Is lymphatic drainage effective against varicose veins?

Key points to remember.

Manual lymphatic drainage stimulates lymph flow, aiding in tissue decongestion and enhancing the removal of accumulated fluids.
Lymphatic drainage does not directly target varicose veins but, by alleviating lymphatic congestion, it can facilitate blood flow and limit the worsening of varicose veins.
Studies show that lymphatic drainage reduces swelling and improves quality of life in patients before and after varicose vein surgery.
Lymphatic drainage is useful in managing varicose veins as complementary therapy, in conjunction with other medical or surgical treatments.

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Reminder: what is lymphatic drainage?

The lymphatic drainage is a massage technique aimed at stimulating the lymphatic system, a network of vessels through which lymph flows. This clear fluid, composed mainly of water, proteins, white blood cells, and metabolic waste, makes it possible to eliminate toxins from the body and support the immune system. Unlike blood circulation propelled by the heart, lymph has no pump: it relies on muscle contractions and respiration but sometimes needs a boost. That’s where lymphatic drainage comes in, reinforcing the efficiency of this system. Two main forms of lymphatic drainage are distinguished.

Manual lymphatic drainage : It relies on gentle, precise movements that mimic the action of a pump and are designed to direct lymph toward the lymph nodes. This type of lymphatic drainage is often considered more effective because it is more targeted.
Non-manual lymphatic drainage : It may involve, for example, pressotherapy or the use of pneumatic compression devices that apply mechanical pressure through inflatable boots or sleeves.

Between 20% and 35%

of the French population suffer from varicose veins.

18 to 20 million

people in France suffer from varicose veins.

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

The varicose veins are characterized by dilated veins that take on a tortuous shape in the legs. They are caused by a circulatory imbalance. Blood does not return to the heart due to malfunctioning venous valves. As a result, it pools in the veins and causes congestion. The blood vessels then become visible to the naked eye and appear blue or purple. Far from being simply a cosmetic concern, varicose veins produce a sensation of heaviness in the legs and are accompanied by pain and discomfort when walking. Age is the primary factor responsible for varicose veins, although a sedentary lifestyle and genetics also influence their development.

Manual lymphatic drainage is not necessarily used as a first-line treatment to address blood circulation issues. However, it provides several benefits for varicose veins.

Manual lymphatic drainage has an indirect yet noteworthy effect on venous circulation. In the case of varicose veins, blood stagnation in the veins is often aggravated by lymphatic system congestion. When lymphatic vessels dilate due to an accumulation of interstitial fluid, they exert mechanical pressure on nearby veins. This compression further impairs venous return, enhancing the dilation of superficial veins. By manually stimulating lymph flow, lymphatic drainage helps decongest these vessels and restore a healthier dynamic between the lymphatic and venous systems. The resulting pressure relief on the veins then supports a smoother blood flow back to the heart.

This mechanism explains why manual lymphatic drainage can relieve several symptoms associated with varicose veins, such as heavy legs and swelling. By facilitating edema resorption and fluid mobility, it helps reduce pain linked to venous stasis. Lymphatic drainage cannot, however, substitute for medical treatment. Indeed, it does not correct venous valve failure but can help improve patients’ quality of life.

A clinical study evaluated the effects of manual lymphatic drainage (MLD) in patients with chronic venous insufficiency prior to venous system surgery. To this end, 70 volunteers were recruited and randomly assigned to two groups: the MLD group (38 patients), who received manual lymphatic drainage sessions for two weeks before surgery, and the control group (32 patients), who did not receive any massage. The researchers assessed the severity of chronic venous insufficiency according to the CEAP classification, venous refill time (VRT), and foot volume (FV) at three time points: before surgery, 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 - Postoperative	Control group - Preoperative	Control group - Postoperative
CEAP (Clinical Stage)	2.23	2.15	2.10	2.4	2.12
VRT (Venous Refilling 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 outcomes 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).

Vocabulary point: 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 from 0 (C0: no clinical signs) to 6 (C6: presence of active venous ulcers). A decrease in the CEAP score therefore indicates clinical improvement, with fewer varicose veins, edema, and pain.
VRT (Venous Refilling Time) : The venous refilling time is the time required for veins to refill with blood after muscular exertion. A long VRT indicates efficient venous return and, consequently, functional blood circulation.
FV (Foot Volumetry) : Foot volumetry measures the volume of fluid accumulated in the tissues of the lower limb, often due to edema. A decrease in FV therefore indicates a reduction in swelling.

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

Although it does not correct the cause of varicose veins, preoperative manual lymphatic drainage reduces fluid congestion, improves patients’ quality of life, and optimizes surgical outcomes.