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Manual Lymphatic Drainage - Therapeutic Applications

by Brina Eidelson. Photos by John Halford(more info)

listed in massage, originally published in issue 71 - December 2001


In the last ten or fifteen years, awareness of the body's lymphatic system has grown enormously, not only amongst the medical profession, but also in the world of complementary medicine and hence amongst the general public. The lymphatic system has been ignored and abused, and yet it is the life-saving and most hard-working system of the body. It takes nutrients to the tissue cells, collects the debris such as toxins, cell waste and dead particles, delivers antibodies and other immune constituents, and ensures that the right balance of fluid is constantly bathing all the cells of the body.

In the 1930s, Dr Emil Vodder and his wife Estrid, both physiotherapists from Denmark, were working in the south of France in the health spas where many people came from all over Europe to get away from their damp climates in the hope of shaking off the constant respiratory infections they suffered. The accepted view at that time was that lymph nodes were like the proverbial 'can of worms' – harbouring all sorts of diseases – and should not be tampered with. Dr Vodder was inspired to try some gentle pumping movements over the enlarged cervical lymph nodes of some of the patients, who not only had nose and throat infections, but also migraines and blemished skin to name but some of the complaints. Dr Vodder found that generally, after ten treatments, all the complaints cleared up, and this was the beginning of what he came to name Manual Lymph Drainage (MLD).

The Lymphatic System Chart
The Lymphatic System

Dr Vodder and his wife developed systematic movements to treat the entire body and they eventually presented this new treatment to the public. In the years following the war other health professionals became interested in the method and several became associates of Dr Vodder. They eventually went on to establish the first clinics specializing in lymphological disorders, followed by the establishment of the first schools. Today there are five main schools that teach MLD based on the work instigated by Dr Vodder, namely the Vodder School in Austria, the Foldi School in Germany, the School of Professor LeDuc in Brussels, the Asdonk School and the Casley-Smiths School in Australia. These schools are recognized by MLDUK, the authoritative UK association that monitors standards and has a register of practitioners and qualified teachers of the Vodder School who hold courses in the UK.

Method and Applications

Many complementary practitioners are now aware that MLD is an excellent therapy for assisting the body to collect and move lymphatic fluid. This very light and rhythmical massage is used to clear congestion and it is this factor that can make an enormous difference to one's health and well-being. Starting with the tiny lymph collectors just under the skin, the intricate network of lymphatic vessels needs to be stimulated gently to transport the lymph efficiently along the appropriate pathways. The lymph is cleansed by the clusters of nodes it meets along the way and the clean lymph eventually rejoins the bloodstream via the large veins in the cervical area.

While the fluid is still within the tissues of the body it is known as tissue fluid, or prelymph. This fluid can become static for a variety of reasons, such as an overload of toxins and mucus resulting from poor diet or exposure to a polluted environment, or the lymph pathway may have been cut off due to surgery or injury, or there may be a congenital problem such as an insufficient lymphatic system or impaired venous circulation. When this happens the result is a puffy or swollen appearance in all or certain parts of the body, slow healing, problems such as allergies, headaches, acne, sinusitis, low energy and constant infections due to impaired immune function.

Clients who undertake a series of MLD treatments notice a dramatic improvement in all these symptoms and additionally will usually find new energy, a feeling of lightness and improved skin texture. Additionally, because of the light, rhythmical strokes the nervous system is calmed down and this lowers blood pressure, counters stress and improves sleep patterns.

The first therapists who were willing to try out this new technique were the beauty therapists. They quickly found that a MLD face treatment improved the skin's appearance by minimizing scar tissue, bringing elasticity and freshness back to the skin and tightening up sagging tissue. It was also found that welcome side effects were the same as those discovered by Dr Vodder, i.e. infections cleared up, sinus problems went away and any healing was speeded up. Gradually the news about MLD spread and physiotherapists, nurses and massage therapists became interested.

Amongst the many conditions that MLD can treat successfully are acne, acne rosacea, sinus congestion, strains and sprains, healing of flesh wounds, pain from chronic conditions such as arthritis, migraine and headaches, symptoms of chronic fatigue syndrome, tiredness, constipation and much more. It will also help stretch marks and scarring, although this can take a longer time, as with cellulite.

An MLD therapist will usually take an interest in the client's lifestyle, and in the case of cellulite for example, the therapy will only work if the accompanying diet is free of toxins and mucus-forming foods. The client will be given exercises and be taught some simple massage strokes to be done every day.

