MANUAL LYMPHATIC DRAINAGE & ONCOLOGY MASSAGE
Manual Lymphatic Drainage (MLD), also known as lymphatic drainage massage, is a specialized, gentle form of massage designed to reduce swelling in the arms and legs caused by lymphedema. Lymphedema commonly occurs in individuals recovering from breast cancer surgery. By employing specific techniques, MLD helps move lymph fluid from your tissues to your lymph nodes, reducing painful swelling and promoting fluid circulation in the body.
Developed by Dr. Emil Vodder and his wife Estrid in 1936, MLD is a key component of Complete Decongestive Therapy (CDT). MLD uses four main techniques: stationary circles, scoop, pump, and rotary strokes. While effective on its own, MLD is often part of a comprehensive treatment plan for managing lymphedema.
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There are several approaches to MLD, including:​
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Vodder Method: Uses different hand movements, such as pump, scoop, rotary, and thumb circles, depending on the area treated. It also includes specialized movements for fibrotic areas.
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Földi Method: Based on Vodder’s technique but emphasizes thrust and relaxation phases, along with encircling strokes to stimulate lymphatic flow.
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Casley-Smith Method: This approach involves gentle and slow effleurage movements with the side of the hand, focusing on the lymphotomies, these are the areas in between the lymphatic nodes.
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Leduc Method: This technique focuses on "call up" and "reabsorption" movements to encourage the natural process of lymph absorption, first into the initial lymphatics and then into larger lymph vessels.
Oncology massage is another specialized form of massage therapy designed for individuals undergoing cancer treatment. It is tailored to the unique needs and sensitivities of cancer patients, considering factors such as treatment side effects, the presence of tumours, surgeries, biopsies, scarring, medications, chemotherapy, radiotherapy and overall patient comfort. Oncology massage aims to improve quality of life by alleviating pain, reducing stress, fatigue, anxiety and enhancing overall well-being, all while ensuring safety and comfort throughout the treatment.
Both MLD and oncology massage are valuable therapies for managing non-cancer symptoms, supporting health recovery, and improving quality of life for individuals with lymphedema, cancer and those affected by poor lymphatic circulation.
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How Does Manual Lymphatic Drainage (MLD) Work? Manual Lymphatic Drainage (MLD) is a specialized therapeutic technique designed to address lymphedema, a condition where fluid, or lymph, accumulates in tissues due to disruption in the lymphatic system. Lymphedema often occurs when the body’s natural process of draining lymph is impaired, leading to swelling, typically in the arms or legs. This technique helps restore lymphatic flow, supporting the body's ability to manage fluid balance. The lymphatic system plays a crucial role in fluid regulation, immune defence, and waste removal. Normally, blood from the cardiovascular system delivers essential nutrients to tissues and organs, with the lymphatic system collecting the residual fluid—called lymph—and returning it to the heart through a network of lymph vessels and nodes. When this process is disrupted by surgery, illness, or injury, the lymph pools in tissues, leading to swelling. MLD helps alleviate this condition through a two-step process: 1.Clearing: This stage initiates lymphatic drainage by releasing lymphatic fluid trapped in tissues. 2.Reabsorption: The fluid is guided toward functional lymph nodes to be reabsorbed and reintegrated into the body’s circulatory system. MLD Techniques and Mechanisms: MLD is performed through gentle, skin-stretching movements without the use of oils. The stretching is carefully directed to create variations in interstitial pressure, stimulating lymphatic flow. Slow, repetitive hand movements incorporating a resting phase allow the skin to return to its natural position, enhancing lymphatic drainage. The process typically starts centrally, around the neck and chest, and progresses outward. These movements encourage the rhythmic contractions of lymphatic vessels, which naturally help move lymph fluid through the body. By enhancing these contractions, MLD improves lymph node activity, allowing stagnant lymph to be rerouted through functional lymph pathways. It also boosts blood flow in both deep and superficial veins, contributing to improved circulation and reduced swelling. MLD often includes limb mobilization and relaxation techniques to improve overall lymphatic and circulatory function. Deep breathing techniques are often incorporated into MLD sessions to activate deeper lymphatic pathways and support relaxation. These breathing exercises also encourage lymph movement toward the heart, facilitating overall lymphatic circulation. The combination of manual pressure and deep breathing techniques, such as diaphragmatic breathing, helps stimulate the deep abdominal lymph nodes and vessels, further promoting fluid movement. In some cases, mechanical lymphatic drainage can be used alongside manual techniques. This involves using a pneumatic sleeve attached to a pump, which applies rhythmic pressure to the affected limb, assisting in the movement of lymph fluid.
