Is lymphatic drainage effective against varicose veins?

Key points to remember.

Manual lymphatic drainage stimulates lymphatic circulation, aiding in tissue decongestion and enhancing the elimination of accumulated fluids.
Lymphatic drainage does not directly target varicose veins but, by acting on lymphatic congestion, it can facilitate blood circulation and help limit the progression of varicose veins.
Studies show that lymphatic drainage reduces oedema and improves quality of life in patients before and after varicose vein surgery.
Lymphatic drainage is useful in treating varicose veins as adjunct therapy, alongside other medical or surgical treatments.

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Reminder: what exactly is lymphatic drainage?

The lymphatic drainage is a massage technique designed to stimulate the lymphatic system, a network of vessels through which lymph circulates. This clear fluid, composed mainly of water, proteins, white blood cells and metabolic waste, enables the elimination of toxins from the body and support for the immune system. Unlike blood circulation driven by the heart, lymph has no pump: it relies on muscular contractions and respiration, but sometimes requires an extra push. This is where lymphatic drainage comes in, enhancing the efficiency of this system. Two forms of lymphatic drainage are distinguished.

Manual lymphatic drainage : It relies on gentle and precise movements that mimic the action of a pump and aim to guide lymph towards the lymph nodes. This form of lymphatic drainage is often regarded as more effective because it is more targeted.
Non-manual lymphatic drainage : This may include, for instance, pressotherapy or the use of pneumatic compression devices that apply mechanical pressure via inflatable boots or sleeves.

Between 20 and 35%

of the French population suffer from varicose veins.

18 to 20 million

people suffer from varicose veins in France.

What are the effects of manual lymphatic drainage on varicose veins?

The varicose veins are characterised by dilated veins that adopt a tortuous appearance in the legs. They result from a dysregulation of blood circulation. Blood is unable to return to the heart due to venous valve dysfunction. Consequently, it pools in the veins, causing congestion. The vessels then become visible to the naked eye, appearing blue or purple. Far from a mere aesthetic concern, varicose veins produce a sensation of heavy legs and are accompanied by pain and discomfort when walking. Age is the principal risk factor, although a sedentary lifestyle and genetic predisposition also contribute to their development.

Manual lymphatic drainage is not typically utilised as a first-line intervention for blood circulation issues. However, it offers several benefits for varicose veins.

Manual lymphatic drainage exerts an indirect yet noteworthy effect on venous circulation. In the case of varicose veins, blood stasis in the veins is often aggravated by lymphatic system congestion. When lymphatic vessels dilate as a result of interstitial fluid accumulation, they exert mechanical pressure on neighbouring veins. This compression further impairs venous return, exacerbating the dilation of superficial veins. By manually stimulating lymph circulation, lymphatic drainage helps to decongest these vessels and restore a better dynamic between the lymphatic and venous systems. The reduction in pressure on the veins then favours a smoother flow of blood towards the heart.

This mechanism explains why manual lymphatic drainage can alleviate several symptoms associated with varicose veins, such as heavy legs and swelling. By promoting the resorption of oedema and the mobility of fluids, it helps reduce the pain related to venous stasis. Manual lymphatic drainage should not, however, replace medical treatment. Indeed, it does not correct venous valve failure but can help improve patients’ quality of life.

A clinical study assessed the effects of manual lymphatic drainage (MLD) in patients with chronic venous insufficiency prior to venous system surgery. Seventy volunteers were recruited and randomly allocated to two groups: the MLD group (38 patients), who underwent manual lymphatic drainage sessions for two weeks before the surgical intervention, and the control group (32 patients), who received no massage. The researchers evaluated the severity of chronic venous insufficiency using the CEAP classification, the venous refill time (VRT) and the foot volume (FV) at three time points: before the intervention, after the series of lymphatic drainage sessions, and between 25 and 30 days post-surgery. The results are presented in the table below.

Parameter	DLM group - Before lymphatic drainage	DLM group - After lymphatic drainage	DLM Group - Post-operative	Control group - Preoperative	Control group - Post-operative
CEAP (clinical stage)	2.23	2.15	2.10	2.4	2.12
VRT (Venous filling Time, s)	5	13	15.6	13	14.9
FV (Foot Volume, mL)	3 625	3 472	3 418	3 581	3 559

Comparative clinical results between the DLM group and the control group.

Source: MOLSKI S. & al. Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: A randomized controlled trial. Archives of Medical Science (2013).

Terminology note: understanding the CEAP, VRT and FV indices.

CEAP (Clinical Etiological Anatomical Pathophysiological) : This is an international classification system for chronic venous insufficiency. The CEAP score evaluates the severity of visible symptoms on a scale ranging from 0 (C0: no clinical signs) to 6 (C6: presence of active venous ulcers). A reduction in the CEAP score therefore indicates clinical improvement, with fewer varicose veins, oedema and pain.
VRT (Venous Refilling Time) : Venous refilling time is the duration required for veins to refill with blood following muscular exertion. A prolonged VRT indicates effective venous return and thus functional blood circulation.
FV (Foot Volumetry) : Foot volumetry measures the volume of fluid accumulated in the tissues of the lower limb, often due to oedema. A decrease in FV therefore indicates a reduction in swelling.

The results show that manual lymphatic drainage produced a moderate yet significant reduction in foot volume (an average of 207 mL compared with 22 mL in the control group), accompanied by an improvement in quality of life and symptoms even before surgery. Although the changes observed in haemodynamic parameters (VRT, CEAP) remain limited, it nevertheless appears that the draining massage had a favourable effect on varicose veins. The researchers conclude by supporting the view that manual lymphatic drainage can optimise preoperative preparation and facilitate postoperative recovery, without, however, replacing specific medical approaches to varicose veins.

Although it does not correct the underlying cause of varicose veins, pre-operative manual lymphatic drainage reduces fluid congestion, improves patients’ quality of life and optimises surgical outcomes.