Question 9: Is manual lymphatic drainage useful for my ongoing treatment? Many clinics are taking MLD away as part of treatment?

Jane Wigg RGN, MSc, Lymphoedema Clinical Expert, Answers L-W-O Community Member Questions

All wording and voiceover Jane Wigg RGN, MSc, Lymphoedema Clinical Expert, Answers L-W-O Community Member Questions

Video creation and Graphics, Mary Fickling, PhysioPod UK Limited.

Is manual lymphatic drainage useful for my ongoing treatment? Many clinics are taking MLD away as part of treatment?

This is a very common question which unfortunately a difficult answer. Within many lymphoedema services, due to resources, Manual Lymphatic drainage is one of the treatments that is having reduced resources committed to it.

What we know is that there is lack of evidence to support manual lymphatic drainage as part of ongoing treatment programs. It is however important that we understand the research surrounding this and therefore apply self-lymphatic drainage treatments appropriately.

There is absolutely no doubt that MLD works, in most cases.

What you will be aware of is that if you’ve experienced manual lymphatic drainage and had a change of your skin or reduction of your lymphoedema, that MLD works. It is always difficult analysing its effects, as it is usually combined by many other treatments including bandages or other electrotherapy, meaning that the ‘pure’ effect of MLD is difficult to ascertain.

Adding to that that there are many variables that can take place from the point that you leave the clinic, to getting home, to the weeks and months after, that analysing the long-term effects and  intervention of MLD is challenging. Many studies look at long-term outcomes meaning that weight gain, reduced activity, wearing older compression, becoming stressed and anxious or being distracted with life’s other incidences taking priority, can all play a consequence as to the long-term outcomes of MLD.

Moving forward, I believe that manual lymphatic drainage will be reserved for clearance at the tops of limbs as opposed to the whole limb, knowing that compression bandaging works fantastically on the limb.

I will also be reserved for those tricky areas such as problematic feet and hands, breast oedema, head and neck and “bits and pieces”.  This is what has been recommended in treatment protocols for several years, where understanding NHS resources, have been to get the best use for their budgets. In addition, understanding that there is conflicting evidence of MLD research due to study designs.  Compression works really well, if it is the right compression, and the job of the skilled hands of the therapist, is to ensure that you do not become congested at the root of the limb.

From my perspective if when you have an MLD, treatment you feel response, the fluid is being moved and the most important outcome is that you are wearing the correct compression and having the correct dose of treatment to maintain the outcome from your MLD.

From my previous questions answered you are aware that LTA takes a ‘top-heavy intervention for long-term control’ approach to lymphoedema management therefore meaning that you carry out an intensive phase of treatment in order to get a good reduction initially, and not just carry it our aimlessly twice a day for life.  Then maintain it understanding you have the right dose of treatment input versus the fluid build-up.

For many people this may mean increased activity, to encourage lymphatic drainage.

Of course, reduction of, or maintaining body weight, to take the pressure off the lymphatic system, wearing good compression, which is regularly reviewed and is of the appropriate compression to counterbalance the filtration of the lymph.  

Of course, there are many other components of lymphoedema management but for successful treatment we need to make sure that you take control of your lymphoedema and you do not allow it to take control of you. The caveat to that is that I understand this is not always so easy to do!

Lets take a closer look..

See you in August 2022!

Jane Wigg

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