What Can Manual Lymphatic Drainage (MLD) Treat?
Manual Lymphatic Drainage (MLD) is widely used for managing various medical and postoperative conditions by promoting lymphatic fluid movement and reducing swelling. It is particularly beneficial for patients recovering from surgeries or dealing with chronic conditions that impair lymphatic flow.
MLD is commonly recommended for:
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Post-Surgery Recovery: MLD is particularly beneficial after surgeries involving lymph nodes, such as breast cancer surgery, by reducing swelling (lymphedema) and improving fluid circulation in affected areas. It is used both pre- and post-surgery to decrease tissue congestion, enhance lymphatic drainage, and minimize scar formation. This is especially helpful in post-mastectomy recovery and after weight-related surgeries. MLD also helps reduce immediate oedema and fibrosis following surgery and serves as a preventative and supportive therapy in postoperative rehabilitation, including post-traumatic and post-surgical oedema.
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Lymphedema: MLD effectively reduces swelling in patients with both primary and secondary lymphedema by promoting lymphatic drainage and redirecting fluid through functional pathways.
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Lipoedema: Assists in managing swelling in the lower body caused by excess fat buildup, which can block normal lymphatic flow.
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Limb Root Swelling: Targets and alleviates swelling at the base of a limb, improving fluid circulation.
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Trunk and Midline Oedema: Addresses swelling in the torso and central body, helping to restore normal fluid balance.
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Rheumatoid Arthritis: Alleviates joint pain, swelling, and stiffness in chronic arthritis.
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Fibromyalgia: Provides relief from chronic muscle and joint pain.
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Chronic Venous Insufficiency: Assists in returning blood to the heart from the legs when veins struggle to function properly.
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Effective for: managing oedema, skin disorders, headaches, sinus congestion, sprains, aches, stress, and digestive issues.
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Can be an adjunct therapy in palliative care for comfort and pain relief when other treatments are no longer appropriate.
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Pain Management: Supports pain relief as part of a comprehensive treatment plan.
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Psychological Stress: May complement treatment for patients dealing with significant psychological stress.
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Intracranial Pressure Reduction: Cranio-cervical MLD can help reduce intracranial pressure in individuals with severe cerebral conditions.
MLD is a versatile therapy that can provide relief from a wide range of conditions, particularly those involving fluid retention, swelling, and post-surgical recovery.
How Effective is Manual Lymphatic Drainage (MLD)? MLD has shown effectiveness in reducing oedema and improving musculoskeletal injuries, either on its own or alongside other treatments. Scientific research on MLD highlights its potential benefits, though some studies present mixed results. Key findings from research on MLD include: Intensive MLD treatment over a three-week period has been shown to be highly effective in reducing lymphatic congestion, particularly in patients under 60. While MLD applied for more than 20 sessions or two weeks significantly reduced upper extremity swelling. In patients under 60, MLD significantly reduced lymphedema within a month of treatment. Other studies have also noted improvements in sleep, breathlessness, and secretion of key hormones like serotonin and histamine. While animal studies suggest MLD can enhance blood flow, potentially improving systemic venous return which may help with pain and discomfort. However, conflicting research does exist. For example, some studies found that MLD did not provide additional benefits for moderate to severe lymphedema when combined with complex decongestive therapy (CDT), nor did it significantly prevent lymphedema after breast cancer surgery in some patients. While MLD, developed by Vodder, remains one of the few effective methods for facilitating lymphatic drainage and reducing lymphoedema-related swelling, more high-quality research is needed to fully validate its widespread use in clinical practice.
How Long Do the Effects Last? The duration of relief from MLD varies based on individual health conditions. While some people may experience immediate improvements after a single session, others may require multiple treatments to achieve optimal results. For some, the effects may not be noticeable right away. If multiple sessions yield no results, it's important to consult your healthcare provider to explore alternative treatment options. Factors influencing the longevity of MLD benefits include the individual Body’s Response, returning too soon to daily stressors and poor lifestyle choices. For long-term benefits, regular MLD sessions is often recommended, maintenance sessions every 2-4 weeks can help prevent symptoms from returning. For chronic and severe conditions this may need to be repeated daily initially reducing to 2-3 times per week as symptoms improve followed by fortnightly working through to monthly for a period of 3-6 months to manage the condition. In the event more rigorous treatment may be required MLD professionals may teach self-massage techniques to help maintain the effects between professional treatments. They can also combine MLD with self-care, such as compression bandages and prescribed exercises, to further support long-term results.
