Manual Lymphatic Drainage (MLD)

The primary function of the lymphatic system is to support the immune system, maintaining volume in the vascular system, circulation of lymphocytes, removal of fluid leaked by capillaries into connective tissue spaces, removal of protiens and lipid molecules too large to enter blood capillaries and importantly removalmof organic and inorganic materials, waste products, cells and cellular debris.

You could say the lymphatic system is the bodies waste desposal system, it makes good sense to ensure it is in good working order.

This is a gentle, non-invasive manual technique that has a powerful effect on the body. Research in Australia, Europe and North America has proven its efficacy as a stand-alone treatment and in combination with other therapies. Developed in France in 1932 by Emil and Estrid Vodder MLD has grown to be the most well known manual technique to assist lymph flow and aid in drainage of tissues.

What makes this technique so distinctive? Dr. Vodder himself worked “with the skin”. He used circular or spiral strokes, while alternately increasing pressure to 30 torr (or roughly 4 kPascal) and reducing it to virtually nil. This constant change in pressure generates the pumping effect. Pressure is increased towards the natural direction of lymph flow. The strokes involve skin-to-skin contact as a result of which the skin is gently displaced by the hands. The technique is generally applied to dry skin, although it may be necessary to apply a drop or two of oil on hairy areas of the body.

Oil will likewise be used on skin areas that do not move (such as scars, ulcer margins, firm edemas) or on very dry or coarse skin (e.g. eczema). The MLD therapist works with steady and rhythmic strokes. The speed at which strokes follow one another is determined by the maximum frequency of lymphangiomotoricity. Under no circumstances should these strokes cause redness of the skin or pain. Now used for varying pathologies, the so-called therapy strokes are all part of the basic Vodder technique which is adjusted to the condition of the tissue in question and may be combined with exercises if required.

The Dr. Vodder technique always begins with treatment of the lymph nodes and lymph vessels found at the neck and the junction of the large lymph channels in the venous arch on both sides of the body (connection of the jugular and subclavian veins). Dr. Vodder calls this “clearing the chain lymph nodes down to the terminus”.

For MLD to be effective, use of the proper specialist technique and adaptation of the length of individual therapy sessions to meet the needs of the pathology concerned are essential. In comparison with other forms of massage, MLD sessions are unusually lengthy. A typical MLD session requires 60 minutes, but may be extended to 90 minutes, depending on the indication.

Forty years of scientific studies MLD produces three major effects, all of which have been scientifically studied and confirmed:

Degongestive Effect

Any swelling of the body – with the exceptions of cardiac(heart) and renal(kidney) edema – can be successfully treated with MLD. The lymphatic system is a kind of “one-way street”, which ultimately transports the lymphatic load (protein, fat, cellular and water load) in the right ventricle from the tissue back into the circulatory system. Just picture the lymph fluids as the waste removal system of the human body. Wherever “waste” (toxins, proteins, detritus from wounds) is produced, the lymphatic system must act in order to drain such waste. The special MLD massage technique induces a pumping effect in the tissue. The lymphatic pathways’ own rhythm is accelerated to up to 27-30 times its normal rate. This enhanced drainage effect results in rapid decongestion and restoration of normal tissue condition.

Sympathicolytic Effect

Manual Lymph Drainage is very soothing. Frequently patients doze off within minutes. Steady and rhythmic hand strokes by a good therapist are the prerequisite for successful treatment. Are very stressed? Try a series of 6 x 30 minutes lymph drainage sessions. It is a wonderful preventive measure against burnout.

Analgesic Effect

Pain relief through MLD is like trying to “scratch away” the pain and itching of mosquito bites. Scratching will stimulate large skin areas, thus reducing the feeling of pain, just as MLD stimulates the lymphatic system to alleviate pain. (Gate control theory). Moreover, MLD results in pain mediators being drained into the lymphatic system more rapidly, so that they are no longer active in the tissue. Any prolonged pain, such as pain generated by migraine, acute injuries, complex regional pain syndrome (CRPS), fibromyalgia, etc., therefore is among the indications for lymph drainage. MLD’s fourth effect The above three effects of Dr. Vodder’s MLD have already been studied and confirmed on numerous occasions. However, we believe that MLD has yet another, i.e. an

Immunological Effect

MLD helps accelerate the transportation of bacteria and allergens to the places where the body’s defense system is located (i.e. the lymph nodes) and where the increased rate of lymphatic drainage heightens the sensitization of lymphocytes and macrophages. The latter can travel more rapidly via the blood flow to reach the “scene of action” and intervene by phagocytosis, which in turn will improve immunisation.

Indications for MLD

Manual Lymph Drainage is indicated for a variety of conditions as it both affects and acts upon the diverse physiological functions of the human body. It is an alternative or key supplement to the many forms of physical therapies available today.

1) Extensive lymphedemas of the limbs head the list of conditions. These may be primary or secondary lymphedemas, such as those which form after mastectomy combined with the removal of axillary lymph nodes, or after radiation injury of the axillary or inguinal lymph nodes, iliac or lumbar lymphatic pathways. Although MLD rarely achieves complete removal of edemas in such cases, it greatly improves the patient’s general condition by reducing their size. Combining MLD, compression bandaging and remedial exercises will optimize edema reduction. Medication containing benzopyrone may help clear plasma proteins from the interstitial space, whereas diuretics result in only a short-term outflow of edema fluid. The fluid thus cleared will re-accumulate immediately as the plasma proteins that remain in the tissue once again begin to draw fluid to the edematous area. Moreover, this tends to encourage the formation of fibrosis, whereby highly fibrotic edemas which have been pre-treated with diuretics become very difficult to drain.