But the condition that MLD is most famous for helping is oedema, or water retention in all its guises, and its more serious manifestation known as lymphoedema.


The medical profession is primarily interested in MLD due to its ability to help manage problems of lymphoedema. This condition manifests as severe swelling of a limb, or parts of the torso, which causes great discomfort and inconvenience to the sufferer. The limb's ability to recover from infection due to a bite or injury is impaired and this can lead to cellulitis, a serious localized infection that will not heal without the help of antibiotics. There are two types or lymphoedema: primary lymphoedema and secondary lymphoedema.

Primary lymphoedema may be caused by an insufficient lymphatic system or poor venous circulation. It usually starts in the feet and ankles and can gradually move up one or both legs. It can come on at any age and is often seen in the young.

Secondary lymphoedema results from the lymph pathway being cut off. This is common after cancer surgery where the adjacent lymph nodes are removed. Women who have had breast cancer often develop a swollen arm, while surgery for uterine cancer and testicular or prostate cancer can cause swelling to develop in the lower abdomen, legs and sometimes the genitals.

Lymphoedema can be brought under control and managed with the use of Complex Decongestive Therapy (CDT) of which MLD is an essential part. CDT consists of exercises for the affected limb, MLD, compression bandaging, skin care and the wearing of compression garments.

In the case of primary lymphoedema, the MLD treatment begins with gentle stimulation of the whole system by working on the neck region, then stimulation of the whole lymphatic pathway connected to the affected limb(s). Secondary lymphoedema is treated differently in that the excess fluid has to be directed away from the blockage and made to drain via a different pathway. For example, if a patient has a swollen arm due to the axillary lymph nodes having been removed during breast surgery, there would be no point in stimulating the arm to drain via its usual route, i.e. into the axilla (armpit). So MLD techniques are applied to open up collaterals in the chest and across the back, and the fluid is 'pushed' across to the other axilla where it can drain into the rest of the lymphatic system.

Following the MLD massage, compression bandaging is applied to the arm or leg. This consists of bandaging the fingers or toes, then wrapping the limb in layers of padding followed by several layers of short stretch bandages firmly wound around it. Specific exercises are prescribed for the limb and the bandages are left on for 24 hours, preventing the fluid from building up again. The process of MLD, bandaging and exercise is repeated each day for two to three weeks in order to achieve a dramatic improvement in the swelling. The client then needs to follow up this intensive period of treatment with maintenance treatments every few weeks, and to wear compression stockings or sleeves as often as possible.

There are some contraindications where MLD would not be appropriate and the practitioner will always check these out and speak to the GP or specialist if necessary. The main contraindication is oedema caused by cardiac insufficiency.

Lymphoedema Case Study

Susan Parker (53) has had primary lymphoedema in her feet and ankles since a very young age. As a teenager she remembers sometimes not being able to get her shoes on and, although she was quite sporty, her abdomen would regularly get bloated and her whole body seemed to swell. Susan has a history of constipation and sometimes would not pass stools for three weeks at a time. She often had headaches or a 'woolly' head. Her GP offered very little in the way of help with any of these problems.

With the menopause, the swelling seemed to get worse and Susan finally got cellulitis in her left leg. Out of desperation she asked her GP to arrange for her leg to be amputated, and it was then that he eventually referred her to a vascular consultant. The consultant diagnosed primary lymphoedema and gave her the name of an MLD therapist.

The MLD therapist applied CDT treatments every day for four weeks. Not only did Susan's feet and ankles go down, but she started to pass stools almost every day and her abdomen and body stopped swelling quite so much. For the first time in years she was able to wear ordinary shoes.

The MLD therapist moved away and Susan let things slide despite having been referred to another therapist. When the swelling started to return she undertook another intensive three-week course of treatment with the new therapist and good results were achieved. The therapist took an interest in Susan's diet and they decided that an intestinal cleansing programme would be beneficial. Susan did a three-month cleanse, using herbal tablets and a powder containing psyllium husks and herbs, while continuing with the CDT treatments. This combination had the effect of getting rid of old faeces and intestinal residue, giving Susan new energy and a feeling of lightness. The swelling in her legs, abdomen and around her neck reduced further. She now feels good most of the time and likes to eat a fresh, wholefood diet.

Susan continues to have CDT treatments every three weeks, wears her compression stockings and is enjoying the look on the faces of her friends when they see the difference in her.

Sinus Congestion

Oedema of the mucus membranes and an impaired immune system can cause chronic sinus congestion and sinusitis. These conditions respond well to MLD because it has the effect of reducing the oedema of the membranes while also boosting the immune system.[1] The treatment includes intensive work on the face and also intra-orally to stimulate lymph flow over the hard and soft palates.