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Does MLD Hurt? MLD is generally a very relaxing treatment, with many individuals falling asleep or entering a deeply relaxed state due to its slow, gentle, and rhythmic motions. Because of this calming effect, patients may feel too relaxed to drive themselves home after their first session. The massage uses gentle pressure, which is essential to promote effective lymphatic drainage. The pressure applied is much softer than in traditional massage but may be adjusted based on the condition of the underlying tissue. In areas with fibrosclerosis (hardened tissue), deeper and firmer movements may be used, often in combination with compression therapy, to improve drainage.
Is it Safe? Yes, generally considered safe when performed by a trained and qualified practitioner. MLD is in an industry that is unregulated, and the level of training among practitioners can vary significantly. Unfortunately, some individuals are not even certified but offer the massage to the general public anyway. Additionally, some complete online courses with minimal practical training. These courses often provide only a superficial understanding of the treatment, human anatomy and physiology and the precautions necessary for safe practice. Given the nature of the therapy, training should always be done in-person to be able to assess what the practitioner is feeling, as well as assess the levels of force the practitioner is using. When choosing a professional, it's important to ask about their qualifications. Inquire about where they trained, the level of their certification, the provider of their training, and the duration of their education. Ideally any MLD or Oncology Massage course should be a minimum of a diploma level 3 with a minimum of 8 case studies ranging from singular treatments to a block of 4 treatments with the practitioner being certified upon successful completion of all the case studies and classes. The course must include anatomy of the lymphatic system as well as clinical skills and an examination. This cannot purely be taught online for a fully qualified therapist and cannot be achieved over the space of a one day or weekend course, realistically it takes many hours of training in MLD, combined with years of hands-on experience, to become truly skilled lymphedema therapist. Keep in mind that the quality of practitioners varies. Not every practitioner with minimal training is unsafe, just as not every highly qualified practitioner is effective. The experience and skills of therapists can differ greatly based on their education and who trained them. In the UK, complementary, and holistic industries remain unregulated. This lack of regulation extends to the insurance companies that cover these practices, which can make treatments risky in some cases even though the practitioner is certified and insured. The risk of serious side effects is minimal, generally deemed safe and well-tolerated, with minor side effects that are usually temporary. Ensuring that the treatments are performed by trained professionals. The most common side effects include mild discomfort at the treatment site. These effects are generally short-lived and resolve within a few days.
What are the contraindications. reasons I can’t have treatment?
MLD is generally safe when performed by trained professionals. However, there are conditions that may not be suitable or need adaptions such as:
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Active cancer, Metastases or undergoing oncology treatments. .
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Unstable hypertension
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Untreated thyroid dysfunction
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Acute cellulitis/erysipelas
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Severe cardiac insufficiency
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Superior vena cava obstruction
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Hepatic cirrhosis with abdominal fluid (ascites)
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Renal failure
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Untreated tuberculosis or malaria
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Recent DVT, Embolism or thrombosis still requiring medication.
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taking blood thinning, anticoagulant or clotting medication.
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Active severe bruising, cuts or abrasions
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Recent surgeries, procedures, injections, fractures or sprains.
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Uncontrolled or undiagnosed Skin Disorders such as: Psoriasis, Eczema, Dermatitis, Acne Vulgaris, Vitiligo, Rosacea, Chloasma.
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Infectious skin diseases, such as: impetigo, shingles, Herpes Simplex, Ringworm, Scabies, Conjunctivitis, MRSA, Warts, Verrucae’s.
It is always important to consult with a qualified practitioner to determine if MLD is appropriate for your specific needs.
