Manual Lymphatic Drainage: Difference between revisions

No edit summary
m (link corrected)
 
(19 intermediate revisions by 6 users not shown)
Line 1: Line 1:
<div class="editorbox">
'''Original Editor''' - [[User:Chew Chee Boon|Chew Chee Boon]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>  
<div class="editorbox">
'''Original Editor''' - [[User:Chew Chee Boon|Chew Chee Boon]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>
<div class="noeditbox">
== Description  ==
This article is currently under review and may not be up to date. Please come back soon to see the finished work! ({{REVISIONDAY}}/{{REVISIONMONTH}}/{{REVISIONYEAR}})  
[[File:Lymphatic system - Kenhub.png|alt=Overview of the lymphatic system|right|frameless|600x600px|Overview of the lymphatic system]]
</div>
Manual Lymph drainage (MLD), is a technique developed by the Vodders (Dr. Emil Vodder and his wife, Estrid) in 1936 in Paris for treatment of swollen lymph nodes<ref>Dr Vodder School International. Manual Lymph Drainage History (MLD). Available from: https://vodderschool.com/manual_lymph_drainage_history (Accessed 3 September 2020)</ref>. 


== Description  ==
Lymphatic diseases, especially [[Lymphoedema|lymphedema]], represent a serious problem in the health community<ref name=":0">Tzani I, Tsichlaki M, Zerva E, Papathanasiou G, Dimakakos E. [https://www.researchgate.net/publication/326301004_Physiotherapeutic_rehabilitation_of_lymphedema_State-of-the-art Physiotherapeutic rehabilitation of lymphedema]: State-of-the-art. Lymphology. 2018 Jul 2;51(1):1-2.</ref>.   
[[File:Lymphoma Lymph Node Diagram.jpg|right|frameless|482x482px]]
Manual lymph drainage (MLD), is a technique developed in Germany for treatment of [[Lymphatic Obstruction (Lymphedema)|lymphedema]].   


Lymphatic diseases, especially lymphedema, represent a serious problem in the health community<ref name=":0">Tzani I, Tsichlaki M, Zerva E, Papathanasiou G, Dimakakos E. [https://www.researchgate.net/publication/326301004_Physiotherapeutic_rehabilitation_of_lymphedema_State-of-the-art Physiotherapeutic rehabilitation of lymphedema]: State-of-the-art. Lymphology. 2018 Jul 2;51(1):1-2. Available from:https://www.researchgate.net/publication/326301004_Physiotherapeutic_rehabilitation_of_lymphedema_State-of-the-art (last accessed 16.8.2020)</ref>.   
MLD is a light, skin-stretching massage that helps promote the movement of lymphatic fluid out of the swollen limb. It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics.   


MLD is a light, skin stretching massage that helps promote the movement of lymphatic fluid out of the swollen limb. It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics.
Deep breathing techniques called [[Diaphragmatic Breathing Exercises|diaphragmatic breathing]] are usually done at the beginning and end of a therapy session to help open the deep lymphatic pathways. It’s not only relaxing, but it helps increase movement of fluid toward the [[Anatomy of the Human Heart|heart]]<ref>Lymph care [https://www.lymphcareusa.com/patient/therapy-solutions/complete-decongestive-therapy/manual-lymphatic-drainage-mld.html MLD] Available from:https://www.lymphcareusa.com/patient/therapy-solutions/complete-decongestive-therapy/manual-lymphatic-drainage-mld.html (last accessed 17.8.2020)</ref>.


