatic drainage training.

In this brief 17-minute video below, we'll review this information in detail, and review why the lightest pressure is used to relieve swelling amongst other medical reasonings.

For comprehensive Lymphatic Drainage training please visit and register at: https://ceinstitute.com/collections/lymphatics

To review this Lymphatic drainage article in greater details please visit Massage Magazine at: https://www.massagemag.com/manual-lymphatic-drainage-128255/

#MLD #manuallymphaticdrainage #lymphaticdrainage #lymphatic #lymph #massage #massagetherapist #massagetherapy #bodywork #bodyworker

Suggested appointment prices for manual lymphatic drainage (MLD) services are difficult to develop for some practitioners, especially when they first get started in the modality.

In this brief 7-minute video, we'll review some tips to follow if you're trained in lymphatic drainage and wondering what to charge for your service.  This video was primarily created for CE Institute LLC students who train in our MLD application - however some others may find it helpful.

For comprehensive lymphatic drainage training, please visit: https://ceinstitute.com/collections/lymphatics

Here is some basic info about setting prices in general for massage therapy and bodyworker services:

Here are some common questions, answers and tips about setting these massage prices:

What should I charge for a one-hour treatment or service?
Look to your local peers and consider what they are charging? Consider their property amenities, training or years of experience with their one-hour price. Then, look to your own practice and try to determine if your service is the same, less or better than what they are providing and charge accordingly.

It is important to consider your market’s average price for viability of your own.

Should I charge more for specialized work more so than a "regular" appointment?
This can be one of the most puzzling questions and situations in practice today.

One solution would be to charge a fairly high hourly rate and tell the client that they can have any type of service for this charge. Then, I may discount the service if it’s an easy appointment, or they book regularly, or whatever feels appropriate.

Sometimes I feel that massage therapists should charge a little more than their “average” market price so that there is room to offer discounts on slow days/seasons and for repeat/good clients.

Some customers may also be intrigued as to why you “costs” more than average, too. Keep in mind that good pricing involves providing your best possible service for the best possible charge.

How do I explain a price difference for different services?
While I personally charge an “expensive” one-size-fits-all price for services, some therapists will have a low base price for massage, and charge more for additional modalities.

It’s perfectly acceptable to charge more for harder or complicated work. Here are three reasons why therapists can (and sometimes should) charge more:

Additional equipment and/or training was involved to provide the service; therefore, a higher price will recoup the financial investment for training and/or equipment. This is often applicable for prenatal, stone, aromatherapy, NMT and so forth.

The work is physically “harder,” which means you will not be able to provide as many appointments that day. This is often applicable for deep tissue and hot stone work.

Extra time is required to provide the service. This often applicable to mobile appointments, stone work, prenatal, shirodhara, etc. (Be sure to add any parking expenses to a mobile appointment price, too!)

What is the best practice to charge for add-on services?
You should always charge for “add-ons” such as a foot scrub, paraffin or anything else that would not be normally added to the scheduled service.

If you do provide “add-ons,” it’s important to publicly post a detailed price list of these add-on services on your website, at the reception counter and/or in your service menu.

And, if a client requests an “add-on” during service, tell them the additional costs for the “add-on” before it is provided. While it’s never ideal to talk about money during a service, it could also be considered unethical to charge more than agreed without the client’s informed consent.

Setting your own appointment prices can often feel confusing and conflicting.

Using these guidelines will hopefully help make decisions about this important process. Be upfront, honest and clear about pricing.  Regardless of what you charge, you should always provide a professional, reputable service that is reliable for your customers.

Good business usually provides good prices, so don’t be shy to charge what you’re worth, and let those cash registers ring!

 #manuallymphaticdrainage #mld #lymphaticdrainage #massagetherapist #bodyworker

Selena Belisle, an instructor and original founder of CE Institute LLC has been published by MASSAGE MAGAZINE in lymphatic drainage.

In this article, Selena explains how lymphatic drainage is different from other bodywork, how to show results, the different types of lymphatic drainage being practice and many other details of MLD (manual lymphatic drainage):

Lymphatic Drainage is an easy, noninvasive, nonpharmacologic intervention for post-surgical pain relief. It often prevents secondary injury by relieving swelling and more. Learn this and more in one of our Lymphatic Drainage courses by clicking HERE:

In this Les Nouvelles Magazine article, CE Institute LLC Founder & Instructor Selena Belisle explains how lymphatic drainage works and some particulars you should know prior to practicing:

Check out our latest article about our Lymphatic Facial practice, published by Les Nouvelles Esthetiques & Spa Magazine! This article is written by CE Institute LLC founder and instructor, Selena Belisle.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/collections/lymphatics

At CE Institute LLC, we have always taught lymphatic drainage as a bodywork that uses technical skills that include pumping and very light strokes to reduce swelling and improve healing of inflamed human tissue (minus a few contraindications).  Inflammation causes could be post-surgical, a sports sprain or strain, post oncology treatments, lymphedema, burns or more.  All of these medical conditions should not be treated with excessive or forceful physical pressure.

Last month, a Florida Massage Therapist was served an EMERGENCY RESTRATING ORDER (ERO) for forcibly pushing bodily fluid out of surgical incisions which is also known as "incisional drainage".   According to the ERO, the practitioner was advertising her work as "manual lymphatic drainage massages".  The ERO reads in part:

the therapist's "...poor judgment in performing dangerous services outside the scope of licensure and the disregard for the laws and regulations governing massage therapists in this state will cause harm to clients and the public in the future.  This probability constitutes an immediate, serious danger to the health, safety or welfare of the citizens of the State of Florida."

We are glad that this ERO was issued, and we have heard that there are others.  We feel that this ERO reinforces the fact that lymphatic drainage should never forcibly expel bodily fluid out of surgical incisions.

Our opinion of "incisional drainage" which forces bodily fluid out of a surgical incision could cause:

• immediate and acute damage to inflamed tissues that are SUPPOSED to be healing.
• a greater amount of long-term tissue fibrosis than if left to heal without this forceful assault of the inflamed tissues.
• improper handling of biomedical waste (which is not within a massage therapy scope of practice).
• an increased risk of infection to the client, many of which are already in a compromised medical condition to be seeking service to reduce their inflammation.
• potentially longer and/or greater use of opioids due to the pain this type of treatment could cause (when the country is already in an opioid crisis).
• unnecessary and risky exposure to hepatitis, HIV and other blood-borne disease when a practitioner's primary training and license does not include the handling of bodily fluid pathogens.

There is a laundry list of medical logic that will never agree with the practice of incisional drainage. As such, we continue to encourage all LMTs to work within their scope of practice, avoid negative news coverage with illegal or out-of-scope practices and do not do anything that could harm your client (or you)!

To learn more about about lymphatic drainage, please register for one of our professional lymphatic drainage classes.  We have several different live, hands-on trainings to choose from, starting with 6 hour courses.  You can view all of our lymphatic drainage courses by clicking HERE.