Lymphatic drainage side effects, and who shouldn’t do it

Who should not have lymphatic drainage, when to wait or ask your doctor first, what you might feel afterwards and which signs mean stop. Set out in four levels, based on guidance from the British Lymphology Society, the National Lymphedema Network and NHS leaflets.

10 min read Reviewed on September 28, 2026 Sources ↓

Edited by José Antonio Neto Not clinically reviewed

Contraindications: who should not do it

The four levels run from most to least urgent, and they are the same ones Rinpa goes through with you before your first session. The lists come from the British Lymphology Society (BLS),¹ the National Lymphedema Network (NLN)² and NHS self-drainage leaflets. The area-by-area adaptations are our own precautionary rules and have not been clinically reviewed, as we explain in our methodology.

1
See a doctor today

No self-massage today: this needs a doctor to see you today. If you are short of breath or have chest pain, call 911 or your local emergency number.⁵
- New or sudden swelling, especially on one side; for example, a swollen, painful calf with red or darkened skin⁵
- Shortness of breath or chest pain
- A fever, or red, hot and painful skin⁶
- A new lump you cannot explain⁷
2
Wait for the all-clear

Do not do lymphatic drainage until your doctor gives you the all-clear. These are the contraindications listed by the BLS¹ and the NLN.²
- A blood clot or pulmonary embolism, now or being treated
- Uncontrolled heart failure
- Kidney failure
- Cirrhosis with fluid in the abdomen
- Uncontrolled high blood pressure
- Superior vena cava obstruction
- An infection, such as cellulitis
3
Get the go-ahead, or adapt the routine

You can do it, but with changes and, in some cases, only after talking to your doctor, surgeon or physical therapist.
- Active cancer or cancer treatment. Nothing until your oncology team gives you the go-ahead, and even then, never over the tumor.¹
- Heart problems, lymphedema or lipedema, or a first-trimester or high-risk pregnancy. Get the go-ahead before you start. With lymphedema, the affected area is left out: your therapist sets its direction.
- Radiation therapy in the last 6 weeks. That area waits until 6 weeks have passed.⁷
- Recent surgery, including cosmetic surgery. That area is left out until your surgeon gives you the go-ahead.
- A tummy tuck or abdominal liposuction, at any time. The lower abdomen is never moved toward the groin, because the route the lymph takes can change.⁸
- Lymph nodes removed or treated with radiation therapy. The direction changes, and your physical therapist sets it. Neck nodes: no neck or face work. Armpit nodes: no armpit, chest, arm or side work. Groin nodes: no groin, lower abdomen or leg work.⁹
- An overactive or poorly controlled thyroid, arrhythmias, dizziness or fainting when your neck is pressed, or a device in your neck. No neck or face work until you have the go-ahead.^{1, 17}
- A stroke, or being told your carotid arteries are narrowed. Ask for the go-ahead before you start and, until then, no neck or face work.³
- A device implanted in your abdomen. The abdomen is left out.
- A low-risk pregnancy, from the second trimester. On the abdomen, only breathing with your hands resting and no pressure.
4
Stop if you notice…

At any point in the session. And do not start it if you have a fever or feel unwell today.¹¹
- Pain⁹
- Skin that stays red or marked¹⁰
- Dizziness
- More swelling; if it is also on one side, new or hot, go to level 1

If anything changes in your health, such as a new diagnosis, an operation or a pregnancy, go through the list again before your next session.

Side effects: what is normal and what is not

Few people have negative reactions to lymphatic drainage,³ and it has been well tolerated in clinical trials: in the Cochrane review, which pooled six small trials in women with lymphedema after breast cancer, it was safe in all of them.⁴ Even so, after a session you may notice some of these:

Calm. Lymphatic drainage brings on a relaxation response, driven by the parasympathetic nervous system.²
Tiredness, a headache or nausea. Some people notice these after lymphatic drainage.³ If it happens, rest, and if it keeps happening, tell your doctor.
Slight dizziness. Deep breathing without pauses can make you dizzy, which is why the West Suffolk leaflet asks you to rest for a moment between breaths.⁹ And in a study of 30 healthy people, blood pressure fell after drainage of the neck, arms or legs.¹² When you finish, get up slowly.

What is not normal is pain, skin that stays red or marked, or more swelling. These are not side effects to put up with: they are signs to stop.

Special situations

Pregnancy

In the first trimester, or if your pregnancy is high-risk, ask your doctor or midwife for the go-ahead first. Most pregnancy care providers advise waiting until the second trimester before having a massage, and they may advise against it if you have gestational diabetes, high blood pressure or other complications.¹³

After that, the app changes two things. On the abdomen, only breathing with your hands resting, with no pressure and no strokes toward the groin. And it drops legs up, which is done lying on your back, a position that can lower blood pressure in pregnancy.¹³ These are our own precautions, not published clinical guidance. Keep the level 1 signs in mind too: pregnancy and the six weeks after giving birth raise the risk of a blood clot.⁵

After surgery or liposuction

After any operation, including cosmetic surgery, the operated area is left out until your surgeon gives you the go-ahead. If they have prescribed drainage sessions with a professional, follow their plan: self-massage does not replace it.