Case Study – Sinus Congestion with Chronic Catarrh and Abdominal Bloating

Allan (73) has had chronic catarrh as far back as he can remember, but it became intolerable in 1972 after he'd had a bad cold. Mucus continually collects in his sinuses, then drips down the back of his throat and collects in his lower pharynx causing him to cough and choke. Allan was unhappy with the drugs and sprays from the doctors and when he read about MLD decided to give it a try.

When there are problems with the respiratory tract there is usually a connection with the digestive tract, and during the consultation it came to light that Allan also had gaseous bloating of his abdomen with some discomfort and irregularity of bowel movements.

MLD treatments commenced, concentrating on Allan's face, sinuses and intra-orally and also his abdomen. After the third treatment the symptoms were the same but Allan was feeling good. He had tried to do his own intra-oral work but found it difficult. By the fourth treatment both the catarrh and bloating were starting to improve and by the seventh treatment the congestion in his throat was almost under control.

After ten treatments Allan was feeling very good and was only having an occasional episode of catarrh and bloating. He can now cope quite well for up to three months at a time without a treatment. The episodes are also related to his diet - Allan has a healthy vegetarian diet but binges occasionally on cream teas and this can trigger an episode!

Migraines and Headaches

A migraine attack characteristically has sudden onset pain, which becomes unbearably sharp and is usually accompanied by nausea and even vomiting. It can be triggered by many factors, such as the weather, hormonal changes, certain foods, etc. In the disease picture, the physical processes that occur result in oedema accumulating around the blood vessels in the head and neck area, therefore MLD is very effective in treating it. Again, there is a connection with the digestive tract, and migraine sufferers often have constipation.[1]

Chronic headache can be the symptom of any number of ailments, e.g. high or low blood pressure, stress, muscle strain, sinus congestion, poor eyesight, poor digestion and toxicity, etc.

Case Study – Migraine and Headaches

Roberta (42) had to have a lot of surgery to her face as a child and teenager as well as the removal of her tonsils and appendix. This has left her suffering with at least six migraine attacks every month and headaches in between. Her abdomen gets bloated and by the end of every day it is hard, bloated and tender even though she has one or two regular bowel movements per day. Roberta takes a lot of painkillers and has of course had a lot of drugs through her system due to all the surgery.

Roberta heard about MLD and decided to give it a try and initially came for treatments twice a week.

Roberta was quite swollen around the neck area and this started reducing almost immediately. After the third treatment she noticed an improvement in her abdomen and her headaches seemed to be at bay for a few days. After the fourth treatment the bloating had come back, but the headaches were milder. In discussion, Roberta decided that she would undertake the three-month intestinal cleansing programme to try and rid her body of the toxic residue that must have built up. She started the cleanse just before the fifth treatment, and at the seventh treatment the bloating was much better and the pattern of migraines was changing.

At this stage Roberta got a virus and had to miss some treatments, and then was laid up with a bad back. Some of the oedema to her neck and face returned. She restarted treatments but had to spread them out. The cleansing programme was going well and she had lost six pounds. By the twelfth treatment the abdominal swelling was very much improved and the number of migraines and headaches had reduced to a tolerable level. She maintains this situation by continuing to have occasional treatments.


1. Kasseroller Renato. Compendium of Dr Vodder's Manual Lymph Drainage. Haug Publishing. Heidelberg. ISBN 3-7760-1729-5. 1998.

Further Information

For more information about MLD, therapists or where to train, please send an SAE to MLDUK, PO Box 14491, Glenrothes, Fife, Scotland KY6 3YE; tel: 01592 840 799; or visit the website at For information on lymphoedema, contact the Lymphoedema Support Network, tel: 020 7351 4480.


  1. Debbie said..

    This is great i nformation. I am currently studying manual lymphatic drainage for my diploma of Beauty Therapy. Thanks

  2. gayle said..

    Fantastic information. I have recently been diagnosed with breast cancer and am working with a Muscle Therapist who works specifically with the lymph system. WHY ISN'T THE MEDICAL COMMUNITY more aware of the importance of stimulating the lymph system?

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About Brina Eidelson. Photos by John Halford

Brina Eidelson is trained in MLD, naturopathy, aromatherapy and Reiki and specializes in the management of lymphoedema. John Halford is also trained in MLD and lymphoedema management, as well as scenar therapy and colon hydrotherapy. Brina may be contacted on Tel: 07798 765986;

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