Manual Lymphatic Drainage

Does Manual Lymph Drainage Make a Difference?

In people with damage, genetic abnormalities, or comorbidities impacting the lymphatic function causing abnormal collection of fluids in the peripheral tissue (aka lymphedema) complete decongestive therapy is the gold standard of treatment. Complete decongestive therapy involves the use of compression therapy, healthy skin care practices, and specialized massage called manual lymphatic drainage to improve the mobility, reduce the size of the affected limb, and improve the quality of life of individuals suffering from this disease. To get a better understanding of this modality let’s cover some terms, anatomy, and physiology.

Figure 1.

The lymphatic system is a bridge between the circulatory system and the endocrine system. It has aspects like arterial and venous systems designed to help with edema management, immune function, and part of the sewage system of the body (figure 1). The vessels themselves are designed like the venous system in that they have one-way valves aimed at returning lymph fluid to the heart. And, like the arterial system they have intrinsic muscles that help to pump fluid up toward the heart in conjunction with muscle contraction (figure 2). As the fluid is pumped closer to the heart, they pass through nodules that house lymphocytes which evaluate particles as either cancerous or bacterial/viral and can sound the alarm for the immune system to attack. This is why doctors will feel lymph nodes around your neck to see if they are swollen when sick. This can be a sign of infection or a sign of the presence of cancer in conjunction with correlating symptoms (just because you feel a bump somewhere doesn’t mean you have cancer – contact your physician or trusted physiotherapist if you are concerned!).

Figure 2.

Manual Lymph Drainage (MLD) is a modality used by certified lymphedema therapists to stimulate alternative routes of drainage in the superficial lymphatic tissue of individuals that have either damage or genetic abnormalities in their lymphatic tissue. The process involves light massage in specialized ways to simulate the pumping mechanism innervated by the sympathetic nervous system to empty the cellular debris, pathogens, and damaged tissues combined with fluid to the venous system to be sent to the liver and spleen and kidneys to be broken down and evacuated from the body.

Is this modality effective? The jury is out on this topic according to the literature. In a study by Mining Liang (2020)1 MLD was not significant in helping to reduce edema size or prevent the occurance of lymphedema post breast cancer surgery, however was effective in reducing edema in women > 60years old post breast cancer surgery. Other studies have shown similar results. Oliveria (2018)  shows MLD is as safe and effective as exercise in improving range of motion (ROM), however had no effect on reducing the incidence or dvelopment of lymphedema post breast cancer surgery. In fact, this study show results age and BMI had the biggest effect on wether lymphedema devolped2. Also, those with alternative causes of lymphedema or combined insufficiencies found similar results3.

The bottom line is every body is different and requires different approaches to treat similar conditions and diagnoses. Your trusted physiotherapist should come up with an intervention and treatment plan that is best tailored to you and your needs! MLD is safe, as effective as exercise in some instances for improving ROM, and can be taught to individuals as a safe home intervention plan for the treatment of edema or lymphedema.


  1. Liang M, Chen Q, Peng K, Deng L, He L, Hou Y, Zhang Y, Guo J, Mei Z, Li L. Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials. Medicine 2020;99:49(e23192).
  2. Oliveira MMFd, Gurgel MSC, Amorim BJ, Ramos CD, Derchain S, Furlan-Santos N, et al. (2018) Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial. PLoS ONE 13(1): e0189176. pone.0189176
  3. Müller, M. et al. (2018) “Manual lymphatic drainage and quality of life in patients with Lymphoedema and Mixed Oedema: A systematic review of Randomised Controlled Trials,” Quality of Life Research, 27(6), pp. 1403–1414. Available at:

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