MLD for Post Surgical Recovery - How to heal faster from your tummy tuck, mommy makeover, BBL, breast reconstruction or Lipo procedure
Within the past decades a whole new form of post-surgical healing has emerged – Post Surgical Manual Lymphatic Drainage.
While there are therapists trained to perform MLD for Lymphedema, and other health and wellness purposes, they are not necessarily trained or believers in applying MLD to patients recovering from cosmetic or non elective procedures. . Evidence of it's growing popularity is in the number of post op clients who call saying their surgeon "prescribed" MLD as part of their followup protocol.
The Lymphatic System
The Lymphatic System is a complex pathway of specialized capillaries, trunks, and nodes which assist in returning fluids back into the circulatory system. As a passive system, it has no central pump, like the heart, to move fluids. That task is left to the vein like structures to "pump" fluids,
The post-surgical case for MLD
Inflammation. (and fibrosis). It all really comes down to inflammation. Surgery is trauma. And trauma triggers a trauma response. Part of that response is swelling. Swelling is a normal part of healing, but it can be uncomfortable and chronic swelling can lead to other issues. Manual Lymphatic Drainage helps the lymphatic drainage system function at a peak level to draw fluids away from a swollen area. Stimulation of the lymphatic system increases the rate at which the body removes waste, dead cell particles, and inflammatory agents from our tissue.s Accelerating the lymphatic flow has been demonstrated to reduce swelling and bruising in the injured region. Studies indicate that as the volume of fluid at the injury site is reduced, rehabilitation time may be shortened. Manual Lymphatic Drainage (MLD) can play an important role in post-surgery recovery to reduce inflammation but also by playing a role in the reduction of pain, stiffness and bruising,
You may receive Post-Surgical MLD treatments within 3 days after surgery.
Doctors who know of Post Surgical MLD will sometimes suggest treatment as soon as 3-days after surgery. This early intervention assists with helping to minimize bruising and swelling. However, some doctors suggest or even mandate patients wait from 2-6 weeks after surgery before receiving treatment. With a Doctor's permission, I will work on clients generally beginning 3 days to a week after surgery. No work will be done on or near an incision this early - only after it has healed. Generally after 2-3 weeks all work is safe unless there are complications with your surgery.
Your MLD Therapist should have wound care or medical training if you have issues with your surgical site.
One current trend we are seeing is that patients are flying out of state or out of the country for cosmetic procedures that are more affordable. Often the client returns home with a paper of "instructions" and there is no real medical followup. MLD itself can only do so much, and some Doctors are simply passing the patient responsibility forward. If you are experiencing any issues such as abnormal oozing, sharp pain. redness that is abnormal or other signs of infection, please seek competent local medical care or see your doctor if local. MLD therapists only do what they do which is limited.
Pushing fluids and tissues out from unhealed incisions is NOT MLD
There is a "understanding" in various places in the United States and abroad that the way to get lymphatic fluid out of your body is to reopen the incisions and push fluid out manually. First, this process is outside the scope of practice (100% illegal) for any massage therapist or MLD therapist in any of the 50 United States. Unless the person performing this process is a nurse or similarly licensed healthcare worker in a clinic with biohazard bags, gloves, face shield, gowns, etc., they should not be doing this. If you are a surgery patient and someone wants you to do this, or to do this to you, run.
YouTube videos are NOT an alternative to hands-on MLD - But I can show you Self Care MLD strokes you can do at home
When time and budget allow, MLD is best performed by a trained therapist, however not everyone has the time or budget for a series of visits. One challenge with online videos is that you never know what you are getting. I see massage videos all the time that contradict the actual work. Further it is easy to "mimic, " maybe, but if you don't know the "why" behind what you are doing, or know if you are doing it right, you may be doing things contrary or ineffective to the healing process. If you want to do MLD self care at a minimum, book a treatment with some extra time and go home with a self care routine that you know will be effective.
MLD does NOT use brushes, tools, cupping, bamboo sticks, rollers, or creams.
MLD uses only the hands and is performed without oils, lotions or creams. It involves movement of the skin in particular directions, and gentle pressure toward the body. Any other technique, tool, cream, or even cupping, is not part of the Post Surgical MLD process and should be avoided. If you have a therapist who is insistent on using creams, tool, cups or rollers, just say “No!” and tell them to use hands only. If they refuse, simply end the session and leave. There are instances where cups and tools can be used during the healing process, but it is not for lymphatic drainage.
You Deserve a Better Healing
In all cases, a post-surgical lymphatic drainage session should be gentle and complete, Post surgical MLD is an excellent way to help promote the healing process and is appropriate for almost any surgery or procedure.
