Still a little confused about the different styles of Lymphatic bodywork out there? Let's Talk... To begin, it is essential to understand the basic anatomical actions of the lymphatic system. Our lymphatic system is the primary site of lipid absorption in our digestive tract, large and macromolecular waste removal from interstitial spaces, and immune activation. Unlike our cardiovascular system—which consists of a loop of arteries, veins and capillaries that circulate fluid around and around—our lymphatic system is a one-way network with no central pump.  It relies on our muscular movement, deep respiration  and mechanical overflow to create flow. The lymphatic network starts as blind-ended vessels in our digestive tract and interstitial spaces, and ends by feeding into our cardiovascular system right before deoxygenated blood enters our heart. From there, it is sent back around the vascular network, delivering and exchanging the vital nutrients and materials needed to maintain and grow our bodies.  Lymphatic Bodywork:  The Two Main Approaches As bodyworkers, we are able to access and support this incredible system. Currently, there are two primary categories of lymphatic services being offered by licensed massage therapists, Brazilian lymphatic or Body Sculpting and The Vodder Method or The Foldi Method. Brazilian Lymphatic offers immediate visible de-bloating and temporary aesthetic effects.  The Vodder Method offers internal physiological healing, reduced clinical swelling, and pain relief. 1. "Brazilian Lymphatic" or "Body Sculpting" With these aesthetic services, the practitioner stimulates and moves the lymphatic fluid regionally through the use of vigorous, fast, firm strokes. This technique attempts to train the interstitial fluid to a different location—generally toward lymph node locations.  However, depending on the goal of the client it also aims to moves fluid toward an area they want to enhance or away from areas to give the appearance of less inflammation and a more contoured look. While this service does stimulate the vessels and lymph nodes, it only moves the fluid regionally.  The abdominal focus does support peristalsis and encourage immediate gas relief for constipation or abdominal bloating. This style is often accompanied with osmotic wrapping and a sauna session.  Combining these two efforts, moves fluid temporarily and induces extreme sweating to temporarily create dramatic results.  After a couple of days as the body returns to proper levels of hydration, the fluid will naturally return to its original settling position interstitially.   This service does help with high-performance athletes who want to relieve post work out swelling, abdominal bloating or people looking for temporary physical effects for a special occasion.   2. “The Vodder Method” or “The Foldi Method” These are the medically recognized lymphatic bodywork techniques and are named after the pioneering founders who set them into sequence to promote clinical healing. To offer this, a practitioner undergoes rigorous professional training and is certified in "The Vodder Method" or "The Földi Method." They will often use the credentials MLD-C behind their name to indicate they are certified in manual lymphatic drainage. Both the Vodder and Földi methods are the global gold standards within the field. They utilize feather-light skin stretching techniques to move the fluid systemically, assisting the body to process and effectively eliminate interstitial waste products while returning vital hydration back to the cardiovascular system. Practitioners also utilize specific breathing techniques and protocols alongside specialized deep abdominal sequences to clear bloating from the inside out.  Through these deeply calming services the practitioner immediately stimulates the parasympathetic system, our internal physiological state where healing occurs. Practitioners with this certification are qualified to support general wellness and the immune system, promote full body de-bloating and provide maintenance support for individuals with systemic autoimmune disorders or complex chronic disorders.  Advanced Specializations and the Highest Standard of Care Beyond foundational MLD, there are additional advanced certifications available, such as Certified Plastic Surgery Therapist (CPST) and Advanced MLD-Oncology. Accumulating these certificates requires the practitioner to undergo continued professional training, which teaches them how to safely work with clinical clients and interact seamlessly with the medical directives of a client's primary physician.  A practitioner with these advanced credentials is able to help quicken healing times after a physical trauma and learns how to safely work around timelines of certain medical treatments or elective surgeries. Certified Lymphedema Therapist (CLT) or Certified Decongestive Therapist (CDT) ​ The final credential in medical lymphatic support is known as a Certified Lymphedema Therapist (CLT) or Certified Decongestive Therapist (CDT). This practitioner is qualified to manage lymphedema or lipidema through four specific pillars: -Manual Lymphatic Drainage (MLD) -Compression Therapy -De-congestive Exercises  -Meticulous Skin and Nail Care In the state of South Carolina, a Licensed Massage Therapist (LMT) is fully eligible to obtain this certificate alongside Registered Nurses, Occupational Therapists, Physical Therapists, or allied healthcare equivalents. In the event of open wounds, however, the LMT must refrain from services and refer the patient to a higher tier wound care nurse, physical or occupational therapist or Physician.   Any of these practitioners are eligible to sit for the nationally board certification exam under the Lymphology Association of North America (LANA) to be fully accredited and known as a CLT-LANA-symbolizing the highest tier of verified, medical-grade expertise in lymphology. Ultimately, all MLD-C, CLT, CDT and CLT-LANA practitioners operate in strict alignment with the medical directives of their clients’ primary care physicians or oncologists to ensure safety and integrated health goals. ​ Moving Forward with Clarity None of these services offer "one and done" relief.  They all require a series of regular sessions to achieve optimal results, alongside healthy diet and regular exercise.  It is also important to understand that in the state of South Carolina, a licensed massage therapist does not need to obtain certification to offer “lymphatic body work.”   Often, insurance companies will provide financial support towards the care and management of lymphatic needs.  While South Carolina does not allow a LMT to bill health insurance directly, they can be recognized to accept HSA or FSA payments, provided the client obtains a Letter of Medical Necessity (LMN) from their healthcare provider.   Please contact your individual state licensing authority and insurance carrier to obtain a clear breakdown of the specific requirements and legal rules governing lymphatic therapies regarding scopes of practice and billing directives. All of these services are generally relaxing and are provided with deep care.  I hope this information helps you clearly identify your path forward appropriately with lymphatic body work based on your personal health goals and needs. ​ To Your Health Journey, Andrea "Millie" Miller LMT, CMA, MLD-C Certified Plastic Surgery Therapist (CPST) & Advanced MLD: Oncology Considerations 200-Hour Registered Yoga Teacher (RYT) Pre-Nursing Student Founder & Forever Student of Sahaya Practices