I’ve started offering a new type of bodywork this past fall that I’m calling neuro-lymphatic drainage. I’m incredibly excited about it, and think it’s going to be transformative for a lot of people. I also want to be clear about why I’m excited - there’s a lot of nonsense out there in the wellness world, and it can be hard to tell what’s for real.

When it comes to any kind of healing approach, I like to understand why it works. I want to know the anatomy being worked with, how it interacts with the rest of the body, and how the intervention works to create change. I acknowledge that very real results can come from interventions we don’t understand in this way, but I prefer to train in methods that I can explain scientifically.

So of course, when I first started learning about neuro-lymphatics, I was suspicious. Could it really be as powerful as it seems? How? Why?

Being the nerd that I am, I hit google scholar. Turns out, there’s lots of research backing it up. I just hadn’t heard about it before because it’s incredibly new stuff! In this blog post I want to share some of the key bits of research, and how I apply them to my practice.

Let’s start with the anatomy, since that’s what helps the rest of it make sense. I’ll try to keep the explanation in English instead of Medical, so I’ll stick to the parts that are relevant to what we’re talking about and simplify a lot of the technical terminology. Links to some of the articles I relied on writing this post are at the end if you want a deep dive.

model of a brain — Brain waste, toxins, and inflammation

Living tissue generates waste just by going about its business and doing its thing. The brain is particularly active (insert joke here), so it generates a lot of toxins or waste - carbon dioxide, lactate, various proteins, and so on. That waste hangs out in the cerebrospinal fluid around the brain and interstitial fluid between the cells of the brain.
In order for the brain to function properly, these natural toxins and excess fluid need to be regularly cleared back out again. Without waste getting cleared out, the brain doesn’t work as well. We’ll get into that more in another post.

How the body clears waste

In the rest of the body, the waste products created by cells living their lives is cleared out by the lymphatic system - a one-way transportation system that moves excess fluid and anything collecting in it back towards the heart so it can drain into the bloodstream, get filtered by the liver and kidneys, and eventually get urinated out. The usual components of the lymphatic system aren’t found in the brain.

We didn’t know how the brain cleared its waste until new imaging techniques were developed and the “glymphatic system” was discovered in rodents in 2012. It’s called the glymphatic system because it works very similarly to how the lymphatic system works, and because the glial cells in the brain are part of the process. Even more recently in 2015, the meningeal lymphatics were identified as another part of the waste disposal route. More of these connections and pathways are being identified all the time, so I may need to come back and edit this post in future years! (last updated 5/10/25)

Anatomy

Brain and spinal cord make up the central nervous system
- Neurons are the cells that do the actual electrical activity and processing in the central nervous system
- Glial cells support and protect the neurons
Meninges are the layers of protection between the brain and skull, and between the spinal cord and spine.
- Between the second and third layers is the subarachnoid space
Cerebrospinal fluid (CSF) creates a bubble around the brain in the subarachnoid space
- CSF is made in the ventricles, bubbles of fluid inside the brain
Interstitial fluid (ISF) is the fluid between cells and tissues throughout the body
- ISF is also the fluid between neurons and glial cells in the central nervous system
Blood vessels bring blood to the brain and away again, feeding it
- Larger blood vessels are in the meninges, surrounding the brain
- Small blood vessels and capillaries dive down into the brain tissue
Perivascular space is an important pathway for transporting fluids in the brain
- There’s a layer of glial cells surrounding the blood vessels in the brain tissue, creating a double layer of walls around the blood.
- The space between the two layers is called the perivascular space
Meningeal lymphatics resemble the lymphatic vessels in the rest of the body
- They exist in the meninges around the central nervous system

Glymphatics and Meningeal Lymphatics

As we understand it now, the general pathway of the brain’s metabolic waste and excess fluid is from the glymphatic system to the meningeal lymphatics and out of the skull.

The Glymphatic System

Cerebrospinal fluid (CSF) travels from the subarachnoid space into the brain via the perivascular space, carrying nutrients
CSF and ISF exchange in the capillary beds
- In that exchange, nutrients and waste products are also exchanged
The fluid that’s now a mixture of CSF and ISF exits the brain tissue in the perivascular space

Meningeal Lymphatics

A lot of the fluid exiting the glymphatic moves into meningeal lymphatic vessels
Fluid moves through the meningeal lymphatics until they can exit at the base of the skull
The meningeal lymphatics then empty into the regular lymphatic vessels of the head and neck
The regular lymphatic system does its usual thing, cleaning fluid in the lymph nodes and carrying it towards the heart to join the bloodstream.

Other Pathways

Fluid exiting the glymphatic system can also exit via space around the cranial nerves, especially the olfactory nerve
In the sheaths around the olfactory nerve, fluid exits through small holes in the skull behind the nose in an area called the nasopharyngeal lymphatic plexus
Once exiting the skull, that fluid will also drain into the regular lymphatic vessels of the head and neck

Neuro-lymphatic Drainage

When I talk about neuro-lymphatic drainage, I mean this waste disposal system that helps the brain function at its best, without too much toxic waste or accumulating fluid. When we can encourage the brain’s waste disposal, we help the brain work better.

In future posts, I’ll talk about what conditions we know are linked to problems with neuro-lymphatic drainage. I’ll also get into what we know can help maximize neuro-lymphatic drainage and what evidence there is for the hands-on techniques I use in therapy sessions. In the meantime, scroll down enjoy some anatomy and physiology science geekery!