Godoy & Godoy define lymph drainage as a physical stimulation technique that aims to enhance the formation and drainage of lymph. Therefore, it has two distinct goals, that is, to form and to drain the lymph. Lymph forms inside lymphatic capillaries and so it is essential to understand about the anatomy, physiology, pathophysiology and hydrodynamic rules that define how lymph can be drained. Macromolecules from the interstitial space must pass to the lymphatic capillaries for lymph to be formed.
Knowledge of the path of these vessels is fundamental, however it is important to take into account the dynamics of fluids; flow is always from distal to proximal regions and toward the corresponding lymph nodes. The vessels are basically linear, so an understanding about hydrodynamics, how liquid circulates inside a vessel and the factors that interfere with its displacement is central to treatment. When analyzing these aspects, we can see that displacement is inevitably linear, so drainage movements must follow the path of the vessels.
Godoy & Godoy changed the concept of lymph drainage internationally by replacing circular and semicircular movements as promoted by Vodder and the to-and-thro maneuvers suggested by Leduc. Godoy & Godoy advocate linear movements towards the corresponding lymph nodes based on anatomy, physiology, pathophysiology and hydrodynamics. Thus, linear movements are the basis of the Godoy & Godoy method of lymph drainage.
Hence, the different lymph drainage techniques are defined by the type of movement used. When circular and semicircular movements are involved, the therapist is employing the technique of Vodder, when using to-and-thro maneuvers it is Leduc’s technique and when linear movements are being employed in one direction, it is Godoy & Godoy's technique.
The trend around the world is to incorporate linear movements into techniques of lymph drainage because it is the only scientifically based, i.e. scientifically proven option that can be reproduced in vitro, in vivo and in clinical settings. Thus, ethically, when incorporating any form of linear movement into therapy, it must be remembered as the Godoy & Godoy technique. This is important to avoid plagiarism of intellectual property rights, which is inadmissible in the scientific setting.
An important aspect of this technique is how the hands are used to perform lymph drainage. Godoy & Godoy recommend that a constant pressure should be used from a distal starting point to the corresponding lymph nodes to avoid reflow and significant loss of efficiency by following the principles of hydrodynamics. When we evaluate the displacement of fluids inside a blood vessel by direct vision or using examinations such as arteriography, venography or lymphoscintigraphy, it is clear that linear movements must be used to comply with the anatomy.
When we analyze the functionality of a lymphatic vessel using lymphofluoroscopy, significant reflow is detected if pressure is not employed as far as the corresponding lymph nodes. This is mandatory for the lymph drainage technique to be effective. Thus, there is no doubt that the movements must be linear and the compression constant until reaching the corresponding lymph nodes.
The physiology of the microcirculation shows that lymph formation is stimulated when the pressure within the interstitial space is increased. Therefore, we can use this strategy to stimulate lymph formation artificially using manual compression.
It is important to remember that the most important part of lymph drainage is the formation of lymph and for this there are rules in which the pressure and the velocity of drainage must be considered. By using stimulation to form lymph and by performing drainage correctly, a satisfactory therapeutic result will be achieved.
The only way lymph can be formed is by the passage of macromolecules to the capillaries. It is impossible for the edema to move from one region to another region of the body except by following capillaries. This concept of Godoy & Godoy changes a series of ideas about some lymph drainage techniques.
Thus, the Godoy & Godoy technique uses linear manual compression movements with uniform displacement to the corresponding lymph nodes, respiratory movements to stimulate drainage of the deep lymphatic system of the chest, abdominal compression to drain the deep lymphatic system of the abdomen and muscle activity to drain the deep lymphatic system of the extremities. This technique can be used to treat all cases of primary lymphedema and for aesthetic rehabilitation.
When it comes to secondary lymphedemas, the technique may change completely with pathophysiological adaptations. In hypertensive-type lymphedemas, the Godoy Method of intermittent compression is associated with linear lymph drainage for uninjured vessels. This adaptation is essential as incorrect techniques can further worsen lesions of the lymphatics and thus, further aggravate the lymphedema. Therefore, it is preferable to do nothing rather than to use inappropriate techniques that cause more damage.
In this way, we can synthesize lymph drainage as a technique that aims to:
1) Stimulate the formation of lymph
2) Stimulate lymph drainage
To achieve these goals we use the hand to perform:
1) Manual compression (formation of lymph)
2) Manual sliding (lymph drainage)
What distinguishes the Godoy & Godoy's technique of manual lymph drainage (Manual Lymphatic Therapy) from the other two commonly used techniques of Vodder and Leduc is related to the movements and compression: