When you start feeling under the weather, you might reach to the sides of your neck (just like your parents used to) to see if you have inflamed lymph nodes. Even if you know nothing else about the lymphatic system, you may have this understanding that it’s associated with your health—when something’s “off,” your lymph nodes (and the lymphatic system) help tell the tale by getting bigger and maybe giving you some discomfort to help show something is wrong.
So, just as you work to maintain the health of your heart, lungs, muscles, and brain, it makes sense to do what you can to care for your lymphatic system. And just as exercise and heart health have a codependent relationship (exercise improves heart health, and heart health helps improve exercise performance), the relationship between exercise and the lymphatic system is similarly entwined.
Here’s what you need to know to maximize lymphatic system health while identifying how the lymphatic system can work to maximize exercise performance—and what lymphatic drainage has to do with both.
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What to know about the lymphatic system
When you think about your lymphatic system, it might be helpful to imagine your circulatory system—all the arteries and veins mapping and coursing throughout your body. This is because the lymphatic system is almost like a “shadow” of the circulatory system; its map is essentially the same.
“The lymphatic system is our second circulation. It’s a low-pressure system, with no central pump like the heart,” explains Kathryn H. Schmitz, Ph.D., M.P.H., a leading researcher in exercise oncology at the UPMC Hillman Cancer Center. “It acts to return a high proportion of the blood that is delivered to the periphery (fingers and toes) back toward the heart. It’s a second venous system. It also acts to return a high proportion of the large molecules like bacteria, fats, and cellular debris back toward the heart.”
If the primary venous system is doing its job, why would a secondary system be required? The answer is simple: The body, circulation, and waste production and removal are complicated. As the venous system delivers blood, fuel, and oxygen throughout the body, your cells uptake and metabolize what’s delivered, and the waste that’s produced has to be removed. The circulatory system plays a large role in this removal, but the lymphatic system does, too.
The lymphatic system’s role is necessary because there’s interstitial space that exists between cells and blood vessels. This space holds fluid that filters in from the circulatory system’s microvessels and provides structure. But the fluids that filter into this interstitial space generally can’t be reabsorbed by the circulatory system.
“The lymphatic system collects and transports fluid from the interstitial spaces back to the venous circulation. This is accomplished with a series of lymph vessels and lymph nodes,” says Karen Hock, M.S., P.T., a certified lymphatic therapist and physical therapist specializing in lymphedema management and oncology rehabilitation at The Ohio State University Comprehensive Cancer Center.
Without a secondary system to help collect and remove excess fluid from the interstitial space, you’d essentially be left with a major problem: the buildup of fluid in your extremities—like your body is a water balloon that’s getting filled up with no release. “We balance the fluids around the body largely because of the lymphatic system,” Schmitz confirms.
Unfortunately, when there are problems with the lymphatic system, fluid builds up and can lead to other major problems. A result is swelling or edema, which “is a natural consequence of trauma to and subsequent healing of soft tissues,” Hock says. “Lymphedema is an excessive and persistent accumulation of extravascular and extracellular fluid and proteins in tissue spaces. It occurs when lymph volume exceeds the capacity of the lymph transport system.”
While there are lots of causes of lymphedema, including genetic predispositions, cancer treatments, infections like cellulitis, inflammation from conditions like eczema, obesity, and even (though more rarely) injuries or trauma, exercise can actually help this buildup of fluid.
How exercise (including running) influences the lymphatic system
The thing to remember about the lymphatic system is that unlike the circulatory system, which has the heart to help keep the blood flowing, it’s a system without a pump. That means it requires pressure to move the fluid from the interstitial space into the lymphatic system, then away from the extremities and back into the venous system.
“The lymphatic system and lymphatic fluid are facilitated by pressure changes within the body with help from mechanics that help cause these pressure changes, including breathing, peristalsis [the involuntary contraction of the intestinal tract to help move contents through the intestines], and muscle contraction,” says Hock. “With exercise, there is an increase in blood flow and therefore an increase in lymphatic fluid. Muscle contraction assists the body to transport that fluid within the lymphatic structures. So, in essence, exercise helps with movement of fluid and therefore movement of waste products.”
While any form of exercise can be beneficial in increasing blood flow and muscular contraction, remember that the circulatory system and lymphatic system are closely linked and aligned. Just as cardiovascular exercise greatly increases blood volume and leads to an ongoing, steady increase in circulation and circulatory efficiency, this benefit can extend to the lymphatic system, as well. In other words, the health benefits you experience from improving cardiovascular health, through running or other cardio exercise, are likely “shadowed” in the lymphatic system.
“Regular exercise has a known, documented positive effect on the first circulation. It stands to reason that it has a similar benefit for the second circulation. The hypothesis is that [exercise] helps with waste management,” Schmitz says. Effective waste removal and management can help boost immune system effectiveness and efficiency, while reducing the likelihood of excessive fluid buildup.
The body of research regarding exercise and lymphatic health is still relatively small, and most studies on exercise and lymphedema have been done specifically in populations of women undergoing breast cancer treatment. These studies indicate that exercise is both safe and effective for individuals experiencing lymphedema caused by cancer-related treatments, and is unlikely to cause greater problems while generally improving overall health, wellness, and quality of life.
It appears that all forms of exercise can be beneficial (cardio or strength training), although strength training, specifically, may have a greater overall advantage in this population.
How your lymphatic system may influence your exercise performance
Of course, if your lymphatic system isn’t working properly, you’re going to feel the effects. And not just in day-to-day life, but your exercise performance could falter, too. “Problems with the lymphatic system cause abnormal accumulation of lymph fluid in the affected part of the body, interfering with movement, causing discomfort, and altering mobility.” Schmitz explains.
