Manual lymphatic drainage (MLD) is a gentle, rhythmic massage technique designed to improve the flow and function of the lymphatic system, aiding in detoxification and reducing swelling, especially after surgery or cancer treatment. Originating in the 1930s with Emil and Estrid Vodder, MLD has since been integrated into medical and therapeutic practices worldwide. Recent studies support its effectiveness in managing lymphedema, improving range of motion, and relieving pain, particularly when used over extended treatment periods. Today, MLD continues to evolve as a valuable approach within holistic and rehabilitative healthcare.
Key Takeaways
- MLD utilizes gentle, rhythmic movements to stimulate the lymphatic system, thereby reducing swelling and promoting detoxification, particularly in cases of post-surgical and cancer-related lymphedema.
- The technique was developed in the 1930s by Emil and Estrid Vodder and has since gained acceptance in medical and therapeutic settings, particularly in Europe and later in the U.S.
- Scientific research indicates that MLD is most effective when applied over longer treatment periods, resulting in improved symptoms such as edema, pain, and limited range of motion.
- MLD can be combined with other therapies to enhance patient outcomes in conditions like Axillary Web Syndrome and oral cavity cancer recovery.
- Modern variations of MLD, such as manual lymphatic mapping, allow for more targeted therapy and continue to expand its role in holistic and clinical health care.
Manual lymphatic drainage is a specialized manual technique that aims to improve the flow and function of the lymphatic system. By utilizing gentle, rhythmic movements, this therapeutic modality has gained significant recognition for its potential benefits in treating postsurgical edema and cancer-related lymphedema by enhancing detoxification and promoting overall well-being.
In this article, we will delve into the history and origins of manual lymphatic drainage (MLD), also known as lymphatic drainage massage, and elucidate the most recent scientific studies supporting claims related to MLD’s benefits.
An Overview of the Lymphatic System
The lymphatic system is a critical component of the human immune system. It is a complex network of vessels and organs that runs throughout the body, working continuously to maintain health and facilitate the regulation of the immune system. To understand the lymphatic system and MLD, it is essential to have a basic understanding of its components and functions:
• Lymphatic vessels: Lymphatic vessels are similar in structure to blood vessels, but they carry a clear, colorless fluid called lymph. These vessels form an extensive network that permeates nearly all tissues and organs in the body. Lymphatic capillaries, which are the smallest vessels, reach into interstitial spaces, collect and transport the fluid that surrounds the cells as lymph.
• Lymphatic fluid (lymph): Lymph is a clear fluid that contains white blood cells, proteins, cellular waste and pathogens. It originates from blood plasma and plays a crucial role in maintaining tissue health by removing toxins and waste products from the body’s cells.
• Lymph nodes: Lymph nodes are small, pea-shaped structures located throughout the lymphatic system. They monitor and cleanse lymphatic fluid by filtering out toxins and harmful substances, including bacteria and viruses.
Specialized white blood cells called lymphocytes trap and destroy invaders as part of the body’s adaptive immune system. Swollen or tender lymph nodes are therefore often a sign of an immune system response.
• Lymphatic ducts: There are two main lymphatic ducts in the body that collect lymph from various parts of the body and return it to the venous bloodstream. The right lymphatic duct drains the right upper quadrant of the body while the much larger thoracic duct collects lymph from the rest of the body.
• Lymphatic organs: In addition to lymph nodes, there are other lymphatic organs that play crucial roles in the immune system. These include the spleen, tonsils, thymus gland and bone marrow. Each of these organs contributes to immune function and helps filter, produce or store lymphocytes and other immune cells.
The Importance of the Lymphatic System
• Pathogen defense: Lymph nodes and lymphatic vessels serve as the body’s checkpoints for harmful pathogens. They trap and neutralize bacteria, viruses and other foreign invaders before they can spread throughout the body.
• Immune cell production: The lymphatic system plays a role in the production, maturation and activation of immune cells, particularly lymphocytes (T cells and B cells). These cells are responsible for recognizing and attacking specific pathogens.