I treat clients in my Needham, MA office who have had procedures such as lipo-360, mommy makeover, breast reduction or augmentation, Brazilian butt lifts, abdominoplasty (tummy tucks), cool sculpting, brachioplasty, facelifts, hip replacements, shoulder surgeries, lumpectomies, mastectomies and reconstruction, gender affirmation surgeries. . If your situation involves Lymphedema, active cancer or is in general more complex, my colleague, Virginia Murphy, is available to handle almost special care cases from her nearby Hanover studio, She has hundreds of hours of training in oncology massage, lymphatic systems and manual lymphatic drainage. We would like to be your healing partner. Together, we see clients on Martha's Vineyard as well, me year round, Virginia from spring to fall.
The Missing Pieces: Less and less body is being included in "full body" massage - It doesn't have to be.
This article came across my desk and caught my attention. The discussion is about how and why more and more, therapists and schools in the US are backing away from a true full body experience. It does not have to be. with proper training, good client communication and informed consent there is no reason why in 2019 this should be. I have interjected my thoughts in italics, but otherwise this is re presented in abridged form from Massage Magazine. published from
The anterior (front) torso, including the chest and abdomen; hips; buttocks; and medial thigh are often avoided or only given cursory attention during many massage sessions.My awareness about this developed after reading many posts on social media about “full-body massage.” Discussions with massage colleagues, educators and therapists indicate this problem is real. I Have seen many posts about the chains not allowing massage 1" below the collar bone, or glutes at all.
“There is a significant decline in the number of massage therapists that are willing to perform massage therapy on gluteal, pectoral and abdominal areas,” said Brent F. Jackson, academic program manager, massage therapy, at Central Carolina Technical College, headquartered in Sumter, South Carolina. He said he believes there are three factors contributing to this situation.
First, he said, massage therapy businesses and schools alike are wary of being involved in litigious situations, because of criminal acts by some massage therapists have made the news and are therefore overly conservative when it comes to creating curriculum.
Second, he said, “In academia, we are also encountering a broad spectrum of skill, and therefore a possible lack of qualified and confident massage therapy educators. That lack of training may be inhibiting the student’s professional growth.”
Third, said Jackson, there is simply a growing trend of the therapist not wanting to put in the effort required of a true full-body massage. Instead, he said, therapists are cutting corners.
“As a profession,” Jackson said, “it is necessary to be open to treating these areas when warranted, as would any other health care professional.”
Educator Nancy Dail, of Downeast School of Massage in Waldoboro, Maine, has also witnessed this trend. “I have long been aware that massage therapists have been cutting corners around the human body, basing massage on a rote recipe and repetitive sequence versus a treatment based on the individual’s medical history, posture, repetitive actions or injuries,” she said.
“Since society has a vulnerable perception of the abdomen, it has been the most logical area to skip,” Dail continued. As to other areas, she said, state regulations on breast massage, draping and professional conduct have led to restrictions on how the client’s body is addressed.”
However, student ignorance and state regulations cannot fully explain the diminishment of the full-body session. In my research and conversations, I have come to realize there are three pieces to this situation: incomplete massage education; apprehension on the part of clients; and insufficient informed consent across the profession.
Massage Education“Attempting to avoid excessive intimacy, my students’ hands often tense up around buttocks, chest, belly and inner thighs. I teach them instead to deliberately connect with these tissues using safe touch,” said Barbara Helynn Heard, a continuing education provider and practicing massage therapist in Seattle, Washington.
Although many massage schools provide a comprehensive education that prepares students to offer complete, full-body massage sessions, Heard’s approach isn’t how all massage students are being taught to touch clients’ bodies.
I, and many other massage educators, believe some schools’ entry-level education falls short in developing skills in positioning, draping, time management, communication and consent about the process of massage. Massage education sometimes creates fear related to boundaries and sexual misconduct litigation instead of developing professionalism. Instead of assessment and critical thinking skills imbedded into the massage session, a massage sequence is sometimes drilled into students.
For example, the common statement, “Disrobe to your level of comfort,” only creates confusion. Instead, direct instruction needs to be given. Such an instruction might sound like one of these two examples:
“I regard the anterior torso as crucial, yet it is avoided in 90 percent of the massages I receive,” said Eric Stephenson, who was interviewed for this article when he was director of education at imassage continuing education and consulting company and who is now chief wellness officer for Elements Massage. “This is one of the great paradoxes of massage therapy.”
Part of the problem, in my opinion, is that the two national massage organizations do not accurately educate the public. One association’s website states, “A typical full body session will include work on your back, arms, legs, feet, hands, head, neck, and shoulders. You will not be touched on or near your genitals (male or female) or breasts (female).” This statement essentially omits the chest, abdomen, hips, buttocks, thighs and face. With these areas unmentioned, what type of expectation does this create in the consumer and employer?
Another association’s website states, “Depending on your needs, the massage therapist will massage either the full body (except private areas) or only specific areas that need attention, such as especially tight muscles.” This statement is so ambiguous that the information is confusing. What are private areas?
