Manual Lymphatic Drainage (MLD) and Complete Decongestive Therapy (CDT)

What is manual lymphatic drainage (MLD)?

Manual lymphatic drainage is a gentle technique that employs the knowledge of the lymphatic system and uses subtle hand motions to assist in clearing fluid. It was first invented by Dr. Emil Vodder in 1932, and adapted by Dr.'s Michael and Ethel Foeldi to include compression and exercise for the now gold standard treatment of lymphedema - Complete Decongestive Therapy (CDT).

This gentle mobilization of the soft tissue increase the uptake and transport of lymph and interstitial fluid. This lymph fluid ultimately empties into the blood circulation. Following treatment many patients report feeling generalized relaxation, and increased urine output due to the movement of fluid.

Common conditions treated with manual lymphatic drainage (MLD)

Manual lymphatic drainage can be used to increase local uptake of fluid in various conditions including:

  • Lymphedema (post breast cancer surgery and treatment, post cervical cancer surgery and treatment, primary lymphedema)
  • Phlebo-lymphostatic edema
  • Post-surgical edema (hip and knee replacements, post c-section, post abdominoplasty and breast reduction)
  • Complex regional pain syndrome
  • Dependent edema related to paralysis
  • Rheumatoid arthritis

Contraindications

Please inform your physiotherapist if you have any of the following conditions:

  • Congestive heart failure (CHF)
  • Cellulitis
  • Renal failure
  • Acute deep vein thrombosis (CVT)
  • Abdominal aortic aneurism (current or history of repair)
  • Crohn's, ulcerative colitis
  • Clot prevention devices ("greenfield filter")
  • Recent abdominal surgery

Complete Decongestive Therapy (CDT)

What is CDT?

CDT is a treatment approach developed with two phases, an intensive phase, and a home care management phase to address lymphedema. The intensive phase involves being seen by a certified lymphedema therapist (CLT) 3-5 days a week for 1-2 hours at a time. This phase lasts on average 2 weeks, but may last longer depending on severity of symptoms. The patient will then transition to a home care phase with compression garments.

It is endorsed by The Canadian Lymphedema Framework, the International Lymphedema Framework, and the National Lymphedema Network, among others, as the gold standard approach to treatment. While there is no cure for lymphedema at this time the symptoms can be well managed with this approach.

CDT has 4 components:

  1. Compression bandaging: Application of a short stretch bandage in multi-layers creates a "soft cast" that provides gradient compression to assist in moving fluid. This compression can also assist with softening skin changes seen in chronic lymphedema. Bandages are kept on for 23 hours a day during the intensive phase.
  2. Manual Lymphatic Drainage (MLD): specialized form of manual therapy using sound knowledge of anatomy to stimulate fluid movement in the lymphatic system and by-passing any blockages. The technique takes between 30-45 minutes a session and is very light and comfortable. Patients may be taught a modified version of MLD for home treatment.
  3. Skin care: Due to the accumulation of protein-rich fluid found in patients with lymphedema there is a high risk of developing an infection. Patients are directed to pay close attention to the skin daily, applying a low pH lotion to keep the skin barrier healthy.
  4. Exercise: Often known as "remedial exercise". This combines specific movements with compression bandaging on to activate the muscle pump and assist with fluid movement.

What to expect with CDT?

When CDT is administered by a Certified Lymphedema Therapist (CLT), research has shown the most common outcomes to be limb volume reductions of 50-70%.

Lymphedema predisposes patients to an increased risk of cellulitis (a sudden infection that requires antibiotics immediately as it can spread very quickly to the bloodstream). CDT assists in moving stagnant fluid in the limb, teaches patients risk reduction practices, and reinforces the importance of skin care which will reduce the risk of cellulitis.

If you have questions about CDT please contact Amanda (Certified Lymphatic Therapist) at the Welcome Back Clinic.