Manual Lymph Drainage also referred to as Lymphatic Drainage is a type of hands on therapy that focuses on managing the flow of lymphatic fluid in the body. It was developed by Dr. Emil Vodder and his wife, Estrid) in 1936 in Paris for treatment of swollen lymph nodes. It is a light stretching of the skin and is composed of four main strokes: stationary circles, scoop technique, pump technique, and rotary technique. Lymphatic diseases, especially lymphedema, benefit from MLD.
There are a few other variations of MLD created by other practitioners:
Vodder Method – Different kinds of hand motions are used on the body depending on the part being treated. It also includes treatment of fibrosis.
The Dr. Vodder School teaches the original method of Manual Lymph Drainage (MLD) and has been authorized to do so by the Vodder themselves as well as the Dr. Vodder School in Austria. The North American School was founded by Robert Harris in 1994 and the administrative office is located in Victoria, British Columbia.
Foldi Method – Based on the Vodder technique, this method lays emphasis on thrust and releaxation. It helps in management of edema through ‘encircling strokes’. Guenter Klose, (Klose Training) the only MLD/CDT Instructor certified by the Physical Therapy Association of Germany (Verband Physicalische Therapie) actively teaching in the United States. Guenter was trained in Complete Decongestive Therapy at the world-renowned Foeldi Clinic in Germany in 1984.
Casley-Smith Method – This method involves use of small and gentle effleurage movements with the side of the hand based on the Foldi Method. Casley-Smith International offers training http://casleysmithinternational.org/
Leduc – It involves use of special ‘call up’ (or enticing) and ‘reabsorption’ movements which reflect how lymph is absorbed first in the initial lymphatics and then into larger lymphatics
- manual lymphatic drainage
- lymphedema rehabilitation exercises
- compression therapy
- skin care
- pneumatic compression
- elevation of the extremities
- thermal therapy
- complete decongestive physiotherapy (CDT) which is a combination of which of four methods (manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care)
- aqua lymphatic therapy.
History of Lymphatic Drainage
- The lymphatic system was first described in the 17th century independently by Olaus Rudbeck and Thomas Bartholin.
Gaspard Asselli (1581 – 1626). The first historical discovery of the lymphatic system was documented in 1622 which refers to the findings of milky in a dog after digestion. ‘Chilieferi’ ‘chlye’.
- Swedish anatomist Olauf Rudbeck (1630 – 1708) who declared that the lymphatic system was actually a complete and definite system within the human body and compared this to the venous circulatory system
- 1637 -Thomas Bartholin a young Dane studied Aselli’s work and injected gum resin and indigo into the lymph vessels to make them visible. He was the first to describe the entire lymphatic system. Wrote 4 papers in Latin describing the Lymph system as a natural process that purifies the body and regulates irritation, swelling and oedema. No official terminology was used to this stage
- 1650- John Pecquet (1622-1672) discover the lacteal vessels and the flow of lymph fluid in the largest lymphatic vessel into the vena cava. He had of course revealed the `Pecquets cistern` or as it is know today the `Cisterna Chyli`.
- Alexander of Winiwarter from Belgium (1848- 1910) who was the first medical practitioner to use manual lymph drainage in hospitals for relieving lymphoedema symptoms. This self- education of lymphatics was at last starting to show in Johan Conrad Peyer (Schaffhausen) some 20 years later described the intestine Lymph Nodes ‘Payers Patches’
- 1878- 1951 Add 20 or so years and the first International Lymphatic Society was formed. The Founder and president Fredrick.P.Millard (1878 – 1951) coined the phrase “lymphatic drainage” suggesting different techniques would affect the lymph flow. His work and discoveries were 10 years ahead of Emil Vodder Ph.D., M.T (1896 – 1986) and Estrid Vodder (1898 – 1996)
- 1892 (1). Alexander vonWiniwarter, in his book “Billroth’s Book of German Surgery”, described the four pillars for the treatment of lymphedema: lymphatic massage with very gentle pressure, in elastic bandaging, special skin care, and exercises
- 1936 – Emil and Estrid Vodder. Vodder’s technique was characterized by gentle, pumping, circular movements using pressures of around30mmHg, combined with a ‘zero’ or resting phase. The aim was to enhance drainage of lymph from the interstitial tissues without producing increased capillary filtration
- The Voders asked Hildegard and Günther Wittlinger in Austria to be their successors and to teach and train teachers in this method. The Wittlingers established the Dr. Vodder School – Austria in 1971 and brought the Dr. Vodder method to North America in the 1970’s.
