Ask the Expert - Amy Hartl, Licensed Massage Therapist
Q & A with Amy - Licensed Massage Therapist in Buffalo, NY.
The first time I was introduced to the lymphatic system was after my breast surgery - double mastectomy. I was given an order to go to a physical therapist to learn lymphatic massage to help prevent lymphedema. I’m sure it was a system lightly touched on back in school, however what I’ve learned about it now has been really eye opening. The physical therapist provided massage 1x a week for a few months and they provided me with stretches and instructions on how to self massage. I also wore a compression sleeve for a few years especially when working out and flying. I no longer wear the compression for prevention, but I continue to do my self massage here and there when I’m putting on oil or lotion.
Last year, Amy Hartl and I met at the Young Survival Coalition and she shared that she is a licensed massage therapist with focus on oncology massage and lymphatic drainage. One of these days I’m going to get to Buffalo for a massage, but until I get there I thought we’d do a Q&A with her to talk about the lymphatic system and zero in on her expertise.
Thanks Amy for taking the time to chat with us about massage therapy, dry brushing, lymphatic drainage and how being educated on these topics can enhance your self-care, especially when you’ve been diagnosed with breast cancer.
1. Were you always interested in oncology massage? Did your breast cancer diagnosis have an impact on the focus of your practice?
I learned about oncology massage in 2011 towards the end of my 18 month professional massage therapy program. I found it fascinating that the power of touch and human connection could be available to anyone, even those facing major health challenges.
Even though I had not yet had my own cancer diagnosis I WAS considered high risk due to a long family history and the likelihood of a BRCA mutation. I thought back to my mom who was 38 when she was diagnosed and treated, with three young children, and I wished that this had been available to her to bring her comfort. So yes, my own family experience with cancer played a part in my initial interest.
I do remember thinking it could be me someday and ultimately in 2017, it was. The skills and knowledge I possessed from my professional training and experience with clients navigating this path was a huge source of empowerment when facing my own diagnosis and treatment plan.
2. What is the difference between oncology massage and other massage therapy? Did you go through special training for oncology massage and lymphatic drainage?
Oncology massage is about understanding cancer and cancer treatments and how to modify traditional massage therapy techniques to be safe, effective, and relevant to someone living with cancer or a cancer history. While I WISH it was part of every massage therapist’s professional education, for now it is considered a specialty and does require separate training and continuing education.
The same is true for manual lymphatic drainage therapy. While there are elements of both that overlap when dealing with someone who has or has had cancer, they are ultimately independent modalities and both require a therapist to see additional learning opportunities and accreditation.
3. What is the lymphatic system and what does it do? Why is it important to support/take care of this system?
The lymphatic system is a critical organ system made up of various organs (the spleen, thymus, tonsils, and bone marrow) along with delicate lymph vessels and lymph nodes that run throughout the body (most people know these as “glands”).
It has three main functions:
To balance the fluid load in the body and transport fluid in conjunction with the cardiovascular system.
To filter the fluid and clear the body of harmful substances such as virus, bacteria, cellular waste (including cancer cells), molecular debris, dust, and any other non-viable particles that our body can’t use or support.
To stimulate white cell production and assist with immune defense.
While the lymphatic system does know how to do its job quite well, it has a disadvantage in that it doesn’t have a manual pump, like the heart, to support it so it relies primarily on physical movement of the body to assist it.
4. Can breast cancer or other serious illnesses affect your lymphatic system?
Yes, unfortunately almost everyone who experiences a cancer diagnosis will face some level of impact to their lymphatic system. While the cancer itself has the possibility of disrupting the lymphatic system (typically in more advanced stages) it is usually the diagnostic and treatment processes that cause the most damage.
The most common problems occur from lymph node biopsy and/or removal and radiation therapy. I like to think of the lymphatic system as a machine. If you remove or damage any part of it, it could keep working but it also might now work as well as it once did.
One positive thing though is that the lymphatic system follows very specific pathways so the damage that occurs is typically localized. For example if someone has breast cancer in their left breast and has a lumpectomy with a sentinel node biopsy and radiation on the left side, then the damage to their lymphatic system is usually isolated to that area - what we call the upper right quadrant which includes the breast, chest, shoulder, trunk, arm and hand.