• Waste removal: Lymphatic vessels remove cellular waste, toxins and excess fluids from tissues, helping maintain a clean and healthy environment for cells to function optimally. • Fluid balance: By regulating interstitial fluid levels, the lymphatic system helps maintain the body’s fluid balance, preventing edema (swelling due to fluid buildup).
The Pioneering Work of Emil and Estrid Vodder
The systematic development of lymphatic drainage massage began in the early 1930s with the groundbreaking efforts of Danish physiotherapist Emil Vodder. Inspired by the lymphatic works of French anatomist Marie Philibert Sappy, Vodder and his wife, Estrid, developed a unique manual method of stimulating the lymph vessels.1
While they initially intended to treat respiratory ailments, the Vodders soon discovered that gentle, rhythmic movements on the skin’s surface encouraged and improved the flow of the lymphatic fluid. Vodder’s revolutionary work and its benefits for the lymphatic system was documented in his book Manual Lymph Drainage, published in 1936.2
Vodder’s contributions gained recognition and acceptance within the medical community, particularly in Europe. Physicians began incorporating lymphatic drainage massage into their treatment protocols for conditions such as lymphedema or cases of chronic swelling because of post-surgical conditions or cancer treatment.
The technique’s effectiveness in reducing swelling and promoting healing contributed to its growing popularity, especially among post-surgical patients. This widening acceptance in the health care field led to the establishment of lymph drainage massage as a recognized medical practice in Europe.
During and after World War I and World War II, it was used to treat soldiers with lymphedema, a condition often associated with combat injuries.3 Lymphatic drainage massage also became a significant part of the European spa tradition in the mid-20th Century, particularly in countries like France and Germany.4
In the 1960s, Robert Lerner, MD, who had trained with Emil Vodder in Europe, became a passionate advocate for lymph drainage massage. He was instrumental in introducing Dr. Vodder’s Manual Lymph Drainage (MLD) treatment into the U.S. health care system during the 1980s. As one of New York’s leading surgeons, Lerner started offering diagnosis, treatment and education in his many clinics. Considered a pioneer in lymphedema care, he had a desire to help patients suffering with lymphatic conditions that could be managed with MLD.
3 Manual Lymph Drainage Research Studies
1. A systemic review of four electronic databases analyzed trials comparing treatment regimens with and without MLD as therapeutic interventions for breast cancer related post-mastectomy lymphedema (BCRL). A total of 457 patients were included in this study.
There was no significant difference in reduction of upper extremity edema reported between the treatment group that received MLD and the control group without; however, when the course of treatment was extended beyond 20 sessions, a significant reduction in the edema of the upper extremity could be observed.6
These findings suggest that, regardless of the initial presentation, the duration of treatment plays an influential role in the effectiveness of MLD in reducing clinical symptoms.
2. Another recent study explored the effectiveness of MLD combined with vacuum-sealing drainage in Axillary Web Syndrome (AWS) after breast cancer surgery. In this trial, 102 patients who had developed AWS after axillary lymph node biopsy or axillary lymph node dissection were included.
It was concluded that MLD combined with vacuum-sealing drainage can relieve relevant clinical symptoms, lessen the degree of pain, improve upper limb disability function and enhance the overall quality of life in patients with AWS.7
3. A third randomized single-blind study was conducted with 39 patients who underwent surgery for oral cavity cancer. Twenty of these patients were assigned to the rehabilitation-only group (R) and 19 to a rehabilitation plus MLD group (M). The R group received 30 minutes of rehabilitation intervention; the M group received 30 minutes of MLD in addition to 30 minutes of rehabilitation intervention.
The preliminary findings suggest a potential therapeutic role for early intervention when MLD is administered in addition to rehabilitation exercises. Clinical findings include improved lymphedema control and improvement of range of motion of the neck in acute care.8
Modern Applications
Lymphatic drainage massage as a therapeutic technique has evolved over time, drawing upon a rich history of practices already reported as part of ancient Egyptian and Chinese healing practices. While its origins can be traced back to ancient civilizations, it is in the modern era that MLD has gained recognition as a valuable therapeutic modality.
