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Manual Lymphatic Drainage

Manual lymphatic drainage (MLD) is a technique developed by Vodders (Dr. Emil Vodder and his wife Estrid) in Paris in 1936 to treat enlarged lymph nodes [1].

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

MLD is a gentle skin-stretching massage that helps promote lymphatic drainage from swollen limbs. It should not be confused with traditional massage. MLD pays special attention to the lymphatic vessels to help the flow of lymph fluid. Treatment is applied to your unaffected areas Start by making it possible for fluid to flow out of the affected area or “relieve” the area. MLD helps open the remaining functional lymphatic collectors and move proteins and fluids into them, and helps speed up the flow of lymph through the lymphatic vessels.

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[3].

A deep breathing technique called diaphragmatic breathing is usually performed at the beginning and end of treatment to help open deep lymphatic pathways. Not only does it relax, but it also helps increase fluid flow to the heart [3].


  1. Designed to stimulate lymph nodes and increase the rhythmic constriction of lymphatic vessels to enhance their activity so that stagnant lymph can be redirected.
  2. The MLD consists of four main strokes: the fixed scoop technology, the pump technology, and the rotating technology.
  3. It is effective both as a preventive treatment and as a post-operative rehabilitation treatment, and has the best results when combined with other elements of CDT (Complete Decongestant Therapy). [2]
  4. MLD also increases blood flow in deep and superficial veins. [5]
  5. In addition to lymphedema, MLD may be useful in settings such as post-traumatic and post-operative edema and palliative care.


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

Often, MLD is recommended as part of a treatment plan known as complete decongestant therapy (CDT), although it can be combined with other treatments. Studies haven’t definitively proven MLD’s effectiveness, but they show CDT is effective — and CDT Usually includes MLD[2].

Lymphedema therapists often require hours of MLD training and years of hands-on experience to become truly skilled.

The most appropriate techniques, optimal frequencies and indications for MLD, and the benefits of treatment remain to be elucidated, but the different approaches share several commonalities [6]

  1. Usually performed with the patient supine
  2. Begin and end with deep diaphragmatic breathing
  3. Treat unaffected lymph nodes and body areas first
  4. Move proximally to distally to drain the affected area
  5. Slow and rhythmical movements 
  6. Uses gentle pressure

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


There are four main stages of lymphedema, each of which affects the body in different ways and can be classified according to severity.

The way the treatment duration is determined depends on the stage of the client’s lymphedema, eg intensive treatment may last 2-4 weeks, while less intensive treatment may last for months or years. [2]

Different Approaches
  1. Vodder – Use different kinds of hand movements on the body depending on the area to be treated. It also includes the treatment of fibrosis
  2. Foldi – Based on Vodder technology, this approach emphasizes thrust and relaxation. It helps manage edema by “surrounding strokes”.
  3. Casley-Smith – This method involves using small, gentle gentle movements on the side of the hand.
  4. Leduc – It involves the use of special “calling” (or seductive) and “reabsorption” movements that reflect how lymph is first absorbed in the initial lymphatic vessels and then into the larger lymphatic vessels. [7]


  1. Primary or secondary lymphedema 
  2. Lipedema
  3. Phlebo-lymphostatic edema
  4. Postoperative edema
  5. Posttraumatic edema [8]
  6. Chronic venous insufficiency [5]
  7. Palliative care: providing comfort and pain relief when other physical therapies are no longer appropriate [6]
  8. This technique can be used as a supplement to the treatment of stressed patients. [9]
  9. May be effective in reducing intracranial pressure in severe brain disease. [10]

General Contraindications

Absolute Contraindication:
  1. Decompensated cardiac insufficiency
  2. Untreated Congestive Heart Failure (CHF – Cardiac Edema)
  3. Acute inflammation caused by pathogenic bacteria (bacterial fungal viruses). Bacteria can spread through artificial lymphatic drainage, causing blood poisoning (sepsis).
  4. Acute renal failure
  5. Acute deep venous thrombosis (DVT)
Relative Contraindication:
  1. Malignant lymphedema due to active cancer [11]
  2. Renal dysfunction


  1. Use hand movements to stretch the skin in specific directions to promote changes in interstitial pressure without the use of oil.
  2. Use slow, repetitive movements that include rest periods that allow the skin to return to its normal position.
  3. The pressure varies according to the underlying tissue in order to promote lymphatic drainage.
  4. Fibrotic areas are treated using a combination of deeper, firmer exercise and compression therapy.
  5. Lymphatic drainage begins centrally and proximally, and treatment usually begins in the neck.
  6. Functional and healthy lymph nodes are treated first, followed by proximal and contralateral areas, followed by ipsilateral and lymphedema areas.
  7. In the early stages before treating the swollen limb, the focus is on the treatment of the front and rear trunk.
  8. The breathing technique used, combined with the pressure of the therapist’s hands, promotes the drainage of the lymph nodes in the deep abdomen.
  9. Physical mobility and relaxation techniques are often combined with lymphatic drainage. [7]


MLD is often given as part of Complete Decongestive Therapy (CDT).

  1. CDT is the most effective treatment for lymphedema because it reduces symptoms of lymphedema and improves the patient’s functional mobility and quality of life.
  2. CDT is a combination of four methods (Manual Lymphatic Drainage Lymphedema Rehabilitation Exercises Compression Therapy Skin Care). It can reduce lymphedema volume by 45-70%.
Components of CDT include
  1. Skin care
  2. Self-massage as directed by your therapist
  3. Special light exercises designed to promote lymphatic flow out of the affected limb.
  4. Wear compression clothing, such as long sleeves or stockings, designed to compress the arm or leg and promote lymphatic flow out of the extremity [12].

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