top of page

Lymphedema Care 

Manual Lymphatic Drainage

If you’re living with lymphedema, you may have heard about Manual Lymphatic Drainage (MLD). This is a very gentle massage that helps move extra fluid out of swollen areas. Unlike deep tissue massage, it uses light, skin-level strokes.

 

Let’s look at what it is, what science says, and how you can safely try simple self-MLD at home.

What Is MLD?:

  • MLD was created in the 1930s by Dr. Emil Vodder.

  • It uses gentle, skin-stretching movements to guide fluid into healthy lymph pathways.

  • It is not deep massage — no strong pressure, kneading, or oils.

  • It’s one of the main parts of Complete Decongestive Therapy (CDT) (International Society of Lymphology [ISL], 2023).

What Does the Research Say?:

  • Helps with symptoms:

    • People often feel less heaviness, tightness, and discomfort after MLD (McNeely et al., 2012).

  • Best in mild-to-moderate lymphedema:

    • A large Cochrane review found

      • MLD may give extra benefit in mild-to-moderate lymphedema (especially after breast cancer).

      • But in moderate-to-severe cases, MLD does not add much extra reduction beyond compression (Ezzo et al., 2015; Moseley et al., 2007; Thompson et al., 2021).

  • Works best as part of CDT:

    • MLD is most effective when combined with compression, exercise, and skin care (ISL, 2023).

  • Quality of life:

    • Even when swelling reduction is small, people often report better comfort, mobility, and relaxation (Yamamoto et al., 2020).

Self-MLD: Gentle Steps You Can Do:

General Rules

  • Use light pressure — just enough to gently stretch the skin, not press into the muscles.

  • Each stroke should be slow, sweeping, and directed toward the nearest healthy lymph node area.

  • Always clear central pathways first (neck, armpit, or groin), then move fluid from the swollen limb toward these areas.

 

For arm swelling 

  1. Begin at the neck and healthy armpit, using gentle circles or scooping strokes to “open” the drainage pathway.

  2. Sweep across the chest or back toward the healthy armpit.

  3. Starting near the shoulder, gently stroke downward toward the elbow, then wrist, then hand.

  4. Then reverse: stroke from hand → wrist → elbow → shoulder → healthy armpit.

  5. Always finish by moving fluid upward into the healthy armpit and across the chest/neck, so the fluid can drain centrally.

 

For leg swelling

  1. Start by clearing the abdomen and groin with gentle circles or scooping motions.

  2. Stroke the thigh downward to the knee, then the calf, then the foot.

  3. Then reverse: sweep fluid from foot → calf → thigh → groin.

  4. Always finish by moving fluid upward toward the groin and abdomen, so it can re-enter central lymph pathways.

 

This “start at the center, then work outward, then finish back at the center” sequence is what helps MLD be effective.

Safety Notes:

  • Do not use MLD if you have an infection (cellulitis: redness, fever, sudden pain).

  • Avoid MLD if you have untreated heart failure, kidney problems, or active cancer.

  • MLD is not a substitute for compression — it works best with garments or bandaging (ISL, 2023).

  • Learn from a professional — a certified therapist can show you the right way to do self-MLD safely.

Key Takeaways:

  • MLD is a gentle skin massage that helps move lymph fluid.

  • It’s most effective in mild-to-moderate lymphedema; less benefit in severe cases.

  • It works best as part of Complete Decongestive Therapy (CDT).

  • Self-MLD can help at home, but training is essential.

  • Compression, exercise, and skin care remain the foundation of lymphedema management.

Scientific References:

  • Ezzo, J., Manheimer, E., McNeely, M. L., Howell, D. M., Weiss, R., Johansson, K. I., ... & Bily, L. (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews, (5).

  • International Society of Lymphology (ISL). (2023). The diagnosis and treatment of peripheral lymphedema: 2023 Consensus Document of the ISL. Lymphology, 56(1), 1–44.

  • McNeely, M. L., Peddle, C. J., Yurick, J. L., Dayes, I. S., & Mackey, J. R. (2012). Conservative and dietary interventions for cancer-related lymphedema. Current Oncology, 19(4), e271–e282.

  • Moseley, A. L., Carati, C. J., & Piller, N. B. (2007). A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Annals of Oncology, 18(4), 639–646.

  • Thompson, B., et al. (2021). Manual lymphatic drainage in mild vs. moderate-to-severe lymphedema: Evidence summary. Medicine (Baltimore), 100(31), e26844.

  • Yamamoto, T., Yamamoto, N., Hayashi, A., Koshima, I., & Narushima, M. (2020). The roles and evidence of complex decongestive therapy and manual lymphatic drainage for lymphedema. Annals of Vascular Diseases, 13(1), 10–16.

bottom of page