How to Prepare for your Appointment. Preparing for an appointment involves a few simple steps to ensure you get the most out of the treatment: Skin Care:- Try to Avoid using any Retinol, exfoliants, AHA acids, BHA acids, Vitamin C, or Vitamin A products on the treatment area for several days prior to the appointment. Fluids:- Drink plenty of water and try to stay hydrated, before your appointment. Being well-hydrated can help your body respond better to the treatment. Diet:- have a small, balanced light meal or snack about 1-2 hours before your appointment. This helps maintain your energy levels during the session. Avoid arriving with an empty stomach, as this can lead to dizziness or light-headedness. Attire:- Wear loose, comfortable clothing as the treatment is performed over clothing on the arms, legs, and abdomen. Try not to wear stiff or heavy fabrics that restrict sensation or movements such as denims and wool. Leggings, joggers’, skirts or shorts are advised. Please tie up long hair or bring along a hairband to do so for access to the head, ear and neck vicinity. Punctuality:- please arrive on time, giving yourself enough time to arrive at your appointment without rushing will help you to reax. Please try not too early though as the clinic does NOT have any waiting area and space in the car park is limited. Consultation:- be prepared to discuss your health history, current symptoms, medications, and any concerns you have with your practitioner. This information helps tailor the treatment to your specific needs. Please don’t forget to bring with you a full list of medications, medical conditions, and any reading glasses required. Mindset:- Approach the session with an open mind and a calm attitude. Treatments works best when you're relaxed, so try to clear your mind and focus on your breathing during the treatment. Following these tips can help you be more prepared for your appointment aiding you to have a more positive, effective and relaxing treatment.
What to Expect During Your Treatment Before starting your treatment, you'll need to sign a consent form, acknowledging that you understand the procedure and its potential outcomes. It also clarifies that while the treatment aims for improvement, individual results may vary, and some concerns may not be fully resolved. Your treatment will begin with a brief consultation lasting 10-20 minutes., including a medical history review and lifestyle assessment. This may include an examination of body areas, of a review of your body movements to help select the appropriate treatment plan. You will have the opportunity to ask questions and discuss your concerns. It is important to understand that while the treatment aims to improve, no guarantees are made regarding the outcome. The Treatment Process: at the start of the treatment, you will lie down in a relaxed position, every effort will be made to make you comfortable, and any necessary clothing removal will be minimal and respectful. This massage is performed over the clothing without the use of any oils. The practitioner will begin with establishing your breathing pattern, followed by very gentle flowing rhythmic movements at strategic areas of your body including movements of the body. As the treatment progresses, you may feel differing sensations such as: warmth, heat, coldness, sleepiness, heaviness, tingling, or a sense of movement, these should not be painful but may be uncomfortable. The treatment itself is performed in 2 cycles with a short pause for the toilet in between, typically the treatment lasts between 40 to 60 minutes During this time, you are welcome to either rest quietly and have a quick nap or engage in conversation with the practitioner it is our policy the patient does whatever helps them feel most at ease. After the session, take your time getting up, as you may feel lightheaded or dizzy. It’s important to reorient yourself gradually before stepping off the treatment couch. You may also find yourself very thirsty or have a dry mouth following treatment, you will be offered some water, it is recommended to drink this. At the end of the appointment the practitioner may offer aftercare advice, before taking payment and arranging any further appointments.
What are the after-effects of Treatment? While generally a safe treatment for all age groups and the majority of people when administered by a qualified, insured, registered and experienced practitioner, treatments can still have after-effects. These effects are typically mild and temporary, but it's important to be aware of them. Common After-effects - Relaxation:- Many people feel deeply relaxed, or even slightly drowsy after the treatment. This sense of calm can last for several hours. Skin reactions:- there may be possible skin reddening, rashes, darker patches, altered skin pigmentation, Lymphatic leakage, skin sensitivity, tightness, itching or altered skin sensation from the local vicinity of the treatment site that may persist for up to 14 days post treatment, taking up to 21 days to fully subside or disappear. During this time the skin may also be tender or sore and can have an elevated risk of infection. Bruising:- where possible treatment is designed to minimize bruising but these can still occur. Occasionally, bleeding, swelling, bumps, inflammation or small bruises can appear at the treatment site. These are usually harmless and will fade within a few days but can sometimes be more severe in some people especially with anticoagulant usage or disposition to bleeding. In this event any of these occurring the use of a topical arnica lotion will help. Muscular Discomfort:- for some, it is very common to experience mild soreness, aching, tenderness or localized pain at the treatment site or in the body following a treatment. This may be similar to how a person feels after a hard day’s work or workout at a gym but can be more extreme as the body is trying to regulate following the treatment. This usually resolves within the 24-48 hours but may persist for 