2) Another major group of indications is that of traumatic injuries: hematomas, distortions, muscle fiber tears, as well as the choice of therapy following dislocations of joints.

2a) Hematoma and post-fracture treatment provide numerous applications for Manual Lymph Drainage. In hematomas MLD should start as early as possible once the bleeding has stopped, i.e. before hematomas have formed a barrier of fibrin and leukocytes. Even large hematomas can be drained away with a few but extended treatment sessions.

2b) MLD’s pain relieving effect can be put to use when treating distortions and dislocations. In such cases hematoma therapy will be combined with isometric exercises. Active exercises and elastic bandaging supplement the treatment program.

2c) MLD greatly reduces the duration of treatment for torn muscle fibers. CRPS – Complex regional pain syndrome

3) Hematoma in fractures can be treated before the split cast is put on, as well as for the time period in which it is needed, thus enabling patients to receive a full cast soon. MLD treatment of hematomas greatly helps prevent the development of post-fracture complications. MLD may also be used pre- and post-operatively when fractures are managed by surgical intervention.

4) CRPS – (complex regional pain syndrome) in all its stages is a major indication for Manual Lymph Drainage. Its also called RSD (Reflex Sympathetic Dystrophy). Alongside edema removal, MLD’s analgesic effect plays a significant role. This enables patients to begin with passive and active remedial exercises relatively soon. Acute burn injury

5) Scar therapy is another major application. HUTZSCHENREUTER has demonstrated in a study that MLD improves wound healing and optimizes the scarring process. Damaged lymph drainage routes can be restored in existing scars. If post-surgical scars interrupt the lymphatic pathways and local edemas form, they can be drained away, while MLD scar treatment reconnects the interrupted drainage routes. MLD also has a salutary effect on large scars, such as those caused by burns. Hyperkeratotic scars cease their itching, the deep reddening of the scar area pales and the scar tissue softens. Frequently MLD makes surgical corrections of scars unnecessary. However, much time must be spent on scar therapy. A particularly good area of indication for MLD is cosmetic surgery aftercare. patient with a stroke

6) MLD is also indicated for treatment of many kinds of rheumatic disorders. If this involves subacute inflammatory conditions, the usual regime for treating chronic inflammation applies: the MLD therapist begins with short therapy sessions which are gradually extended. If there are no acute reactions, the therapist may move on to full-length sessions. Conditions that respond well to MLD are all types of rheumatoid arthritis. Since MLD alleviates pain and removes edema, it helps improve patients’ mobility.

7) Various soft-tissue rheumatic disorders (such as tendinitis, tendoperiostitis, tendovaginitis, bursitis, periarthritis, periarthrosis, carpal tunnel syndrome) respond well to MLD but need comparatively long individual courses of treatment.

8) In dentistry MLD is frequently part of an effective and successful combination therapy for correcting jaw positions or following tooth extraction and operations.

9) MLD treatment cycles also provide good therapy results for chronic inflammations (such as chronic cold, chronic tonsillitis, chronic sinusitis, chronic bronchitis).

10) Experience has shown that MLD can also be successfully included in the treatment of pathological conditions associated with local edema in the brain region (stroke, craniocerebral trauma). There are no lymphatic vessels within the skull. The lymphatic load produced there is drained via the Virchov-Robin spaces in the vessel walls and via the arachnoid sheaths along the olfactory and optic nerves to the lymphatic vessels of neck and face. Intrabuccal drainage encourages and supports cerebral decongestion. This has a favorable effect on cerebral concussion, apoplexy, headache, migraine and Meniere’s syndrome. Conditions associated with local edema in the bulbus, spinal marrow or along peripheral nerves also show distinct signs of improvement as a result of MLD therapy. acne patient

11) Proven dermatological applications for MLD include acne and rosacea.

12) MLD is used to drain away edematous changes in post-thrombotic syndrome and to heal ulcera cruris of various origins (venous, arterial, diabetic).

13) There are a number of other indications based on more recent experience with MLD, such as: mastodynia, so-called “cellulite”, fibromyalgia, scleroderma. As shown by a study conducted at the EVK hospital in Dusseldorf, MLD helps in cases of postpartum milk-stasis. One or two treatment sessions suffice to induce lactogenesis. Hence doctors at this hospital have stopped prescribing the medication previously used. Healthy individuals will also benefit from Dr. Vodder’s Manual Lymph Drainage. Women have long appreciated its salutary effect on swollen legs and its promotion of a healthy venous flow.

Contraindications for MLD

Manual Lymph Drainage (MLD) – contraindications Despite the great variety of applications for Manual Lymph Drainage there are a number of conditions which are contraindicated for this therapy:

  1. Any metastatic or systemic malignant condition must be excluded from MLD.
  2. MLD is not suited for the treatment of acute inflammation (caused by bacteria, viruses or foreign bodies).
  3. Any thrombosis at risk of causing embolism is an absolute contraindication.

Moreover, precautions are required if MLD is used in the following conditions:

  • a) Edema following carcinoma treatment
  • b) Thyroid dysfunction
  • c) Chronic inflammation
  • d) Bronchial asthma
  • e) Hypotension
  • f) Edema caused by cardiac decompensation should not be drained manually, as this may exacerbate such decompensation
  • g) Diabetes

Manual Lymph Drainage is an invaluable therapy that Dr. Vodder has put into our hands. It is now up to us to use it for the benefit of humankind. Any questions? If you have any questions as to whether and how you are eligible for our treatment regime, please do not hesitate to contact us.



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