Deep breathing techniques call diaphragmatic breathing are usually done at the beginning and end of a therapy session to help open the deep lymphatic pathways. It’s not only relaxing, but it helps increase movement of fluid toward the heart<ref>Lymph care [https://www.lymphcareusa.com/patient/therapy-solutions/complete-decongestive-therapy/manual-lymphatic-drainage-mld.html MLD] Available from:https://www.lymphcareusa.com/patient/therapy-solutions/complete-decongestive-therapy/manual-lymphatic-drainage-mld.html (last accessed 17.8.2020)</ref>.
Image: Overview of the lymphatic system<ref > Overview of the lymphatic system image - © Kenhub https://www.kenhub.com/en/study/lymphatic-system</ref>


MLD:
MLD:
* is intended to stimulate lymph nodes and increase rhythmic contractions of the [[Lymphatic System|lymphatics]] to enhance their activity so that stagnant lymphatic fluid can be rerouted.   
* The intention behind MLD is to augment the rhythmic contractions and stimulate the lymph nodes to improve their activity in order to reroute stagnant [[Lymphatic System|lymphatic]] fluid<ref name=":0" />.   
* MLD is composed of four main strokes: stationary circles, scoop technique, pump technique, and rotary technique.  
* MLD is comprised of four main strokes: stationary circles, scoop technique, pump technique, and rotary technique<ref name=":0" />.
* Is effective both as a preventative treatment and as a postoperative rehabilitation treatment, and has optimal results when it is combined with the other elements of CDT (Complete Decongestive Therapy).<ref name=":0" />
* It is effective as a preventative and postoperative rehabilitation treatment<ref name=":0" />.
* For conditions other than lymphedema  it is not medically recommended, although it may be promoted by some therapists.
* MLD is a  a key component [[Complete Decongestive Therapy (CDT)|Complete Decongestive Therapy]] (CDT)<ref name="best practice" />. It shows optimal results when it is combined with the other CDT elements<ref name=":0" />.
* MLD also increases [[blood]] flow in deep and superficial veins.<ref name="venous ins">Crisóstomo RS, Candeias MS, Armada-da-Silva PA. Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study.Physiotherapy. 2016 Feb 1. pii: S0031-9406(16)00023-7.</ref>  
* MLD also increases [[blood]] flow in deep and superficial veins<ref name="venous ins">Crisóstomo RS, Candeias MS, Armada-da-Silva PA. Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study.Physiotherapy. 2016 Feb 1. pii: S0031-9406(16)00023-7.</ref>.
* MLD may be useful in conditions such as post-traumatic and post-surgical edema<ref name=":0" /> and [https://www.physio-pedia.com/The_Role_of_the_Physiotherapist_in_Palliative_Care_for_People_With_Lymphoedema palliative care]<ref name=":0" />.


== Techniques  ==
== Techniques  ==
[[File:Lymphedema Grading.png|right|frameless]]
There are various techniques for MLD including the Vodder, Földi, Leduc or Casley-Smith methods.
There are a various techniques for MLD including the Vodder, Földi, Leduc or Casley-Smith methods.&nbsp; 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 <ref name="best practice">Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International consensus. London: MEP Ltd, 2006.</ref>  
 
MLD is recommended as a component of [[Complete Decongestive Therapy (CDT)|CDT,]] but is often used in combination with other treatments<ref name=":0" />. MLD in isolation is effective but a combination of the parts of CDT is optimal<ref name=":0" />. CDT has been shown to be effective in reducing lymphedema volume and improving quality of life patient mobility<ref name=":0" />. &nbsp; 


*Usually performed with the patient in the lying position, unless for lymphoedema of the head and neck
It often takes many hours of training in MLD, combined with years of hands-on experience, for a lymphedema therapist to become truly skilled.
 
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, including the following<ref name="best practice">[https://www.woundsinternational.com/resources/details/best-practice-for-the-management-of-lymphoedema-an-international-consensus Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International consensus.] London: MEP Ltd, 2006.</ref> :
 