- 1969 physician Johannes Asdonk scientifically used and tested the Vodder technique establishing the first training school for MLD in Germany. In the first lymphatic study, 347 years after it’s first discovery, 20,000 patients were tried and tested.
- 1980s Professors Michael Foëldi M.D and Ethel Foëldi advanced to another level by combining techniques known today as CDT, Complete Decongestive Therapy in the treatment of Lymphoedema. Their dedication and practice grew, incorporating specific training alongside Klose Training and Consulting and their methods continue to be used today amongst worldwide Lymphoedema practitioners.
- 1982. Dr. John R and Judith R Casley-Smith were lymphologist in Australia known for their research on the lymphatic system, developing lymphedema treatment options, and for raising awareness about lymphedema. They founded the Lymphoedema Association of Australia in 1982 to bring together the medical community, patients, and researchers to further the knowledge of lymphedema. Complex Lymphatic Therapy (CLT) is the Australian version developed by the Casley-Smiths off the European protocol of Complete Decongestive Therapy (CDT) for the treatment of lymphedema. Casley-Smith Lymphoedema Education Association
- 1980 – 1990. In America, Dr Bruno Chickly a member of the International Society of Lymphology created Lymph Drainage Therapy, LDT.
• Manual Lymphatic Mapping, MLM, differs from CDT as it creates alternative pathways for lymph and interstitial fluid. This safe and non-invasive technique more accurately helps identify alternate pathways in lymphoedema patients.
Benefits of Lymphatic Drainage Massage Therapy
- Reduces edema
- Reduces inflammation
- Prevents Lymphedema
- Used after breast cancer surgery
- Used after any surgery that produces inflammation and edema
Evidence on Manual Lymph Drainage
The mechanisms through which MLD has its effect are not fully established. While many courses and teachers make claims on how and why it works, it is mostly unsubstantiated claims. There is just not any research to support the current claims. It is a very difficult topic to study.
Science Direct – https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-lymphatic-drainage.
Lymphedema management. Sumner A. Slavin, … Arin K. Greene, in Supportive Oncology, 2011
Recommended Reading List
- Silent Waves: Theory and Practice of Lymph Drainage Therapy 3rd Edition by Bruno Chikly, MD, DO, LMT
- Földi, M., Földi, E., Strobenreuther, R., Kubik, S.: Foldi’s Textbook of Lymphology for Physicians and Lymphedema Therapists 3rd edition (amazon affiliate link) Urban & Fischer, 2012. ISBN 13:978-07234-3446-7 ISBN 10: 0-7234-3446-8
- Basic Principles of Manual Lymph Drainage Michael Földi MD, Roman Strößenreuther MD, in Foundations of Manual Lymph Drainage (Third Edition), 2005
- Guyton, A.C., Hall, J.E.: Textbook of Medical Physiology. (amazon affiliate link) 13th edition Chapters 16 and 25. Philadelphia, PA, W.B.Saunders Elsevier, 2015. ISBN 978-1-4160-4574-8
- Kasseroller, R.: Compendium of Dr. Vodder’s Manual Lymph Drainage. Haug Verlage, 1998. ISBN 3-7760-1729-5 (amazon affiliate link)
- Weissleder, H., Schuchhardt, C.: Lymphedema – Diagnosis and Therapy. 4th edition. Kagerer Kommunikation, 1997, and Viavital Publishers, 2001, 2007. ISBN 3-934371-38-8 ISBN 13 978-3-934371-38-5 (amazon affiliate link)
- Wittlinger, H., Wittlinger, D., Wittlinger, A., Wittlinger, M.: Dr. Vodder’s Manual Lymph Drainage. A Practical Guide. 2nd edition.(amazon affiliate link) Georg Thieme Verlag, 2018. ISBN 978-3-13-143191-2
- Zuther, J.: Lymphedema Management: The Comprehensive Guide for Practitioners. 4th edition. Thieme Medical, 2017. ISBN: 978-3-13-139482-8
- Lee, Byung Boong., Rockson, Stanley G., Bergan, John.: Lymphedema: A Concise Compendium of Theory and Practice. 2nd edition. Springer, 2018. ISBN-13: 978-3319524214
Certification in Lymph Drainage Techniques
The one and only Certification in Lymphatic Drainage is through the Lymphology Association of America (LANA)