After a tummy tuck (abdominoplasty), the route the lymph takes also changes. In a study of 20 women, before surgery the skin of the lower abdomen always drained toward the groin; afterwards, only 15% kept that route, and in 65% it drained toward the armpits.⁸ That is why the app never moves that area toward the groin after a tummy tuck. The study did not look at liposuction, but we apply the same caution after abdominal liposuction.

Cancer and radiation therapy: can it spread cancer?

If you have active cancer or are having treatment, talk to your oncology team first, and never work directly over the tumor or a metastasis.¹ Can massage spread cancer? There is no evidence that it does,¹⁴ but no studies rule it out either: that is why the decision is a clinical one, made with your team.¹ We sum up the studies there are in does lymphatic drainage work?

If you have had radiation therapy, wait six weeks before working on that area.⁷ And if you have had lymph nodes removed or treated with radiation therapy, the direction changes: the skin is moved toward areas that drain well,⁹ and your physical therapist or lymphedema service sets that route.¹

Lymphedema and lipedema

If you have lymphedema, drainage is part of the treatment your team prescribes, alongside compression, exercise and skin care, and you learn it from a specialist who teaches you the sequence and checks it with you.¹ It is a complement: in lymphedema after breast cancer, adding it to compression and exercise does little extra to reduce volume.¹⁵

In lipedema, decongestive therapy, the usual conservative treatment, offers limited symptom relief.¹⁶ In both cases, the app asks for the go-ahead before you start, and with lymphedema it leaves the affected area out: your therapist sets its direction.

Thyroid, heart and arrhythmias: no-neck mode

Almost every routine starts at the neck and collarbone, but in some cases it is best not to touch the neck without the all-clear. The BLS advises caution with poorly controlled thyroid problems and with heart failure.¹ And in some people, pressure on the side of the neck, where the carotid sinus sits, triggers a reflex that slows the pulse, lowers blood pressure and can cause dizziness or fainting.¹⁷

So if you have an overactive or poorly controlled thyroid or arrhythmias, feel dizzy when your neck is pressed or have a device in your neck, the app switches to no-neck mode until you have the go-ahead. The opening becomes breathing, shoulders and armpits, and the face is switched off, because lymph from the face drains down the neck.⁹

Why lighter is safer

The right pressure is far lighter than you would think. The BLS puts it like this: light enough not to indent the skin, firm enough to see it stretch, and leaving no redness.¹ The West Suffolk leaflet sums it up as a test: “If you can feel your muscles underneath your fingers, then you are pressing too hard.”⁹

Pressing harder does not help, and it can do harm. The International Society of Lymphology warns that overly vigorous massage (it refers to classical and other massage, not manual lymphatic drainage) may damage lymph vessels or their attachment to the surrounding tissues.¹⁵ And one piece of context, with its limits: in mice, very light stimulation of the face and neck doubled fluid outflow to the neck nodes, while stronger pressure reduced it. We do not yet know whether the same happens in people.¹⁸

Three signs you pressed too hard: your skin is red when you finish,¹⁰ you can feel the muscle under your fingers⁹ or it hurts.¹¹ Next time, lighter still. The technique, step by step, is in our guide to lymphatic drainage at home.

Questions

Can lymphatic drainage be harmful?

Done gently, and outside the situations on this page, it rarely causes problems: it has been well tolerated in clinical trials.⁴ The risks come from doing it when you should not, for example with a blood clot, an infection or uncontrolled heart failure,¹ or from pressing too hard.¹⁵

Can I do it with a cold or a fever?

Not with a fever³ or if you feel unwell: wait until you are better.¹¹ If you notice signs of infection in your face or neck (red, hot or tender skin, a fever or chills), do not work on that area either, and get it checked.⁹ For a mild cold without a fever, the guidance we follow does not say: if in doubt, ask your doctor.

Can I do it if I have varicose veins?

Varicose veins are not among the contraindications listed by the BLS¹ or the NLN,² and self-massage only moves the skin, without pressing. But varicose veins make a blood clot more likely,⁵ so it is worth knowing the signs: if a calf becomes swollen and painful, with red or darkened skin, do not massage it and see a doctor today. If your varicose veins hurt, you have a sore that will not heal or you have had a blood clot before, ask your doctor first.

Can I do it after a long flight?

Yes, if both legs simply feel tired, the way they usually do. But journeys of more than 4 hours by plane, car or train raise the risk of a blood clot.⁵ If, when you arrive, one leg is swollen and painful, with red or darkened skin, do not massage it: see a doctor today, and if you are also short of breath or have chest pain, call 911 or your local emergency number.⁵

Can I do it while breastfeeding?

The guidance we follow does not cover breastfeeding, and none of the app’s routines work on the breast. If part of your breast is swollen, hot and painful, or you have a fever, do not massage it and speak to your midwife or doctor. And if you have had a cesarean, it counts as surgery: that area only with your surgeon’s go-ahead.

How do I know if I pressed too hard?

If your skin is red when you finish, the pressure was too much.¹⁰ During each stroke, the skin stretches but does not dip,¹ you cannot feel the muscle under your fingers⁹ and it does not hurt.¹¹

Sources