Manual Lymph Drainage (MLD) is a lymphatic decrompressive form of therapy. It involves specific manual movements along lymphatic pathways that empty and decompress obstructed lymph vessels. Uses for MLD are many, including treatment for lymphedema and lipoedema. In lymphatic massage lymph nodes are gentle stimulated to increase their functioning 4-5 times.

Effects of MLD:

1. Increases lymph vessels contractility by emptying and decompressing lymph and interstitial fluid.

2. MLD also improves lymph circulation by increasing the volume of lymph fluid transported by abnormal and normal lymph vessels.

3. MLD breaks down areas of fibrotic tissue.

4. Soothing effect.

5. Analgesia

MLD originated in the mid-1930s in Cannes on the French Riviera by Dr. Emile Vodder and his wife, who treted English patients with chronic colds.  They worked intuitively and successfully with swollen lymph nodes in the neck. The colds vanished. Their work forms the basic of present-day Complete Decongestive Therapy (CDT) of which MLD is one of four components to treat lymphedema effectively. (Other 3 components are specific exercises, meticulous skin and nail care, and wrapping with bandages and/or compression garments.)

What is Lymphedema?

Lymphedema is a swelling of a body part, most often the extremities. It may also occur in the face, the trunk, the abdomen or the genital area.
Lymphedema is the result of an accumulation of protein-rich fluid in the superficial tissues, which can have significant pathological and clinical
consequences for the patient if left untreated. Once present, this chronic and progressive condition will not disappear again.

Causes of Lymphedema

Lymphedema is classified as either primary or secondary. Primary Lymphedema is caused by congenital malformations of the lymphatic system and may be present at birth or develop later in life, often in puberty or during pregnancy. Primary forms usually affect the lower extremities but may also be present in upper extremities.

Secondary lymphedema is more common and often the result of surgery or radiation therapy for cancer. Surgical procedures in combination with the removal of lympd nodes, such as mastectomies or lumpectomies with the removal and /or radiation of axillary lymph nodes, are a very common reason for the onset of secondary lymphedema in the United States. Other causes include trauma or infection of the lymphatic system. Severe venous insufficiencies may also contribute to the onset of lymphedema (phlebolymphostatic edema).  Primary and secondary lymphedema may affect the upper and lower extremity. In general it can be said that the legs are more often involved in primary lymphedema whereas secondary forms are more commonly found in the upper extremities.

Stages of Lymphedema with Typical Symptoms

• Latency stage/lymphangiopathy - no sewlling, reduced transport capacity

• Stage I (reversible) - edema is soft ('pitting'), no secondary tissue changes

• Stage II (spontaneously irreversible) - fibro-sclerotic change, hardening of the tissue

• Stage III (lymphostatic elephantiasis) - exterme increase in volume and texture with typical skin changes (papillomas, deep skin folds)

Some general Contraindications for MLD

• Cardiac edema
• Renal failure
• Acute infections
• Acute bronchitis
• Bronchial asthma
• Hypertension

Local Contraindications on the neck include the following

• Carotid-sinus syndrome
• Hyperthyroidism
• Age

Local Contraindications for the abdominal area include the following

• Pregnancy
• Dysmenorrhea
• Diverticulosis
• Aortic aneurysem
• Recent abdominal surgery
• Deep vein thrombosis
• Inflammatory conditions of the small and large intestine
• Radiation fibrosis, radiation cystitis, radiation colitis
• Unexplained pain