*Usually performed with the patient in the lying position  
*Starts and ends with deep [[Diaphragmatic Breathing Exercises|diaphragmatic breathing]]  
*Starts and ends with deep [[Diaphragmatic Breathing Exercises|diaphragmatic breathing]]  
*The unaffected lymph nodes and region of the body are treated first  
*The unaffected lymph nodes and region of the body are treated first  
*Moves proximal to distal to drain the affected areas  
*Moves proximal to distal to drain the affected areas  
*Slow and rhythmical movements&nbsp;  
*Slow and rhythmical movements&nbsp;  
*Uses gentle pressure
*Uses gentle pressure - this is essential
The video below gives a very brief explanation of Manual Lymphatic Drainage 3 minutes 51 seconds{{#ev: youtube | dT6rAL4-D14 | 300}}
The video below gives a very brief explanation of Manual Lymphatic Drainage  
{{#ev:youtube|dT6rAL4-D14 | 300}}<ref>National Lymphedema Network. Manual Lymph Drainage (MLD). Available from: http://www.youtube.com/watch?v=dT6rAL4-D14[last accessed 01/04/2022]</ref>
'''Different Approaches'''<ref name="Williams">Williams A. [https://www.researchgate.net/profile/Anne-Williams-4/publication/44683866_Manual_lymphatic_drainage_Exploring_the_history_and_evidence_base/links/547c94eb0cf2cfe203c1db71/Manual-lymphatic-drainage-Exploring-the-history-and-evidence-base.pdf Manual lymphatic drainage: exploring the history and evidence base]. British Journal of Community Nursing. 2010 Apr;15(Sup3):S18-24.</ref>
* Vodder - Different kinds of hand motions are used on the skin depending on the part of the body being treated. It also includes edema movements at fibrotic areas. The different motions include  "pump", "scoop", "stationery circle", "rotary" and "thumb circle".
* Foldi - Based on the Vodder technique, this method lays emphasis on a "thrust" and "relaxation" phase. 'Encircling strokes' are included in this approach.
* Casley-Smith - This method involves use of gentle and slow effleurage movements with the side of the hand. The effleurage movements are performed over the "watershed" areas between lymphotomes.
* Leduc - It involves use of  "call up" (or enticing) and "reabsorption" movements which reflects how lymph is absorbed first in the initial lymphatics and then into larger lymphatics.


'''Different Approaches'''
== Indications  ==
* Vodder - Different kinds of hand motions are used on the body depending on the part being treated. It also includes treatment of fibrosis
[[File:Lymphoedema red leg.png|right|frameless]]MLD is indicated in primary or secondary [[Lymphatic Obstruction (Lymphedema)|lymphedema&nbsp;]]<nowiki/>in the following situations:
* Foldi - Based on the Vodder technique, this method lays emphasis on thrust and releaxation. It helps in management of edema through 'encircling strokes'.
*When there is swelling at a limb's root<ref name="best practice" />
* Casley-Smith - This method involves use of small and gentle effleurage movements with the side of the hand.
*When trunk and midline edema is present<ref name="best practice" />
* 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.<ref name="Williams">Williams AF. Manual lymphatic drainage: Exploring the history and evidence base. British Journal of Community Nursing. 2010;15(4):S18-24. DOI: 10.12968/bjcn.2010.15.Sup3.47365</ref>
*When comfort and pain relief is required but other therapies are no longer appropriate - palliative<ref name="best practice" />
*As an adjunct to pain management<ref name="best practice" />
*As a preventative treatment<ref name=":0" />
*Chronic venous insufficiency <ref name="venous ins" />