Despite professional strides in the massage industry, confusion between massage therapy and illegal sexual solicitation continues to occur. Something must be done so that the massage therapy profession as a whole can move beyond this degrading situation. I challenge our professional organizations and major employers of massage therapists to collaborate and directly address this issue.
Additionally, there is gender bias pertaining to male massage therapists.
“As a male therapist, I have to maintain trusted professional relationships with clients, [which includes] education about various body areas included in the massage session, to achieve client goals,” said massage therapist (and my son) Luke Fritz, an instructor at my school, Health Enrichment Center in Lapeer, Michigan.
I believe the massage field should launch a public awareness campaign that clearly discusses sexual inappropriateness by both the client and the massage therapist, and that describes body areas included in general massage coupled with an example of informed consent. There should be ethical guidance by our professional associations and employers that frames clear statements to the public and massage therapists about appropriate behavior.
Such a statement might read: “Massage therapy is a nonsexual health service. Sexual behavior by the therapist toward the client or by the client toward the therapist is always unethical, inappropriate and illegal. It is always the responsibility of the massage therapist and business management to ensure that sexual misconduct does not occur and to report sexual solicitation by clients to law enforcement. Clients who feel that the massage therapist engaged in sexual misconduct should immediately report to the business management and to law enforcement.”
The problem is that major employers are accepting substandard massage as the norm.
One reason for this may be that the confusion between massage and sexual interaction will just not go away, so employers might limit massage application to particular body areas because of the fear of sexual misconduct lawsuits.
It is very concerning if we have come to believe that the major body areas cannot be massaged in the typical 50- to 60- minute session. Massage employers and clients need to be assured that all massage therapists are providing quality massage services and can provide massage to all appropriate areas of the body.
I welcome comments on all my posts but especially would welcome comments on this one. What has your experience been? What is your preference?
A couple of clients have asked me about Chi Nei Tsang, and am I experienced in this work. I am familiar with aspects of TCM, (Traditional Chinese Medicine), but because I was unfamiliar with this, I decided to investigate - to how if at all it shares any similarities, goals or methods of touch with Lomi Lomi.
What is Chi Nei Tsang?
Chi Nei Tsang is a centuries-old variety of healing touch therapy from China. It focuses on gentle abdominal massage in order to “train” the internal abdominal organs to work more efficiently, which in turn is said to improve physical and emotional health.
The words "Chi Nei Tsang" roughly translated mean "to work the energy of the internal organs” Practitioners adhere to the belief that unresolved emotional issues are stored in the digestive system.
Chi in Chinese, Ki in Japanese, or Mana in Hawaiian all translate to the inner life force or inner strength..
It is believed that Chi, the life-force energy, moves through the body’s internal channels, nervous system, blood vessels, and lymph glands. Tensions, worries, and stresses of the day, month, or year accumulate and are seldom dispersed. The result is the gradual obstruction of energy circulation, which may lead to any number of maladies including, but not limited to, indigestion, constipation, bloating, insomnia, whole body toxicity, poor skin quality, and an inability to lose weight.
The ancient Taoists realized that negative emotions cause serious damage to one’s health, impairing both physical and spiritual functions. They understood that each human emotion is an expression of energy and that certain emotions could indicate the negative energy behind many physical ailments. They also identified a specific cycle of relationships between the emotions and the organs. For example, the experience of a “knot” in one’s stomach indicated the presence of worry, the negative emotion that accumulates in the stomach and spleen.
Whereas I am not trained in this work, I can not speak to it beyond what I have read - however I do find similarities to the work that I am trained in, specifically Lomi Lomi.
Abdominal massage is an integral component of Lomi Lomi. For many it is their first experience with touch on the belly. This is a personal and emotional center on people, but without exception every one of my clients who has received it has enjoyed it.
Why is it so important to Lomi ?
Lomi lomi is thought to have started as a method of aiding in digestion. Its true, Hawaiian Royalty, after consuming large quantities of food would have a special servant Lomi Lomi their belly to aid in the digestion process. From there as the practice spread beyond the palace to villages and family, it was taken on by the kahunas of medicine and refined to address other physical and mental issues. A combination of observation, touch and medicinal herbs constituted successful medical practice. Later missionaries who arrived on Hawaii observed that Lomi Lomi was a remarkably relaxing experience that also induced calm and helped with sleep.
There are similarities between the beliefs and practices of many early cultures. So while I cannot speak to the claims of Chi Nei Tsang, and in general I refrain from exaggerated claims of any type when it comes to bodywork, I can tell you from observation that abdominal massage when incorporated into tradition or Lomi work has positive effects on peoples sense of well being. Abdominal work is always a choice, is is part of my regular intake. If you never tried, consider it as part of your next massage.
A Really Good Massage Blog
I write about things that I myself need to be mindful of. ways in which I would like to improve. It is not from the perspective of preaching - but rather writing helps me work out what I myself need to do - we are all in this together.