How do Lymphedema and deep breathing work together?

Breathing, our own internal tide, is as automatic as waves rolling into shore, and as central to human existence as our heartbeat. It is the first important proof of life, the initial inhalation that precedes the newborn’s cry. We don’t need to learn how to breathe, it just happens, but we can learn how to use the breath consciously for specific outcomes.

It is the automatic actions of the nervous system that allow breathing to occur, by causing the diaphragm muscle to contract, drop downward and expand the lungs and ribs, thus creating a vacuum action leading to inhalation.  The diaphragm then relaxes and moves upward, thereby reversing the process on the lungs and ribs, allowing exhalation.

Although the breath requires no attention to initiate, we still have the capacity to use intention to control and direct it. In particular, we can affect and benefit our lymphatic function with focused deep breathing. How wonderful to know that we can improve our wellness with an intrinsic tool that is always with us!



As just mentioned, one of the powers of the breath is in supporting lymphatic motility, or fluid flow. As we consider that the main lymphatic highway back to the blood system, the thoracic duct, runs directly through the diaphragm muscle, then it makes sense that the internal massaging of the duct by the diaphragm would enhance the drainage of this largest lymphatic vessel. This leads to a syphoning action on the rest of the system.

Another anatomical consideration is the large collection of lymph nodes around our internal abdominal organs. When we breathe diaphragmatically, engaging the belly and intentionally aiming our breath slowly and deeply to this area of our body, we increase then relax intra-abdominal pressure, squeezing on the nodes that assist with the function of our digestion and have a role in moving fluids back toward the base of the thoracic duct, where the motion of the diaphragm will then propel the contents of the thoracic duct back toward the venous system.

I often describe this as the same kind of action we might notice with a vacuum cleaner. When the bag or canister of a vacuum cleaner is full, the amount of suction generated is reduced, and the vacuum is not efficient. In this same way, when the lymphatic fluid filing our system is mobilized and returned back to the blood stream, the lymph system has increased ability to pull more fluid from the tissues of the limbs, head, and gut, areas that may be feeling or looking bloated. This can be especially important to those with Lymphedema, as every opportunity to support decongestion is so vital to reducing progression of this condition and avoiding the consequences of skin breakdown or infection to which those of us with Lymphedema are prone.



As I’ve pointed out, among the properties often attributed to focused and deep breathing are that it can:

  • Increase movement of lymph through the thoracic duct which
  • Increases the syphoning effect on the lymphatic system which in turn
  • Increases uptake of interstitial fluid which should
  • Help to reduce edema (bloating/puffiness)

Additionally, deep breathing is noted to have benefits to general health, in the it may:

  • Calm the nervous system
  • Clear out the base of the lungs
  • Reduce heart rate
  • Increase blood oxygenation
  • Improve gas exchange at the cellular level
  • Boost mood and energy
  • Improve digestion
  • Increase mind/body awareness
  • Potentially reduce headache or other pain
  • Potentially help improve sleep


To get a sense of the potential to use the breath to increase lymphatic action, I invite you to engage in a couple of brief breathing exercises.

First, find a comfortable position preferably lying down although sitting will also work (standing could lead to a fall if becoming very relaxed), then place one hand on your chest and the other on your abdomen. Don’t worry if the hand placement is not comfortable or possible for you, just do whatever works in your own situation. As you pay attention to the breath entering and leaving your body without trying to change it in any way, what do you notice? Do you feel your abdomen rise? Are your ribs expanding? How about your shoulders? Do they lift or stay stationary? And now tuning in to your sense of wellbeing, do you find that focusing on the breath in this very gentle way is calming, soothing? Or does it start to make you feel tense or anxious? If you are new to focusing on your breath, that anxious feeling can occur, but in general, most tend to report that a mindful practice of focused breathing is calming.

The results of this activity on our lymphatic system can be subtle but if we engage in focused deep breathing, perhaps adding some resistance with over pressure from our hands, we may experience more potent effects.

To give this a try, let’s engage in some diaphragmatic or belly breathing. This is done by slowly and intentionally filling your abdomen with air and then exhaling all the way, engaging your abdominal muscles to both fill and empty your breath. As this area engages, we experience that massaging action to the thoracic duct, propelling the lymph back toward the blood system and increasing the uptake of the fluid that is left out in the tissues. To enhance the impact of this diaphragmatic breathing on affecting the lymphatic system, place your hands on your abdomen below the ribcage, following your exhale inward with some gentle pressure, then holding this increased resistance as you inhale again. The process recurs with each breath cycle. Do not hyperventilate here, just a few breaths to experience this practice.

There is no right or wrong response to the above exercises! We are in exploration mode, noticing that the breath can cause a variety of responses affecting not only our lymphatic function, but also our mood, stress level, sense of wellbeing or lack thereof. The breath is powerful.



So how can we enhance our breathing? As mentioned above, specific practices and/or exercise will generally lead us to deeper breathing, but without awareness and intention, we may actually hold our breath as we exert effort, depriving our muscles of the fresh oxygen required to burn fuel and create energy. In weightlifting, we are taught to exhale on the contraction of the muscle or concentric phase, the work phase, and to inhale slowly during the controlled relaxation or the eccentric phase of the exercise. And in activities such as Pilates, Yoga, Qi Gong, Tai Chi and other movement arts, there are very specific use-of-breath recommendations for best outcomes.

Counted breathing, known to have energizing and calming effects, is a method of engaging the breath and learning to control it. I’ve used a counting practice called Box Breathing, also known as 4 Square Breathing, during which we inhale through the nose to a slow count of 4, hold another slow count of 4, then exhale through the nose or pursed lips to a slow count of 4, and hold again for a slow count of 4 before beginning over.

There are other things you can do aside from intentional breath practices or exercising that will can engage appropriate deep breathing and encourage lymphatic flow, including humming, singing, chanting and laughing! Yes, laughter engages the diaphragm and can deepen the inhalation and massage the thoracic duct, helping to propel the lymph fluid up the center of our body and, as mentioned before, back to the blood system.

Enhancing our lymphatic circulation can improve immune function and may make us feel better in general. Whether in good health or in cases of lymphedema, lipedema and chronic venous insufficiency, we are well advised to do everything within our power to keep that fluid flowing optimally along the proper pathways.

The breath is a powerful and ever-available tool to use as we pursue this goal.

References and resources:

Breath: The New Science of a Lost Art by James Nestor, Riverhead/Penguin Random House 2020

The Lymphatic Code by Leslyn Keith, Gutsy Badger Books, 2021

Douglass J, et al. An Enhanced Self-Care Protocol for People Affected by Moderate to Severe Lymphedema. Methods Protoc. 2019 Sep 4;2(3):77. doi: 10.3390/mps2030077. PMID: 31487887; PMCID: PMC6789820.


Adie Mackenzie
Adie Mackenzie

Adie MacKenzie is a national board-certified health and wellness coach and a Certified Lymphedema Therapist. She has over 40 years of experience in manual therapy, including medical massage and physical therapy. She currently treats lymphedema patients and people with chronic pain and chronic illnesses as part of her private practice and during clinical hours at an integrative health facility in Nashville, Tennessee.