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Lymphatic therapy for exercise and injury recovery among athletes

Updated: May 17, 2023

The bulk of published research on lymphatic therapies are on oncology patients, and the majority of these are on breast cancer-related arm lymphoedema (BCRL). So it's always exciting to find publications on something completely different, such as this study on MLD for post exercise regeneration of the forearm muscles of mixed martial arts (MMA) athletes.

Zebrowska and colleagues (1) divided 20 MMA athletes into 4 groups and measured blood flow in the cephalic vein, maximal forearm strength (Fmax), and biochemical blood markers, before and after isometric grip exercises. After the exercises session, three groups received lymphatic therapy via MLD or another device, and the control group received a sham laser treatment. Results show that following all 3 modalities

  • blood flow in the cephalic vein increased

  • hand-grip strength returned more quickly than in the control group

  • the pain threshold was raised

  • muscle fatigue reduced

The main difference between the three lymphatic therapies was in the rate of removal of lactic acid, which was more effective in the group receiving MLD.

Since lactic acid (LA) is implicated in post exercise soreness this is an important finding and the authors conclude that; MLD accelerated post-exercise regeneration of the forearm muscles of the MMA athletes, and was more effective than other therapies in reducing muscle soreness both immediately after application and 48 hours later.

These results build on and reinforce the 2006 study by Shillinger et al (2) who studied recreational athletes performing treadmill exercise, after which half the participants received MLD. In the MLD group there was a faster immediate decrease in lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) concentrations and significantly lower values for LDH after 48 hrs.

More recently, Bakar and colleagues in Turkey (3) also report on a more rapid and significant drop in LA and LDH serum levels in the MLD group (compared to controls) two hours after performing submaximal treadmill exercise. In the MLD group myoglobin levels were also significantly different at 2 hours, and creatine kinase levels at 24 hours after the exercise.

Although all studies were on small groups of athletes, the findings were consistent enough to be considered a moderate level of evidence that muscle recovery can be enhanced by the application of MLD.

This supports my own clinical experience of working with marathon runners who used MLD in their recovery program to reduce muscle soreness and speed healing.

1. Zebrowska, A., Trybulski, R., Roczniok, R., & Marcol, W. (2019). Effect of Physical Methods of Lymphatic Drainage on Postexercise Recovery of Mixed Martial Arts Athletes. Clinical Journal of Sport Medicine, 29(1), 49-56. doi:10.1097/jsm.0000000000000485

Objective: Physical methods are reported to be important for accelerating skeletal muscle regeneration, decreasing muscle soreness, and shortening of the recovery time. The aim of the study was to assess the effect of the physical methods of lymphatic drainage (PMLD) such as manual lymphatic drainage (MLD), the Bodyflow (BF) therapy, and lymphatic drainage by deep oscillation (DO) on post-exercise regeneration of the forearm muscles of mixed martial arts (MMA) athletes.

Design and Methods: Eighty MMA athletes aged 27.5(+/- 6.4) years were allocated to 4 groups: MLD, the BF device, DO therapy, and the control group. Blood flow velocity in the cephalic vein was measured with the ultrasound Doppler velocity meter. Maximal strength of the forearm muscles (Fmax), muscle tissue tension, pain threshold, blood lactate concentration (LA), and activity of creatine kinase were measured in all groups at rest, after the muscle fatigue test (post-ex) and then 20 minutes, 24, and 48 hours after the application of PMLD.

Results: The muscle fatigue test reduced Fmax in all subjects, but in the groups receiving MLD, DO, and BF significantly higher Fmax was observed at recovery compared with post-ex values. The application of MLD reduced the post-exercise blood LA and post-exercise muscle tension.

Conclusions: The lymphatic drainage methods, whether manual or using electro-stimulation and DO, improve post-exercise regeneration of the forearm muscles of MMA athletes. The methods can be an important element of therapeutic management focused on optimizing training effects and reducing the risk of injuries of the combat sports athletes.

Key Words: strength training, fatigue, lymphatic system, physiotherapy, muscle regeneration

2. Schillinger A, Koenig D, Haefele C, Vogt S, Heinrich L, Aust A, Birnesser H, Schmid A: Effect of manual lymph drainage on the course of serum levels of muscle enzymes after treadmill exercise. Am J Phys Med Rehabil 2006;85:516–520.


Improving muscular recovery after exercise is an important topic in sports medicine. The aim of the present study was to evaluate the effect of manual lymph drainage on the course of serum levels of muscle enzymes after an extended treadmill exercise.


Fourteen recreational athletes (seven women, seven men) were included in the study. The participants underwent a graded exercise test on a treadmill ergometer to determine the individual anaerobic threshold (IAT). Seven days after the graded exercise test, all subjects performed 30 mins of treadmill exercise at an intensity equivalent to IAT. The subjects were randomized into two groups of seven persons. One group was treated with manual lymph drainage (ML), whereas the control group (CG) received no treatment after the endurance exercise at IAT level.


After an increase immediately after exercise, a fast decrease in lactate dehydrogenase (LDH) and in aspartate aminotransferase (AST) concentration was observed, with significantly lower values for LDH after 48 hrs in the subjects having received lymph drainage treatment. The course of creatine kinase (CK) levels was comparable, but did not reach significance.


Manual lymph drainage after treadmill exercise was associated with a faster decrease in serum levels of muscle enzymes. This may indicate improved regenerative processes related to structural damage of muscle cell integrity.

3. Bakar, Y., Coknaz, H., Karlı, Ü., Semsek, Ö., Serın, E., & Pala, Ö. O. (2015). Effect of manual lymph drainage on removal of blood lactate after submaximal exercise. Journal of Physical Therapy Science, 27(11), 3387-3391. doi:10.1589/jpts.27.3387


It has been well-established that exercise-induced muscle damage occurs following intense

exercise. Massage is commonly used to manage muscle damage resulting from exercise. However the effect of massage after exercise is still not clear. The purpose of this study was to examine the effect of manual lymph drainage on muscle damage and on the removal of blood lactate following submaximal exercise (SE), as part of a solution to the challenging problem in sports medicine of muscular recovery after exercise.

Subjects and Methods.

Eighteen healthy male students, with moderate exercise training, were randomly assigned to either receive manual lymph drainage (MLD) or serve as controls. Both groups were subjected to a graded exercise test, performed on a treadmill ergometer, to determine each subject’s individual anaerobic threshold (IAT). Seven days later, all subjects were made to run for 30 minutes on the same treadmill ergometer, at a running speed equivalent to the IAT. One group received MLD treatment, while the control subjects received no treatment.


Following an increase immediately after exercise, lactic acid (LA) and lactate dehydrogenase (LDH) serum levels dropped rapidly and significantly at the end of MLD application and two hours after SE in the subjects receiving MLD. The course of creatine kinase (CK) and myoglobin levels was comparable, and with myoglobin showing a significant difference at 2 h after SE, and CK at 24 h after SE.


Manual lymph drainage after SE correlated with a more rapid fall in LA and of the muscular enzymes of LDH, CK and myoglobin, and may have resulted in an improvement in the regenerative processes elicted by structural damage to the muscle cells.

Key words: Manual lymph drainage, Recovery, Submaximal exercise

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