== Indications  ==


*[[File:Lymphoedema red leg.png|right|frameless]]Primary or secondary [[Lymphatic Obstruction (Lymphedema)|lymphedema&nbsp;]]
MLD may also be helpful in the below situations:
*Lipedema
*It may be used as a complement treatment for patients with psychological stress. <ref>Jung-Myo S, Sung-Joong K. Manual Lymph Drainage Attenuates Frontal EEG Asymmetry in Subjects with Psychological Stress: A Preliminary Study. J Phys Ther Sci. 2014 Apr; 26(4): 529–531.</ref><ref>Shim JM, Yeun YR, Kim HY, Kim SJ. [https://www.jstage.jst.go.jp/article/jpts/29/3/29_jpts-2016-900/_pdf Effects of manual lymph drainage for abdomen on the brain activity of subjects with psychological stress]. Journal of physical therapy science. 2017;29(3):491-4.</ref>
*Phlebo-lymphostatic edema
*It (craniocervical MLD) may be effective for reducing intracranial pressure in people with severe cerebral diseases.<ref>Roth C, Stitz H, Roth C, Ferbert A, Deinsberger W, Pahl R et. al. [https://www.researchgate.net/profile/Holger-Engel/publication/303687614_Craniocervical_manual_lymphatic_drainage_and_its_impact_on_intracranial_pressure_-_a_pilot_study/links/5c66682d45851582c3e98103/Craniocervical-manual-lymphatic-drainage-and-its-impact-on-intracranial-pressure-a-pilot-study.pdf Craniocervical manual lymphatic drainage and its impact on intracranial pressure - a pilot study]. Eur J Neurol. 2016 Sep;23(9):1441-6.</ref>
*Postoperative edema
== Contraindications ==
*Posttraumatic edema&nbsp;<ref>Michael Földi, Roman Strößenreuther. (2003). Basic Principles of Manual Lymph Drainage. In R. S. Michael Földi, FOUNDATIONS OF MANUAL LYMPH DRAINAGE, 3rd ed (pp. 48-49). St. Louis Missouri: Elsevier Mosby.</ref>
*Chronic venous insufficiency <ref name="venous ins" />
*[[Palliative Care Competence Framework for Physiotherapists|Palliative care]]: Provision of comfort and pain relief when other physical therapies are no longer appropriate <ref name="best practice" />
*This technique may be used as a complement in therapies for patients with stress. <ref>Jung-Myo S, Sung-Joong K. Manual Lymph Drainage Attenuates Frontal EEG Asymmetry in Subjects with Psychological Stress: A Preliminary Study. J Phys Ther Sci. 2014 Apr; 26(4): 529–531.</ref>  
*May be effective for reducing intracranial pressure in severe [[Cerebral Palsy - The Causes|cerebral]] diseases.<ref>Roth C, Stitz H, Roth C, Ferbert A, Deinsberger W, Pahl R et. al. Craniocervical manual lymphatic drainage and its impact on intracranial pressure - a pilot study. Eur J Neurol. 2016 Sep;23(9):1441-6.</ref>
== Contraindications ==


'''Absolute Contraindication:'''  
'''General contraindications'''<ref name="best practice" />''':'''
* Acute cellulitis/erysipelas
* Severe cardiac insufficiency
* Hepatic cirrhosis with abdominal fluid (ascites)
* Unstable hypertension
* Renal failure
* Untreated tuberculosis or malaria
* Superior vena cava obstruction


*Decompensated cardiac insufficiency
*Cardiac&nbsp;edema&nbsp;
*[[Heart Failure|Congestive heart failure]]
*Acute inflammation caused by pathogenic germs (bacteria,&nbsp;fungi, viruses). The germs could be spread by the manual lymph drainage, with resulting blood poisoning (sepsis).&nbsp;
*Acute renal failure


Condition stated above must not be treated with manual lymph drainage.
'''Local contraindications'''<ref name="best practice" />''':'''
*Untreated thyroid dysfunction
*Metastases
*Primary tumours


'''Relative Contraindication:'''
== Principles of MLD ==


*Malignant lymphedema caused by active cancer<ref name="Moffatt">Moffatt C, Doherty D, Morgan P. Lymphoedema framework. Best Practice for Management of Lymphoedema. International Consensus. London: MEP Limited;2006.58</ref>
*The [[Integumentary System|skin]] is stretched in specific directions using hand movements to promote variations in interstitial pressure without the use of oils<ref name=":0" /><ref name="Williams" />.


== Principles  ==
*Slow repetitive movements are used which incorporate a resting phase to allow the skin to return to its normal position<ref name=":0" /><ref name="Williams" />.


*The skin is stretched in specific directions using hand movements to promote variations in interstitial pressure without the use of oils.
*The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage<ref name="Williams" />. The pressure however is softer than in traditional massage<ref name="Williams" />.