There are other diseases and conditions that can damage the lymphatic system but in the western world and developed countries cancer treatment is the largest culprit.
5. What is lymphedema?
Lymphedema is created by a back up of fluid in the lymphatic system. It is when the thick fluid called lymph is unable to move through the appropriate pathways and begins to become stagnant. The fluid is often filled with proteins that are too large to be absorbed back into the bloodstream and as the fluid pools it results in swelling.
There are different stages of lymphedema and the earlier it is detected the easier it is to treat. Unfortunately there is no cure and for most people lymphedema is not reversible but instead becomes about management for comfort and function.
6. What is Manual Lymphatic Drainage? Why is Manual Lymphatic Drainage relevant to a breast cancer experience?
Manual Lymphatic Drainage (MLD) Therapy is a type of gentle hands on bodywork designed to assist the flow of fluid in the body. It is sometimes referred to as “lymphatic massage” though it is technically NOT a massage modality even though massage therapists may be trained in and offer it.
MLD is extremely beneficial when someone has or has had a breast cancer experience on a number of levels. It has been shown to be very effective in speeding postoperative recovery by reducing swelling and bruising.
It can assist in removing anesthetic agents from the body and support immune function
And most importantly it can help reduce the risk of developing secondary conditions such as breast cancer-related lymphedema and/or manage them if necessary.
7. I’ve heard the word fascia thrown around a lot when discussing the scar tissue from my breast surgery. What is this and how is it related to the lymphatic system, massage and surgery?.
Fascia is a connective tissue that wraps around and in between everything inside of our body. The best example is that tough white stuff in a raw chicken breast. It is extremely strong and helps bind all of our muscles and tissues together so that our insides don’t end up as “soup”. Fascial restrictions can happen with or without scar tissue but are more common when collegen fibers create what we know as “scar tissue”. While there is still a lot to learn about both the fascia and lymphatic systems, research is increasingly showing a link between the two and how their relationship affects the proper or problematic formation of scar tissue.
8. Dry skin brushing can be read about everywhere. I’ve read that its benefits may include stimulating the lymphatic system, is dry brushing the same as lymphatic drainage massage?
Dry brushing is a great tool for a few different purposes but it all depends on how you do it. Most commonly it can be used to exfoliate the skin which promotes skin integrity and health, increase blood flow and circulation, smooth fascia and scar tissue, and yes support lymphatic flow.
It is NOT the same as manual lymphatic drainage though which truly only has one purpose - to assist and support the flow of lymph.
9. What is Dry Brushing and what are the main benefits?
Dry brushing is an ancient self-care technique with roots in many cultures from Greece to Egypt to Ayurvedic Indian Medicine. I mentioned some of the general benefits above but for someone who has had a breast cancer experience it’s really important to determine your goals and choose the benefits that are going to be safe, effective, and relevant to your unique needs.
I teach a dry brushing for breast cancer workshop and the main points I focus on are how to choose a dry brush and how to use it appropriately. Because of increased risk of infection and the possibility of lymphedema, a traditional stiff bristled brush may not be as beneficial or even potentially harmful. Learning about your body and the affects of breast cancer treatments as it relates specifically to dry brushing allows you to modify the technique in a way that can create a really beautiful self-care practice for both body and mind.
10. What is lymphatic enhancement technology and do you use it in your practice?
The only tools I use in my practice are my hands and in some cases a dry brush, though I mostly teach my clients how to do that for themselves.
There are technologies that supposedly stimulate lymphatic flow but under my massage therapy license in NYS I am not allowed to use them. Most Certified Lymphatic Therapists will tell you that nothing beats the work of trained hands but things like pneumatic pumps, kinesio tape, and a few others fancy tools can be helpful when facing a more advanced diagnosis.
Lastly, other than massage, what are other ways to take care of the lymphatic system?
Besides staying well hydrated movement and exercise are some of the most important ways to keep your lymphatic system functioning optimally. My top recommendation is swimming because of the gentle hydrostatic pressure that it creates but that is not always available to everyone. Rebounding on a mini trampoline is popular but honestly bike riding or simply walking can do the trick too.