Manual Lymphatic Drainage & Combined Decongestive Therapy

Manual Lymph Drainage (MLD) & Combined Decongestive Therapy (CDT)

What is the Lymphatic System ?

The lymphatic system belongs to the circulatory apparatus, which provides one way for the blood to leave the heart, the arterial system, and two ways for it to return : the venous and lymphatic pathway. The lymphatic system is a second pathway back to the heart, parallel to the blood system.

Lymph is a fluid which originates in the connective tissue spaces of the body. Once it has entered the first lymph capillaries, the fluid is called lymph. The lymphatic circulation is a system with slow rhythm, low velocity and low pressure.

Part of the constituents of the blood will filter out of the blood capillaries. This blood capillary filtrate will join the surrounding tissues and to be reabsorbed in the lymphatic capillaries.

The lymphatic system fine tunes the drainage of the interstitium and constitutes a sort of overflow for the water and excess substances in the interstitial environment.

The lymphatics gradually increase in size : lymph capillaries feed into pre-collectors which connect to the lymphatic collectors, ducks and trunks and eventually join the major venous circulation just before reaching the heart behind the clavicles.

The lymphatic system transports large proteins and foreign bodies to lymphatic nodes which act as active purification centres. The nodes break down and destroy those particles so they can eventually be flushed out of the body through the organs of elimination.

What is Manual Lymph Drainage?

Manual Lymph Drainage (MLD) is not a form of massage but it is a very gentle technique to detect the specific rhythm, direction, depth and quality of the lymph flow and to stimulate the functions of the lymph and interstitial fluid circulation, which are critical for detoxification, removing and filtering of waste, toxins and excess fluids, regeneration of tissues, and a healthy immune system. MLD is a very light technique. This is because the practitioner is trying to influence vessels that are situated in the skin layers.

MLD is performed with appropriate draping. The practitioner will assess lymphatic circulation and determine the best alternate pathways for draining body-fluid stagnations. Practitioners work with flat hands, using all the fingers to simulate gentle, specific wavelike movements.

A treatment commences at the neck to clear the area and make space for lymph to be brought there. The next part of the sequence will depend entirely on why MLD is being performed and the particular needs of the individual.

What are the Benefits?

  • Reduce edema (lymphedema)
  • Activate fluid circulation
  • Detoxification
  • Stimulate the immune system
  • Stimulate the parasympathetic system
  • Promote relaxation
  • Reduce stress and depression
  • Drain toxins and fat
  • Reduce pain and muscle spasm
  • Sports preparation and trauma
  • Acne Vulgaris
  • Sinus

What is Lymphedema?

Lymphedema (LE) is defined as protein-rich fluid accumulation in the interstitial space due to reduced lymph transport capacity as a result of damage to the lymph vessels and nodes, or absence/malformation of lymph vessels.  LE is usually unilateral; if bilateral, it is usually asymmetrical.  It mostly happens on limbs. For example, breast cancer, ovarian cancer and prostate cancer patients after removal of lymph nodes.

LE affects all ages and may occur months or years after surgery.  It is important to understand and manage the life-long risk.

Lymphedema Signs and Symptoms

  • A full or heavy felling in the affected limb
  • A feeling of tightness in the skin
  • Less movement or flexibility in the hand, writs, shoulder or ankle
  • Trouble fitting into clothing or jewelry in one specific area
  • Abnormal swelling in the affected area
  • Recurring infections in the affected limb

Lymphedema Staging

Stage I:

LE is spontaneously reversible.  Clinically evident edema with volume difference more than 10% compared to opposite side

Stage II:

LE is not spontaneously reversible.  Fibrosis is present.  Beginning of abnormal fat deposition starts at the later stage II

Stage III:

LE influences skin to change (elephantiasis).  Fibrosclerosis is present.

Types of Lymphedema

Primary Lymphedema :

It is a congenital abnormal development of the lymph vessel system. It progresses from distal (feet) to central

Secondary Lymphedema :

It progresses from central (thigh) to distal.  It is caused by trauma (eg, post cancer surgery and/or radiotherapy – breast, gynecological and/or prostrate cancers); damage of lymphatic pathways; inflammation; malignancy; obesity and chronic venous insufficiency


Manual Lymph Drainage (MLD) :

Evidence suggests that MLD enhances movements of fluid into initial lymphatics, and influences the contraction rates of pre-collector and collector lymph vessels, moving lymph towards deeper drainage trunks.  It also increases the lymph pressure, frequency as well as amplitude of contraction, resulting in increased transport capacity.

Compression Bandaging :

Compression bandaging influences to increase the tissue hydrostatic pressure during active movement; reduce capillary filtration into interstitial space; encourages passive transport in the collectors; amplifies muscle and joint pump effects; stimulates lymphatic contraction and help break down fibrosclerotic tissue.

Therefore, it reduces edema; restores shape to the affected area; reduces skin changes; supports overstretched inelastic skin; eliminates lymphorrhea and softens subcutaneous tissues.

Compression Garments :

Compression garments (stockings) are useful to stabilize the condition after a period of time applying the bandages.

Exercises :

Exercises include any movement help muscle pump function and lymphatic return.  For example, walking, cycling and water exercise are good for legs.  Swimming and shoulder exercises are beneficial for arms.

Excellent Skin Care :

The use of antibacterial cleansers and pH neutral lotions.