This can manifest as significant, painful swelling in some cases, but it can also lead to less drastic effects. If you’ve ever felt your fingers, toes, or ankles swell slightly on a hot summer day when you’ve been indulging in salty snacks and haven’t consumed much water, you’re likely familiar with the experience. Even small changes in fluid balance to your extremities can leave you feeling less mobile and uncomfortable. “The accumulation of fluid in the tissues can cause joint immobility [less flexibility] and cause the limbs to feel heavy. It can also cause a feeling of achiness in the affected area that could impact performance,” Hock says.
While fluid balance and lymphatic drainage may be impacted by many factors (including hydration status, illnesses, injuries, and exercise), if you notice your extremities and joints feeling tight or heavy, or if you feel swelling and you can’t pinpoint a reason, it might be worth consulting a doctor to help identify possible reasons. They may also refer you for manual lymphatic drainage (MLD), which can help relieve and reduce the buildup of lymphatic fluids.
When lymphatic drainage is necessary
Lymphatic drainage—sometimes (inaccurately) referred to as lymphatic massage due to its manual application—is a known therapy for those experiencing lymphedema. “Manual lymphatic drainage is an established medical approach to moving lymphatic fluid. It is not a form of massage. It is an expert stretching of the skin,” explains Schmitz.
Both experts emphasize that manual lymphatic drainage (or MLD) should only be performed by a therapist certified and trained in this intervention. “MLD utilizes the change in pressure within the body—from breathing and joint movement—along with rhythmic tissue mobilization,” Hock explains. “The purpose is to decongest tissue, improve tissue immunity, and if the lymphatic system is compromised, facilitate the movement of fluid to a body area that can accommodate extra fluid drainage work.”
Manual lymphatic drainage specialists have a wide range of backgrounds and experience, but all have undergone intensive training approved by the Lymphatic Association of North America (LANA). You can find certified lymphatic therapists (CLTs) with this level of training (LANA-CLT) at the following websites:
MLD is often used in patients undergoing cancer treatments, as lymphedema is a common side effect, but its benefits extend to anyone experiencing lymph-associated swelling. For example, those experiencing pregnancy-related swelling, or individuals recovering from a surgery or medical procedure.
Likewise, tough workouts can sometimes lead to temporary swelling in the muscles and joints. While MLD may not be thought of as a “common” form of postexercise recovery, it certainly can help. Schmitz puts it simply: “All people could benefit from MLD, including athletes.”
If you happen to have an injury that seems to be especially slow to heal, it might be time to locate an MLD-certified practitioner near you. “Injuries that are slow to heal likely have a lymphatic component. Seeking the help of a certified lymphatic therapist would be my first stop for a slow-healing injury,” confirms Hock.
While there are limited studies on the benefits of manual lymphatic drainage after sports injuries or orthopedic surgeries, the information that is available is promising. In a 2020 review published in the Journal of Bodywork and Movement Therapies, lymphatic treatments and compression bandaging (both were looked at for the context of the study) appeared to be beneficial to the healing process. After orthopedic surgeries, the study indicated that lymphatic treatments should be considered if “significant edema persists beyond recovery time.” And with more acute injuries, like an ankle fracture, lymphatic treatments and compression should be considered as part of the treatment protocol.
In either case, it’s best to have a conversation with your doctor about options, benefits, and the best time to try the treatment protocol.
Given that the science is still new in the context of lymphatic drainage for individuals recovering from injuries, significant illnesses, or managing chronic conditions, it’s hard to say with certainty whether the benefits could also extend to general preventative care. It does appear to help prevent the development of lymphedema in women undergoing breast cancer treatment, but for the average individual seeking to boost their immune system function or recover faster for their next run? It’s too early for science to say for sure.
If you’re looking for options and you’d like to add manual lymphatic drainage to your routine, it’s certainly unlikely to hurt your performance and might carry positive benefits. Just know that if you do start to feel healthier with manual lymphatic drainage, your experience should be considered anecdotal, rather than evidential. Without more time and well-designed study, it would be hard to know if benefits are due to the MLD, a placebo effect, some other change in your life, or a combination thereof.
Recognize you have control over your lymphatic system
Compared to the primary circulatory system, the lymphatic system is certainly more “passive,” in that it doesn’t have its own pump to keep things moving. But that doesn’t mean you don’t have a measure of control in how it functions.
“Understanding that we can affect lymphatic function with muscle contraction and deep abdominal breathing can be impactful. Optimizing lymphatic function in this way, or with manual lymphatic drainage, could provide a ‘boost.’ If an athlete experiences a sprain, strain, or trauma, utilizing some of these techniques can be beneficial,” Hock emphasizes. Likewise, being aware that the lymphatic system functions through fluid balance, staying hydrated, eating a healthy, well-balanced diet, and staying active throughout the day can all help give this system an “assist.”
Sometimes, simply knowing there are tools and resources at-hand to help optimize health and performance can play a role in long-term results. This is especially true when it comes recovery after exercise and after an injury—feeling a sense of control over outcomes can provide a positive mental boost that can help you feel better, faster.
Laura Williams, M.S., ACSM EP-C holds a master's degree in exercise and sport science and is a certified exercise physiologist through the American College of Sports Medicine. She also holds sports nutritionist, youth fitness, sports conditioning, and behavioral change specialist certifications through the American Council on Exercise. She has been writing on health, fitness, and wellness for 12 years, with bylines appearing online and in print for Men's Health, Healthline, Verywell Fit, The Healthy, Giddy, Thrillist, Men's Journal, Reader's Digest, and Runner's World. After losing her first husband to cancer in 2018, she moved to Costa Rica to use surfing, beach running, and horseback riding as part of her healing process. There, she met her current husband, had her son, and now splits time between Texas and Costa Rica.
