What is manual lymphatic drainage, and does it work?

What is manual lymphatic drainage?

Manual lymphatic drainage (MLD) is a specialised hands-on technique performed by trained therapists. It uses light, slow, rhythmic movements that stretch the skin in specific directions to encourage lymph fluid to move from swollen areas towards working lymph nodes.

It is different from deep tissue massage. The pressure is very light because the lymph vessels lie just under the skin.

How is MLD used in lymphoedema treatment?

MLD is often part of complex decongestive therapy, which combines manual lymphatic drainage, compression therapy with bandages or garments, skin care and exercises that help reduce swelling. The first phase aims to reduce swelling and the second phase to maintain the reduction 1.

During the intensive phase, MLD may be given several times a week together with compression bandaging, followed by self-management with garments and exercise.

What does the evidence show?

A Cochrane review of six trials of MLD for breast cancer-related lymphoedema found that compression bandaging alone reduced swelling by 30 to 38.6 per cent, and adding MLD gave an additional reduction of 7.11 per cent, based on two trials with 83 participants 2.

People with mild to moderate lymphoedema responded better to MLD than those with moderate to severe lymphoedema. MLD was well tolerated and safe in all trials. The trials were small, with 24 to 45 participants each 2.

Is MLD better than compression garments alone?

A randomised trial of 103 women compared compression garments alone with daily MLD and bandaging followed by garments. The reduction in excess arm volume after six weeks was 29.0 per cent with MLD and bandaging and 22.6 per cent with garments alone, a difference that was not statistically significant, although absolute volume loss was greater with MLD and bandaging 3.

These findings suggest that MLD may be most useful as part of combined treatment for selected people rather than as a standalone therapy.

What is simple lymphatic drainage?

Simple lymphatic drainage is a self-massage technique taught by therapists that people can use at home between sessions. It uses similar principles to MLD but is simplified.

Along with exercise, skin care and compression, it forms part of long-term self-management for many people.

Who should not have MLD?

MLD may not be suitable, or may need adaptation, for people with active skin infection such as cellulitis, untreated blood clots, uncontrolled heart failure or some kidney conditions. People with active cancer should discuss treatment with their oncology team.

A qualified lymphoedema therapist assesses whether MLD is appropriate before starting.

What happens during an MLD session?

A session usually starts with gentle work on the neck and trunk to prepare healthy lymph nodes and vessels, followed by slow, rhythmic movements on the swollen area, directing fluid towards areas that drain well. The therapist may also check the skin, measure the limb and adjust compression.

Sessions often end with compression bandaging or a garment to maintain the effect. The treatment should feel relaxing and should not cause redness or pain.

How do I choose a qualified therapist?

Look for a therapist with recognised training in lymphoedema management and experience in combined decongestive therapy. They should assess your medical history, measure the affected limb and explain a plan that includes compression, exercise, skin care and self-management.

A good therapist also teaches you how to manage lymphoedema yourself, including simple lymphatic drainage, skin checks and when to seek help. Long-term self-care is as important as treatment sessions.

When should swelling be checked urgently?

Seek urgent medical help for redness, warmth, pain and increasing swelling with fever, which may indicate infection.

Sudden, painful swelling of a limb could indicate a blood clot and needs urgent assessment.

Frequently asked questions