7 Essential Things to Know About Your Lymphatic System

Coffee enemas, dry brushing, juicing, essential oils — these aren’t just new-age health trends. All have been touted for a common and serious condition of the lymphatic system called lymphedema.

Never heard of it? Not even sure what the lymphatic system does? Here’s a crash course: Every cell in your body, as part of normal functioning, produces byproducts. “Syrupy lymphatic fluid is produced by every cell in the body. The lymph vessels suck up that ‘trash,’ carry it through the body and deposit it in lymph nodes, which are like recycling centers,” says Alan Kimmel, M.D., Medical Director of Rehabilitation Medicine at Greater Baltimore Medical Center.

If lymph nodes or vessels are removed or damaged during cancer treatment including chemotherapy, radiation or surgery, it can disrupt the system. (Extreme obesity can, too, and some people are just genetically prone to lymphedema.) At some point — months, years or even decades after initial lymph damage — the fluid may build up in a limb, causing lymphedema, discomfort and mobility issues. One first notices swelling, then, the fluid can harden and the limb becomes heavy, stiff and susceptible to infection and wounds.

A common but not well-known condition

Although lymphedema affects up to 10 million Americans, it’s understandable if you’ve never heard of it. Even many physicians, nurses and therapists aren’t familiar with current best treatments, Dr. Kimmel says. “It’s not as simple as wearing a compression stocking,” he says. “And, thanks to the internet, there are a lot of squirrely therapies out there.”

What is effective:

See a specialist early

Prevention is the goal, so at GBMC, cancer patients visit the rehabilitation center before undergoing cancer treatment and their progress is tracked. “We do baseline testing to measure lymphatic flow,” he says, which helps the care team (physician, advanced practitioner, certified lymphedema therapists, and RNs) catch lymphedema early. “We also educate patients to come straight to us if they notice swelling, pain or mobility issues.”

Complete decongestive therapy (CDT)

If lymphedema develops, “we come up with a treatment plan that focuses not only on getting the swelling down, but also individual goals — do you want to go horseback riding again or swimming or wear certain shoes?” Dr. Kimmel says. It involves manual lymph drainage and massage, compression bandaging, help with exercises and more. Patients visit the center 3 to 5 days a week for lymphatic massage, during which a therapist breaks up dense tissue and manually redirects lymphatic fluid. In between appointments, limbs are wrapped.


When lying down, place a 3 to 4-inch pillow under your arm or leg. While sitting at your desk, likewise rest your heel on a small step stool. “It’s an old wives’ tale that the limb has to be above your heart,” Dr. Kimmel says.

Walking and range-of-motion exercises

“When possible, walking is the best thing in the world,” Dr. Kimmel says. “If you’re not elevating, you should be moving.” When sitting or lying down, do what he calls ankle pumps: Raise and lower the front part of your foot keeping the heel planted. “It squeezes the lymphatic vessels, helping move the fluid up from the legs.”

Restrict salt intake

That doesn’t mean just avoiding the saltshaker. Most salt comes from processed and prepared foods, so cut back on those especially when dining out.

Lose weight if needed

Aim to drop 10 percent of your current weight if you’re significantly overweight. “Even modest amounts will make a big difference,” Dr. Kimmel says. “Without lifestyle changes, we can treat the lymphedema but it will just keep coming back.”

Compression garments

They aren’t a magic bullet but do help as part of a comprehensive treatment plan, Dr. Kimmel says. There are a lot of different kinds available, so work with your therapist to find those that feel comfortable and that are easy enough to put on and remove.

There are a host of newer treatments — supplements, surgeries, etc. — but be wary, Dr. Kimmel says. Though there are number of cutting-edge surgical procedures, they often come with great risk of complications and limited benefit. Even when surgery is considered, it is the lifestyle modifications that are ultimately the “secret sauce” for success.

Instead, stick with a trained therapist’s program, Dr. Kimmel says. “For most folks, if they do what they’re supposed to, they don’t get into trouble again.”

This webpage is for informational purposes only and not intended as medical advice or a substitute for a consultation with a professional healthcare provider.