*Slow repetitive movements are used which incorporate a resting phase allowing skin to return to its normal position.
*Areas of fibrosclerosis are treated using deeper and firmer movements in combination with compression therapy<ref name="Williams" />.


*The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage.
*The lymphatic drainage starts centrally and proximally<ref name=":0" /><ref name="Williams" /> with treatments usually starting around the neck<ref name="Williams" />.  


*Areas of fibrosis are treated using deeper and firmer movements in combination with Compression therapy.
*Functional and healthy lymph nodes are treated first<ref name="Williams" />.


*The lymphatic drainage strats centrally and proximally with treatments usually starting around the neck.
*There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated<ref name="Williams" />.


*Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas and then ipsilateral and lymphoedematus areas.
*Breathing techniques are combined with pressure by the therapist's hands to promote drainage of deep abdominal lymph nodes and vessels<ref name="Williams" />.


*There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated.
*Limb mobilization and relaxation techniques are often combined with MLD.<ref name="Williams" />


*Breathing techniques used are combined with pressure by the therapist's hands which promotes drainage of deep abdominal lymph nodes.
== Physiotherapist-administered MLD ==
Physiotherapy for patients with lymphedema can only be successful if the physiotherapist is specifically educated, trained and experienced in each method<ref name=":0" />.


*Limb mobilization and relaxation techniques are often combined with lymphatic drainage.<ref name="Williams" />
It is often given as part of  [[Complete Decongestive Therapy (CDT)|Complete Decongestive Therapy]] (CDT) which has two phases  - phase I and II<ref name=":0" />. MLD is performed in phase I and II, but phase II has more MLD<ref name=":0" />. The two phases consist of the following:


== Techniques - to use in conjunction ==
'''Phase I'''
CDT is the most effective treatment for lymphedema, as it reduces the symptoms of lymphedema and improves patients’ functionality, mobility, and quality of life.
* MLD<ref name=":0" />
* lymphological compression bandages<ref name=":0" />
* remedial exercises<ref name=":0" />
* physiotherapy<ref name=":0" /><ref name="best practice" /> where patients are struggling with mobility or joint mobility/function<ref name="best practice" />
* Education regarding self-management and skin care<ref name=":0" />


CDT  is a combination of four methods (manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care). It can achieve a 45-70% reduction in lymphedema volume. Components of this include eg.[[File:Lymphedema 02 Base 175.jpg|right|frameless]]
'''Phase II'''
* Self-massage following instructions from their therapists
* MLD<ref name=":0" />
* Special light exercises designed to encourage the flow of lymphatic fluid out of the affected limb.
* wearing of fitted compression stockings<ref name=":0" />
* Wear compression garments such as long sleeves or stockings designed to compress the arm or leg and encourage lymphatic flow out of the limb<ref>WEIL [https://www.drweil.com/health-wellness/balanced-living/wellness-therapies/lymphatic-massage-therapy/ MLD] Available from:https://www.drweil.com/health-wellness/balanced-living/wellness-therapies/lymphatic-massage-therapy/ (last accessed 28.7.2020)</ref>.


== Resources ==
== Resources ==
see videos on this page reagarding techniques on [[Lymphatic Obstruction (Lymphedema)|Lymphodema]] management
* Browse videos on this page regarding techniques on [[Lymphoedema|Lymphedema]] management.
* [https://vodderschool.com/manual_lymph_drainage_history Manual Lymphatic Drainage (MLD) History]  


== References  ==
== References  ==

Latest revision as of 14:30, 9 January 2023


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


Description[edit | edit source]

Overview of the lymphatic system

Manual Lymph drainage (MLD), is a technique developed by the Vodders (Dr. Emil Vodder and his wife, Estrid) in 1936 in Paris for treatment of swollen lymph nodes[1].

Lymphatic diseases, especially lymphedema, represent a serious problem in the health community[2].

