About manual lymphatic drainage (specialised massage) for lymphoedema

Manual lymphatic drainage (MLD) is a way of reducing swelling caused by fluid build up after cancer treatment. There are different types of manual lymphatic drainage (MLD). They include Vodder, Földi, Casley-Smith and Fluoroscopy guided manual lymphatic drainage (FG-MLD).

You should only have MLD from a specially trained therapist in one of these types.

How it works

The aim of MLD is to move fluid from the swollen area into a place where the lymphatic system is working normally.

To do this, the specialist first uses specialised skin movements to clear the area that they want the fluid to drain into.

It might seem strange to have skin movements on your chest and neck if you have lymphoedema in your arm. But it means that the fluid has somewhere to drain to when the therapist treats your arm.

How you have MLD

You usually lie down to have MLD. But if you have lymphoedema in your head and neck, you sit up.

When you have MLD, you feel a gentle pressure. The skin movements are very light so that the small lymph vessels are not flattened. Flattened lymph vessels would prevent the lymph fluid from draining. The movements are slow and rhythmic so that the lymph vessels open up.

You might have MLD daily from Monday to Friday. Or you might have it 3 times a week, for about 3 weeks.

The number of treatments you have depends on the type of MLD and what you need. Your specialist will also take into account the amount of swelling you have.

After MLD

The specialist might bandage the area. They use a specialised bandaging technique called multi-layered lymphoedema bandaging. If it is not possible or necessary to use bandages, you will need to wear a compression garment.

Your lymphoedema specialist will regularly check how well your treatment is working. They’ll look at whether the tissues are softening and how much the swelling is going down.

Once the swelling is under control, you might need another compression garment to wear.

Remember that you are the person who will notice changes in the swelling first. You need to talk to your specialist about how your treatment is working. Managing lymphoedema is very much about you and the specialist working together.

Simple lymphatic drainage

Simple lymphatic drainage (SLD) means that you learn how to do an easier version of MLD yourself. It is sometimes called self massage.

A specialist needs to teach you how to do this. Your lymphoedema specialist might teach you to do SLD in only the areas where you don’t have lymphoedema. This frees up space for the lymph fluid to drain into from the swollen area.

You don’t do SLD in the area where you have swelling. The skin movements in the swollen area are more difficult to do. Your therapist will show you how to move the skin in the surrounding areas. Ask them questions if anything is not clear.

You do SLD twice a day, for about 20 minutes each time. Only apply light pressure, as your lymphoedema specialist taught you.

When you shouldn't have MLD or SLD

There are some situations when you should not have MLD or SLD. Your lymphoedema specialist will tell you whether you can or can’t. Always check with them if you aren't sure.

You might not be able to have MLD or SLD if you have any of the following:

  • an infection or inflammation in the swollen area
  • a blood clot
  • heart problems
  • cancer in the area

If you are uncertain about having MLD or doing SLD, talk to your doctor or lymphoedema specialist.

Last reviewed: 
20 Aug 2019
  • Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near-Infrared Imaging
    C Lopera and others
    Lymphatic Research and Biology, 2017, Jul 27

  • Manual lymphatic drainage for lymphedema following breast cancer treatment
    J Ezzo and others
    Cochrane Database of Systematic Reviews, 2015 May 21;(5)

  • Lymphoedema Care
    Woods, M
    Blackwell Publishing Ltd, 2007

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