Advancements in medical technology have further expanded the understanding of the lymphatic system and the potential benefits of lymphatic drainage massage, helping MLD to continuously evolve and claim its place within contemporary health care.
Over the years, several specialized technique variations have emerged, such as manual lymphatic mapping, which aims to focus on specific areas of the lymphatic system for more targeted therapy, often associated with cancer staging and sentinel lymph node biopsy.5
MLD is a Valuable Therapeutic Approach
In summary, based on current scientific research it can be concluded that MLD, combined with other therapies, has a measurably significant impact on the treatment of lymphedema, edema, range of motion and pain management, especially when applied over extended periods as part of the overall therapeutic intervention framework. A growing body of research provides increasing evidence for MLD’s physiological and clinical benefits and helps establish its relevance as a valuable therapeutic approach in the realm of holistic health care.
About the Authors
After the sudden death of her father when she was 23, Delhia Gaynor, LMT, began her healing journey, launching her studies in massage at Mueller College of Holistic Studies in San Diego. For 20 years she has evolved a thriving practice in San Diego and Los Angeles, and served as a peer reviewer for the Commission on Massage Therapy Accreditation.
Andrea Winzer, MSc, LMT, CST-D, holds a master’s degree in ecology and is a board-certified massage and bodywork therapist. She practices CranioSacral Therapy and offers a variety of holistic treatment modalities. The authors wrote this article on behalf of the Massage Therapy Foundation.
About the Massage Therapy Foundation
The Massage Therapy Foundation is a 501(c)3 providing support to the massage therapy profession. Since 1990, MTF has provided over $1 million in research grants studying the science behind therapeutic massage.
MTF founded and publishes an open-access, peer-reviewed scientific journal and provides many educational resources for massage therapists, educators and students. MTF also provides community service grants to populations in need of therapeutic massage who would otherwise lack access.
Learn more, donate, or apply for a community service grant at massagetherapyfoundation.org.
Footnotes:
1. Suami H, Pan WR,, Mann GB, Taylor GI. “The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study.” Ann Surg. Oncol. Mar;15(3):863-71. Doi: 10.1245/s10434-007-9709-9. Epub 2007 Nov 28. Accessed Oct. 2023. pubmed.ncbi.nlm.nih.gov/18043970.
2. Vodder E, Vodder E. (2005). Manual Lymph Drainage: Therapy, Vol. 1.
3. Williams, AF (1946). “Lymphedema of the Extremities: The Influence of Peripheral Lymphatic Massage on Circulation.” 1946. The Journal of the American Medical Association, 13(12), 705-709.
4. Michard A, Levassor G, Jehl J, et al. (1965) “Drainage lymphatique en thérapeutique locale de l’insuffisance veineuse chronique des membres inférieurs.” Angéiologie, 17(4), 172-177.
5. Morton DL, Wen DR, Wong JH, et al. “Technical details of intraoperative lymphatic mapping for early stage melanoma.” Arch Surg. 1992;127(4):392-399.
6. Qiao J, Yang LN, Kong YH, Huang X, Li Y, Bai DQ. “Effect of manual lymphatic drainage on breast cancer-related postmastectomy lymphedema: a meta-analysis of randomized controlled trials.” Cancer Nurs. 2023 Mar-Apr;46(2):159–166.
7. Liu J, Chen D, Yin X. “Effect of manual lymphatic drainage combined with vacuum sealing drainage on axillary web syndrome caused by breast cancer surgery.” Int Wound. 2023 Jan;20(1):183–190.
8. Tsai KY, Liao SF, Chen KL, Tang HW, Huang HY. “Effect of early interventions with manual lymphatic drainage and rehabilitation exercise on morbidity and lymphedema in patients with oral cavity cancer.” Medicine. Baltimore. 2022 Oct 21;101(42):e30910.
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