MLD is a light, skin-stretching massage that helps promote the movement of lymphatic fluid out of the swollen limb. It should not be confused with a traditional massage. MLD is specifically focused on the lymph vessels to help the flow of lymphatic fluid. Therapy is applied to your unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region. MLD helps open the remaining functioning lymph collectors and move protein and fluid into them, as well as to help speed up lymph fluid flow through the lymphatics.

Deep breathing techniques called diaphragmatic breathing are usually done at the beginning and end of a therapy session to help open the deep lymphatic pathways. It’s not only relaxing, but it helps increase movement of fluid toward the heart[3].

Image: Overview of the lymphatic system[4]

MLD:

  • The intention behind MLD is to augment the rhythmic contractions and stimulate the lymph nodes to improve their activity in order to reroute stagnant lymphatic fluid[2].
  • MLD is comprised of four main strokes: stationary circles, scoop technique, pump technique, and rotary technique[2].
  • It is effective as a preventative and postoperative rehabilitation treatment[2].
  • MLD is a a key component Complete Decongestive Therapy (CDT)[5]. It shows optimal results when it is combined with the other CDT elements[2].
  • MLD also increases blood flow in deep and superficial veins[6].
  • MLD may be useful in conditions such as post-traumatic and post-surgical edema[2] and palliative care[2].

Techniques[edit | edit source]

There are various techniques for MLD including the Vodder, Földi, Leduc or Casley-Smith methods.

MLD is recommended as a component of CDT, but is often used in combination with other treatments[2]. MLD in isolation is effective but a combination of the parts of CDT is optimal[2]. CDT has been shown to be effective in reducing lymphedema volume and improving quality of life patient mobility[2].  

It often takes many hours of training in MLD, combined with years of hands-on experience, for a lymphedema therapist to become truly skilled.

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, including the following[5] :

  • Usually performed with the patient in the lying position
  • Starts and ends with deep diaphragmatic breathing
  • The unaffected lymph nodes and region of the body are treated first
  • Moves proximal to distal to drain the affected areas
  • Slow and rhythmical movements 
  • Uses gentle pressure - this is essential

The video below gives a very brief explanation of Manual Lymphatic Drainage

[7]

Different Approaches[8]

  • Vodder - Different kinds of hand motions are used on the skin depending on the part of the body being treated. It also includes edema movements at fibrotic areas. The different motions include "pump", "scoop", "stationery circle", "rotary" and "thumb circle".
  • Foldi - Based on the Vodder technique, this method lays emphasis on a "thrust" and "relaxation" phase. 'Encircling strokes' are included in this approach.
  • Casley-Smith - This method involves use of gentle and slow effleurage movements with the side of the hand. The effleurage movements are performed over the "watershed" areas between lymphotomes.
  • Leduc - It involves use of "call up" (or enticing) and "reabsorption" movements which reflects how lymph is absorbed first in the initial lymphatics and then into larger lymphatics.

Indications[edit | edit source]

Lymphoedema red leg.png

MLD is indicated in primary or secondary lymphedema in the following situations:

  • When there is swelling at a limb's root[5]
  • When trunk and midline edema is present[5]
  • When comfort and pain relief is required but other therapies are no longer appropriate - palliative[5]
  • As an adjunct to pain management[5]
  • As a preventative treatment[2]
  • Chronic venous insufficiency [6]


MLD may also be helpful in the below situations:

  • It may be used as a complement treatment for patients with psychological stress. [9][10]
  • It (craniocervical MLD) may be effective for reducing intracranial pressure in people with severe cerebral diseases.[11]

Contraindications[edit | edit source]

General contraindications[5]:

  • Acute cellulitis/erysipelas
  • Severe cardiac insufficiency
  • Hepatic cirrhosis with abdominal fluid (ascites)
  • Unstable hypertension
  • Renal failure
  • Untreated tuberculosis or malaria
  • Superior vena cava obstruction


Local contraindications[5]:

