Manual lymphatic drainage

Manual lymphatic drainage (MLD) is a type of gen-tle massage which is intended to encourage the natu-ral drainage of the lymph, which carries waste productsaway from the tissues back toward the heart. The lymphsystem depends on intrinsic contractions of the smoothmuscle cells in the walls of lymph vessels (peristalsis)and the movement of skeletal muscles to propel lymphthrough the vessels to lymph nodes and then beyond thelymph nodes to the lymph ducts which return lymph tothe cardiovascular system. Manual lymph drainage usesa specic amount of pressure (less than 9 ounces persquare inch) and rhythmic circular movements to stim-ulate lymph ow.[1][2]

1 HistoryManual lymphatic drainage was pioneered byDanish Drs.Emil Vodder and Estrid Vodder in the 1930s[2] for thetreatment of chronic sinusitis and other immune disor-ders. While working on the French Riviera treating pa-tients with chronic colds, the Vodders noticed these pa-tients had swollen lymph nodes. In the 1930s, it was con-sidered taboo to tamper with the lymphatic system due tothe medical professions poor understanding of this sys-tem. The Vodders were not deterred by this and, in 1932,began to study the lymph system, developing light, rhyth-mic hand movements to promote lymph movement. In1936, they introduced this technique in Paris, France, andafter WorldWar II, they returned to Copenhagen to teachother practitioners to use this therapy.[3]

2 RecognitionMLD is now recognized as a primary tool in lymphedemamanagement. Therapists can today receive certica-tion through special classes conducted by various orga-nizations specializing in MLD, or through a completelymphedema treatment certication course.[4] Scienticstudies show mixed results regarding the ecacy of themethod in treating lymphedema and further studies areneeded.[5] A 2009 meta-analysis of studies in the areaof sports medicine and rehabilitation showed best ev-idence of eectiveness for Manual lymphatic drainagetreatment to enzyme serum levels associated with acuteskeletal muscle cell damage as well as reduction of edema[swelling] around broken bones. [6] A 2013 system-atic review of manual lymphatic drainage with regard to

breast cancer related lymphedema found no clear supportfor the eectiveness of the intervention in either prevent-ing limb edema in at-risk women or treating women forthe condition.[7]

3 References[1] Miladys Guide to Lymph Drainage Massage; Ramona

Moody French; Delmar/Cengage; 2004

[2] Stillerman, Elaine (2009). Modalities for Massage andBodywork. Mosby. p. 129-143. ISBN 032305255X.

[3] Levine, Andrew (1998). The Bodywork and MassageSourcebook. Lowell House. pp. 17384. ISBN9780737300987.

[4] Complete Lymphedema Certication. Courses.Academy of Lymphatic Studies. Retrieved 16 July 2013.

[5] Manual Lymph Drainage Combined With CompressionTherapy for ArmLymph- edema Following Breast CancerTreatment. SBU.CE. Retrieved 25 April 2014.

[6] Vairo GL, Miller SJ, McBrier NM, Buckley WE (2009).Systematic review of ecacy for manual lymphaticdrainage techniques in sports medicine and rehabilitation:an evidence-based practice approach. J Man Manip Ther17 (3): e809. doi:10.1179/jmt.2009.17.3.80e. PMC2755111. PMID 20046617.

[7] Huang TW, Tseng SH, Lin CC, Bai CH, Chen CS,Hung CS, Wu CH, Tam KW (2013). Eects of man-ual lymphatic drainage on breast cancer-related lym-phedema: a systematic review and meta-analysis of ran-domized controlled trials.. World J Surg Oncol 11 (15).doi:10.1186/1477-7819-11-15. PMC 3562193. PMID23347817.

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