7-10 days. BP & Blood Glucose fluctuations:- patients often experience a lowering of their Blood Pressure, Heart rates and Blood Glucose levels following treatments – this can leave people feeling slightly woozy, nauseous, light-headedness, or dizzy and may persist for a few hours following treatment, plenty of clear fluids and a light sugary snack will help with this. Energy & Fatigue:- It's not uncommon to feel tired or fatigued following a session. This is typically a sign that your body is responding to the treatment and beginning the Homeostasis process. Conversely, some people may feel a surge of energy following their session, which can last for several hours or even days. Short flu-like symptoms:- as the body rebalances itself it enters a detoxification period which can leave people experiencing 24-48 hours of flu-like symptoms – enlarged tender glands, achy bodies, Headaches, Sinus congestion, energy and temperature fluctuations, these are a good sign of your body responding to treatment. Its best to allow your body to rest during this timeframe and keep hydrated. Temporary Symptom Exacerbation:- In some cases, a person’s pre-existing medical conditions or symptoms may briefly worsen or flare before they improve. This is often seen as a sign that the treatment is taking effect and may require further treatment or adjusts to treatment to resolve. Body Temperature fluctuations:- patients often experience strong alterations in their body temperature feeling either warmer or colder following treatments, which may persist for a few hours to a couple of days following treatment. If you are struggling to regulate your temperature following the session, please speak to the practitioner. Digestion:- many do find treatment aids in their digestive systems, reducing bloating and aiding with appetite but can report issues with Nausea, Heartburn, passing wind more or changes in their usual toilet habits finding the consistency and frequency are often improved or altered, this can include having looser more often bowel movements and seriously increased urine frequency and output that should subside within 48 hours. Sleep:- Many individuals find that their sleep improves after treatment, either by falling asleep more easily or experiencing deeper, more restful sleep. Equally, some people find following treatment their sleep is altered and more difficult, they often report changes in their dream patterns which can be more vivid and negative. Emotional Release:- Some people report an emotional release during or after treatment, which can manifest as unexpected feelings of sadness, tearfulness, despair, grief, anger, frustration, irritability, happiness, joy, mania, boredom or relief. This is a normal response to the body's energy balancing and the therapeutic aspects of touch especially where repressed emotions have been the source of disharmony in a person’s health. Most aftereffects of treatment are mild and resolve within a few days to weeks especially when following the aftercare. Although safe, sometimes more serious complications or after-effects can occur with this treatment. Rare But Serious Side-Effects - Severe Skin Reactions:- Persistent discoloration or altered pigmentation. Infections such as Sepsis and Cellulitis can occur. Internal Complications:- Risks of serious complications such as: Movement of Blood Clots. Thrombosis. Embolism. Strokes. Haemorrhage. Respiratory distress. Asthma attacks. Breathing difficulties. Kidney damage. Liver damage. Movement of Bladder, Kidney or Gallbladder stones. Muscle, Nerve, or Tendon damage. Significant Allergic reaction such as Anaphylaxis. Neuro-physical reaction:- Fainting, Dizziness, Syncope, Shock, Hypoglycaemia, Severe Hypotensive Crisis, Tachycardia or alteration in body temperature. Please contact your practitioner or Healthcare provider as soon as possible if you experience any unusual or severe reactions especially within 12 hours post treatment or your symptoms are not showing signs of improvement 48 hours after the treatment.
Aftercare and Recovery
To support your recovery and optimize the results of your treatment, please adhere to the following guidelines:
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Clothing: Loosen any tight clothing to encourage lymph flow for 12 - 24 hours after treatment.
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Additional Treatments: Refrain from undergoing any other treatments for 48 hours to prevent potential interactions.
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Hydration: Increase your water intake over the next 7 days to support detoxification. Herbal teas and fruit juices are also beneficial.
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Diet: Consume light, healthy meals and avoid heavy, greasy, fatty, or spicy foods for at least 24 hours to prevent digestive strain.
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Caffeine and Alcohol: Reduce caffeine intake and avoid alcohol, energy drinks, and recreational drugs for 24 hours post-treatment and 12 hours prior.
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Smoking and Vaping: Minimize or avoid smoking, vaping, and all nicotine products for 48 hours.
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Activity Level: Avoid strenuous activities, heavy exercise, or long drives for 24 hours to allow your body to rest and recuperate.
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Products: Where oils have been applied, leave them on the skin as long as possible.
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Wellness: Try to reduce stress, maybe try light exercise, going for a walk, breathing or mediation to help.
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Follow-Up Care: Adhere to any specific aftercare instructions provided by your practitioner.
By following these guidelines, you can help ensure a smooth recovery and achieve the best possible results from your treatment.
For pricing and to book your session, please CLICK HERE.