Medication Use A common cause to modify treatment, or at the very least monitor it,…
1. Manual Lymphatic Drainage
What is Manual Lymphatic Drainage (MLD)?
Manual Lymphatic Drainage, or simply known as MLD, is a manual technique that is used to
treat swollen Lymph nodes. The MLD technique is very light – to not compress the superficial
lymphatic vessels – and it involves light and subtle stretching to the skin while using techniques
that can encourage the natural lymphatic flow. MLD treatment will focus primarily on the
lymphatic vessels to aid the flow of lymphatic fluid.
Proper Manual Lymphatic Drainage treatment of the affected region will aim to decongest the
area, assist with moving fluid through any functioning lymph collectors, and help to quicken the
overall lymphatic flow. Although MLD is considered a very light technique, it is important to not
mistake it for a traditional, light-pressure relaxation massage.
Origin/History of Manual Lymphatic Drainage
The Manual Lymphatic Drainage technique was born in the 1930s to Emil Vodder Ph.D. and his
wife, Estrid Vodder, ND. Emil Vodder began his studies in medicine, cytology, and microscopy
in his hometown at the University of Copenhagen where he also developed an interest in
physical medicine. Vodder was unable to continue his medical studies after contracting malaria,
however, he received a Ph.D. from the University of Brussels due to his thesis on Historical Art.
After moving to Paris with his wife in 1933, they both continued their biological studies and
dedicated much of their time to the anatomy and physiology of the lymph vessels and lymphatic
Vodder strongly based his method on copper engravings by French anatomist Marie Philibert
Constant Sappey. He used these engravings – along with intuition and numerous practical
treatments – to birth his new manual technique, which was performed with pumping, circular
movements, and very light pressure to prevent hyperemia.
‘Manual Lymph Drainage’ was presented to the world in 1936 by Vodder during a Paris
congress. By the early 1950s, Vodder had received invitations from European countries to teach
his method. German general practitioner Dr. Asdonk expressed an interest in his technique in
the early 1960s and recognized the importance of Vodder’s method, providing the first list of
A conference in New York in 1972 gave MLD the chance to be introduced in North America, and
a decade later began the training program for therapists in Toronto, Canada. Over time as
Manual Lymphatic Drainage gradually became known, in 1993, the Dr. Vodder School – North
America, was founded.
There are various techniques for MLD which include more than just Vodder’s original method.
Generally, Manual Lymphatic Drainage tends to be an integral element of a treatment plan
known as Complete Decongestive Therapy (CDT), however, it may also be used in combination
with other treatments. Although research studies have not definitively proven the effectiveness
of MLD, they have clearly stated the effectiveness of CDT – which usually involves MLD.
The singular, manual procedure of MLD uses a light pressure and relaxation phase which
creates a pumping effect. This approach aims to encourage accumulated lymph to the nodes.
It’s important to maintain a very light pressure to ensure the treatment is affecting specifically
the lymphatic system, as well as improving the flow of lymph and stimulating lymphocyte
production. The Registered Massage Therapist (RMT) will very lightly use stroking, tapping,
and/or rubbing motions to push the skin in the direction of lymphatic flow. This encourages the
lymph fluid to drain through the appropriate channels. Manual Lymphatic Drainage is very
gentle, not aggressive or painful, and does not aim to have a stimulating effect.
Manual Lymphatic Drainage is comprised of four main strokes:
● scoop technique
● pump technique
● rotary technique
The extent of which techniques are most appropriate and the frequency and indications for
MLD, including its treatment benefits can vary. However, all of the contrasting methods have
many aspects in common, including the following:
● MLD is normally performed with the patient lying down
● It will begin and end with diaphragmatic breathing
● The unaffected lymph nodes and side will be treated first
● Treatment will work from proximal to distal (closest to furthest) to drain the affected
● MLD always uses light and gentle pressure
Different approaches to MLD include:
Vodder: There are several different types of hand motions being used on the body and
it varies depending on the area of the body being treated. This approach also includes
the treatment of fibrosis.
● Foldi: While this method is based on the Vodder technique, it emphasizes thrust and
relaxation. This approach utilizes ‘encircling strokes’ to assist with the management of
● Casley-Smith: This approach requires the use of small, light, and gentle effleurage
movements with the side of the hand.
● Leduc: This approach involves the use of exceptional ‘call up’ (or enticing) and
‘reabsorption’ movements which depicts the absorption of lymph in the initial lymphatics,
and then into the larger lymphatics
The Lymphatic System’s main role is to maintain fluid levels in our body tissues by removing all
excess fluid leaking out of our blood vessels. Because the lymphatic system is quite superficial,
the MLD method is used with very light pressure and with a specific technique.
Manual Lymphatic Drainage treatment can be beneficial for many reasons, including the
● MLD treatment aims to stimulate the lymph nodes, as well as improve the integrity and
function of the lymphatics so that stagnant lymphatic fluid can be rerouted
● It can be effective as both a postoperative rehabilitation treatment and a preventative
● MLD has a very relaxing effect
● This technique also increases blood flow in both deep and superficial veins
● MLD is indicated in conditions such as Lymphedema
● It may also be useful in the treatment of post-traumatic and post-surgical edema, as well
as palliative care.
● Promotes the fast healing of burns & wounds
● Assists with filtering of waste products
● It can assist with the healing of sprains/strains and fractures
● It can produce an analgesic effect, resulting in a decrease in pain and discomfort
● Regular stimulation of the lymphatic system can improve the function of the immune
system. This can increase the vessels’ carrying capacity which can allow it to process
much more fluid than usual
● Helps the body’s capability to fight infections
● Diminishes fluid retention & congestion
MLD treatments are commonly used after breast cancer surgery to relieve lymphedema.
However, Lymph drainage techniques can also help numerous conditions.
Some conditions that may benefit from MLD treatment include:
● Rheumatoid Arthritis: Ongoing joint pain, swelling, and stiffness due to arthritis in the
● Fibromyalgia: A medical condition that causes chronic and debilitating muscle and joint
● Chronic Venous Insufficiency: The difficulty of blood to return to the heart from the
legs due to the veins in the legs not working effectively.
● Lipedema: Blockage of the lymphatic pathway causing lymphedema. This is due to an
accumulation of excess fat in the lower body
Typically, MLD treatment is considered safe to relieve Lymphedema. However, there are some
conditions and circumstances where Manual Lymphatic Drainage is not recommended.
This includes patients who have the following:
● Heart condition
● Kidney failure
● Blood clots
Although you may not notice immediate results from MLD treatment, it’s important to note that
you may need to give the technique several sessions before inquiring with your medical doctor
about alternative treatment modalities. If you are concerned that your physical health may be
affected by MLD treatment, then it is recommended to consult with your medical doctor for
advice. It is also imperative to note that with any existing or pre-existing diagnosis/history of
cancer, a doctor’s referral is required.
Christina Sharma, RMT
(Massage Therapy Vancouver)