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Case Study Issue 99: Manual Lymphatic Drainage for Congestion, Oedema and Stress

by Nina Pearson(more info)

listed in case studies, originally published in issue 99 - May 2004

Every health practitioner has cases which are of particular interest and give extra insight into therapies which they practise. One such client of mine is Joanna, a fifty year old self-employed accountant, who works long hours visiting clients all over the Southeast. Joanna was extremely tired when she arrived at my clinic one February afternoon, and I understand that this is a common condition suffered by all accountants at the end of ‘tax assessment’. However, tiredness was the least of her problems. I could see that her stress levels were extremely high. Apart from work, her husband had recently been fitted with a pace-maker, as his heart had begun stopping intermittently and she was looking after her elderly parents, neither of whom were well. Her sleep pattern consisted of only a few hours quality sleep.

Joanna, who was overweight, presented with chronic asthma which was under control with drugs, and muscular pains in the limbs and shoulders, along with aching in the lower spine where her vertebrae were beginning to fuse. When asked to stand, she could not stand fully upright without concentration and scoliosis to the left was visible. Ten years ago, Joanna had a very bad fall down her stairway from which she has never fully recovered, and she felt sure the muscular trauma caused then, plus bending over a computer all day, was the reason for her skeletal problems. Joanna visits a physiotherapist regularly.

Examination of Joanna revealed fluid retention in her legs and ankles and also her fingers, all of which are worse when sitting for long periods. She explained that excluding wheat from her diet helped the abdominal bloating and relieved her loose stools which she was prone to experiencing. She was also menopausal, suffering with extended periods, which were a nuisance. On observation, I could see that her breathing was shallow and more rapid than I would expect. Her blood pressure was normal. After taking a consultation, we agreed that initially I would give Joanna five treatments at four day intervals and the aims of her treatments would be to:

•    Reduce the overall amount of joint and muscle pain that she suffers on a daily basis;
•    Lower her stress levels and increase her energy levels;
•     Reduce the amount of oedema in lower limbs.

To quote from Joanna, “Anything else will be a bonus!”

These aims could be achieved with various therapies, but Manual Lymphatic Drainage (MLD) can address all of these problems at the same time. MLD is primarily thought of as a treatment for lymphoedema; however its other known benefits are often forgotten, including a reduction in stress levels, strengthening of the immune system, and an increased feeling of well-being. Although asthma is a contra-indication of MLD, and certainly during an acute allergic reaction it is specifically contra-indicated, it can be used with caution with a client whose asthmatic attacks are under control with drugs, providing over stimulation of the vagus nerve does not occur, as this could trigger an attack.

First Treatment

This was a half hour treatment, involving the drainage of face and upper chest. Joanna was impressed by the feeling of relaxation she achieved. Could such light moves be doing anything?

Homecare advice:

•    Increase water intake;
•    Exercise the ankles to improve circulation – exercises given;
•    Start consciously trying to relax;
•    Discussed wheat free diet and made suggestions;
•    Suggested visit to physiotherapist for weekly treatment.

I was surprised at how much tension I could detect with my fingers as I worked on Joanna’s face with drainage moves which are slow and rhythmic. These specific movements have an on/off pressure in the direction of lymph flow. The skin is moved, rather than the hands moving over the skin as demonstrated in Swedish Massage.

Second Treatment.

I gave a one hour treatment, as no negative effects were experienced previously. It included the drainage of neck, arms, legs, and thoracic back. “It’s not sleep but a state of deep relaxation”, exclaimed Joanna, and her chest felt less tight. Joanna’s legs felt very congested indicating that toxin and cell waste were not being cleared away and the lymph had become less fluid and slightly ‘sticky’. The ground substance which makes up the connective tissue becomes saturated and concentrated with protein, which then begins to form small masses resulting in stiffness and aching in the muscles and joints. The gentle drainage movements encourage drainage away from the extra-cellular spaces and into the pre-collector lymph vessels.

Third Treatment

Joanna has had a little more energy and two really good nights’ sleep since last treatment. This was a one hour treatment. Drained back of head, full back plus chest and abdomen. Joanna experienced deep relaxation again and her breathing was noticeably deeper. The continuous almost monotonous rhythm of MLD is deeply calming, influencing the parasympathetic nervous system, which determines our rest and sleep. MLD influences muscular hypertension through the autonomic nervous system. Also, constant stimulation of the pressure receptors in the skin can inhibit pain.

Fourth Treatment

Joanna’s sleeping is improving. She is waking later and beginning to feel more refreshed. As her breathing is easier, she is starting to reduce the number of puffs from her inhalers. A complete full body MLD treatment was performed and Joanna was fully relaxed throughout, her back feeling more comfortable afterwards. The MLD treatment encourages the flow of lymph from one lymphangion (the length of vessel between two valves) to the next to become regular and flowing. Everyday movements of the body also encourage the flow of lymph, hence the need for exercise and relaxed breathing.

Fifth Treatment

Joanna arrived today with a spring in her step. She is sleeping well almost every night, feels generally less stressed and “more in control of her life”. Breathing has been easier with much reduced use of her inhalers which in turn reduces their side effects. This is a bonus she wasn’t expecting. Joanna has experienced less aching and heaviness in her legs with a reduction in the fluid retention, especially around her ankles, and her hands feel less tight.

A complete treatment was given again, and  I then confirmed with Joanna that she was following the homecare advice, suggesting that she raised her legs in the evening to help the fluid, which she was accumulating in her ankles by the end of the day.


Joanna now visits me every three weeks for a full treatment, which keeps her physically and emotionally in control of her body and the demands made upon her. She can stand and walk without pain and her breathing is greatly improved. Much can be achieved with this single therapy – Manual Lymph Drainage.


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About Nina Pearson

Nina Pearson is a complementary health practitioner, MLD tutor and therapist, practising from her clinic in Sutton Surrey. Contact Nina for MLD Courses accredited to the British Manual Lymph Drainage Association and taught in Scotland and England. She can be contacted on Tel: 020-8643 1609

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