Manual Lymphatic Drainage


Original Editor - Chew Chee Boon Top Contributors - Chew Chee Boon, Lucinda hampton, Wendy Snyders, Admin, Candace Goh, Vidhu Sindwani, Kim Jackson, Joao Costa, WikiSysop and Rucha Gadgil


Description

Manual Lymphatic Drainage [MLD] is an unique, gentle type of skin massage technique that promotes lymph to drain out of a limb into an area that drains normally. Many physical therapist used it for lymphoedema.

In addition to improving lymphatic circulation, MLD increases blood flow in deep and superficial veins.

Techniques

There are a various techniques for MLD including the Vodder, Földi, Leduc or Casley-Smith methods.  The most appropriate techniques, optimal frequency and indications for MLD, as well as the benefits of treatment, all remain to be clarified, but the different methods have several aspects in common , as:

• Usually performed with the patient in the lying position, unless for lymphoedema of the head and neck
• Starts and ends with deep diaphragmatic breathing
• The unaffected lymph nodes and region of the body are treated first
• Moves proximally to distally to drain the affected areas
• Slow and rhythmical movements 
• Uses gentle pressure

Different Approaches

1. Vodder

Different kinds of hand motions are used on the body depending on the part being treated. It also includes treatment of fibrosis

2. Foldi

Based on the Vodder technique, this method lays emphasis on thrust and releaxation. It helps in management of edema through 'encircling strokes'.

3. Casley-Smith

This method involves use of small and gentle effleurage movements with the side of the hand.

4. Leduc

It involves use of special 'call up' (or enticing) and 'reabsorption' movements which reflet how lymph is absorbed first in the initial lymphatics and then into larger lymphatics.

Indications

• Primary or secondary lymphedema 
• Lipedema
• Phlebo-lymphostatic edema
• Postoperative edema
• Posttraumatic edema 
  
• Chronic venous insufficiency
• Palliative care: Provision of comfort and pain relief when other physical therapies are no longer appropriate

This technique may be used as a complement in therapies for patients with stress. Furthermore, it may be effective for reducing intracranial pressure in severe cerebral diseases.

Contraindications

Absolute Contraindication:

• Decompensated cardiac insufficiency
• Cardiac edema 
• Congestive heart failure
• Acute inflammation caused by pathogenic germs (bacteria, fungi, viruses). The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis). 
• Acute renal failure

Condition stated above must not be treated with manual lymph drainage.

Relative Contraindication:

• Malignant lymphedema caused by active cancer
  

Principles

• The skin is stretched in specific directions using hand movements to promote variations in interstitial pressure without the use of oils.

• Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position.

• The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage.

• Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy.

• The lymphatic drainage strats centrally and proximally with treatments usually starting around the neck.

• Functional and healthy lymph nodes are treated first,followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas.

• There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated.

• Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes.

• Limb mobilization and relaxation techniques are often combined with lymphatic drainage.

Recent Related Research (from Pubmed)

Failed to load RSS feed from https://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1j7KIQXkY7KNdubNmujypuZGro8T7YbqYym6LL8Xp32fEIO9YY|charset=UTF-8|short|max=10: There was a problem during the HTTP request: 422 Unprocessable Entity