MLD_legTo complement the article “Vacuum Therapies: Mastectomy Recovery & Breast Reconstruction” in the October 2014 issue of MASSAGE Magazine. Summary: A certification in Manual Lymph Drainage (MLD) will allow you to network with other health care professionals to receive referrals of clients who may be experiencing swelling (edema) due to many medical conditions, including injury, postsurgical healing, autoimmune disorders, anxiety, post-traumatic stress disorder and cancer.

Adding manual lymph drainage certification to your massage therapy skill set opens up numerous possibilities for client referrals. Manual lymph drainage is a gentle manual technique that stimulates a malfunctioning or fatigued lymphatic system. Keeping the lymphatic system in good condition is imperative for promoting good health, and for restoring good health when the system has been compromised. 

A big part of the lymphatic system is located very close to the surface of the body, thus manual lymph drainage techniques are applied very effectively with much less pressure than regular massage. This reduces wear and tear on the therapist’s body. 

Who needs MLD

Many massage therapy clients suffer from either acute or chronic conditions that affect the lymphatic drainage system. These conditions are therefore more appropriately addressed with manual lymph drainage than regular massage. Clients who respond very favorably to manual lymph drainage include those with post-traumatic and postsurgical swelling, also known as edema. Swelling from a soft-tissue injury causes significant discomfort and pain and slows the healing process. Manual lymph drainage addresses this painful swelling and significantly reduces overall healing time, as shown in a 1999 study, “Manual Lymphatic Drainage Therapy: An Integral Component of Postoperative Care in Plastic Surgery Patients” (First Annual Conference of the American Society of Lymphology). 

Postsurgical clients who can benefit from manual lymph drainage include those recovering from cosmetic surgeries such as face-lifts, breast augmentation, and liposuction and orthopedic surgeries such as joint repair or replacement. Manual lymph drainage effectively reduces swelling even before appropriate muscle movement and function can be restored. 

Reduction in swelling is not the only benefit this technique provides. According to a 1989 study, “Experimental and clinical studies of the mechanism of effect of manual lymph drainage therapy,” in the German publication Zeitschrift fur Lymphologie (Journal of Lymphology), manual lymph drainage improves lymph flow; since waste elimination is an essential function of the lymphatic system, it follows that improved lymph flow helps eliminate waste products and inflammatory mediators from injured tissue. This leads to less pain, reduced scar tissue formation and faster healing overall. 

Manual lymph drainage is also very effective in a variety of autoimmune disorders where regular massage can be contraindicated, such as fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis and scleroderma. The most significant benefits of manual lymph drainage for these clients are a decrease in hypersensitivity and pain, as indicated in the study “Comparison of MLD Therapy and Connective Tissue Massage in Women with Fibromyalgia: A Randomized Controlled Trial,” National University of Health Sciences, Turkey, 2009; a decrease in tissue congestion and inflammatory mediators; and increased range of motion. In addition, in many of these clients, manual lymph drainage promotes a more restful sleep pattern and less overall fatigue. 

Manual lymph drainage also assists with stimulating the parasympathetic response in the body, so it’s indicated in situations where the nervous system has been compromised, such as with anxiety and post-traumatic stress disorder. These clients will benefit from general stress reduction, detoxification and enhanced immune function.

Over the last decade, manual lymph drainage has come to be recognized for its profound benefits to oncology clients immediately after surgery and later during their ongoing recovery period. MLD reduces edema, helps control pain, relieves constipation caused by pain medications, provides general relaxation, reduces stress and improves sleep. Due to the complexity of treatment and care for oncology patients, massage therapists may need to coordinate with their client’s physician.

Oncology clients who have undergone lymph node removal as part of their cancer treatment often develop a very specific swelling called lymphedema caused by localized damage to the lymphatic circulatory system. While a certified manual lymph drainage practitioner is trained to address simple, medically uncomplicated lymphedema, more complex clients—especially those with additional medical issues—should be referred to a physician or certified lymphedema specialist. 

Networking with doctors

Because manual lymph drainage is an effective treatment in clients suffering various medical conditions, networking with physicians and other medical professionals should become commonplace for massage therapists certified in manual lymph drainage. Certified lymphedema therapists, who are usually physical or occupational therapists, often refer their patients with lymphedema to manual lymph drainage-certified massage therapists who can provide a continuum of care.

After obtaining a client’s consent to discuss his medical history and speak with his physician, the massage therapist should introduce herself to the primary doctor or nurse practitioner in charge of the client’s care. Pertinent questions would be “Is manual lymph drainage treatment indicated for my client?” or “Is there a possibility manual lymph drainage will interfere with other medical conditions or treatments for this client?” Inquiries such as these are very important, particularly for oncology clients and clients with other complicated conditions. These inquiries are typically well-received by physicians because they demonstrate responsible client care by massage therapists—and open the door for additional physician referrals in the future.

Guenter Klose 8-20-14 (2)About the Author

Educated at the renowned Foeldi Clinic in Germany, Guenter Klose, L.M.T., C.L.T.-L.A.N.A., was instrumental in establishing lymphedema treatment centers and certification courses in the U.S. ( He is responsible for the manual lymph drainage and complete decongestive therapy education of hundreds of therapists. His most recent innovation is the development of advanced online courses.

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