  • Untreated thyroid dysfunction
  • Metastases
  • Primary tumours

Principles of MLD[edit | edit source]

  • The skin is stretched in specific directions using hand movements to promote variations in interstitial pressure without the use of oils[2][8].
  • Slow repetitive movements are used which incorporate a resting phase to allow the skin to return to its normal position[2][8].
  • The pressure is varied according to the underlying tissue with the aim to promote lymphatic drainage[8]. The pressure however is softer than in traditional massage[8].
  • Areas of fibrosclerosis are treated using deeper and firmer movements in combination with compression therapy[8].
  • The lymphatic drainage starts centrally and proximally[2][8] with treatments usually starting around the neck[8].
  • Functional and healthy lymph nodes are treated first[8].
  • There is emphasis on treatment of anterior and posterior trunk in the early phases before the swollen limb is treated[8].
  • Breathing techniques are combined with pressure by the therapist's hands to promote drainage of deep abdominal lymph nodes and vessels[8].
  • Limb mobilization and relaxation techniques are often combined with MLD.[8]

Physiotherapist-administered MLD[edit | edit source]

Physiotherapy for patients with lymphedema can only be successful if the physiotherapist is specifically educated, trained and experienced in each method[2].

It is often given as part of Complete Decongestive Therapy (CDT) which has two phases - phase I and II[2]. MLD is performed in phase I and II, but phase II has more MLD[2]. The two phases consist of the following:

Phase I

  • MLD[2]
  • lymphological compression bandages[2]
  • remedial exercises[2]
  • physiotherapy[2][5] where patients are struggling with mobility or joint mobility/function[5]
  • Education regarding self-management and skin care[2]

Phase II

  • MLD[2]
  • wearing of fitted compression stockings[2]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Dr Vodder School International. Manual Lymph Drainage History (MLD). Available from: https://vodderschool.com/manual_lymph_drainage_history (Accessed 3 September 2020)
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 Tzani I, Tsichlaki M, Zerva E, Papathanasiou G, Dimakakos E. Physiotherapeutic rehabilitation of lymphedema: State-of-the-art. Lymphology. 2018 Jul 2;51(1):1-2.
  3. ↑ Lymph care MLD Available from:https://www.lymphcareusa.com/patient/therapy-solutions/complete-decongestive-therapy/manual-lymphatic-drainage-mld.html (last accessed 17.8.2020)
  4. ↑ Overview of the lymphatic system image - © Kenhub https://www.kenhub.com/en/study/lymphatic-system
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International consensus. London: MEP Ltd, 2006.
  6. ↑ 6.0 6.1 Crisóstomo RS, Candeias MS, Armada-da-Silva PA. Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study.Physiotherapy. 2016 Feb 1. pii: S0031-9406(16)00023-7.
  7. ↑ National Lymphedema Network. Manual Lymph Drainage (MLD). Available from: http://www.youtube.com/watch?v=dT6rAL4-D14[last accessed 01/04/2022]
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 Williams A. Manual lymphatic drainage: exploring the history and evidence base. British Journal of Community Nursing. 2010 Apr;15(Sup3):S18-24.
  9. ↑ Jung-Myo S, Sung-Joong K. Manual Lymph Drainage Attenuates Frontal EEG Asymmetry in Subjects with Psychological Stress: A Preliminary Study. J Phys Ther Sci. 2014 Apr; 26(4): 529–531.
  10. ↑ Shim JM, Yeun YR, Kim HY, Kim SJ. Effects of manual lymph drainage for abdomen on the brain activity of subjects with psychological stress. Journal of physical therapy science. 2017;29(3):491-4.
  11. ↑ Roth C, Stitz H, Roth C, Ferbert A, Deinsberger W, Pahl R et. al. Craniocervical manual lymphatic drainage and its impact on intracranial pressure - a pilot study. Eur J Neurol. 2016 Sep;23(9):1441-6.
Retrieved from "https://www.physio-pedia.com/index.php?title=Manual_Lymphatic_Drainage&oldid=324865"