Manual lymphatic drainage (MLD) is a type of massage based on preliminary evidence which is hypothesized to encourage the natural drainage of the lymph, which carries waste products away from the tissues back toward the heart. The lymph system depends on intrinsic contractions of the smooth muscle cells in the walls of lymph vessels (peristalsis) and the movement of skeletal muscles to propel lymph through the vessels to lymph nodes and then to the lymph ducts which return lymph to the cardiovascular system. Manual lymph drainage uses a specific amount of pressure (less than 9 ounces per square inch or about 4 kPa) and rhythmic circular movements to stimulate lymph flow. Clinical studies of MLD conclude that further study of the practice is required before recommending it as an effective health treatment.
History
Manual Lymphatic Drainage for Lymphedema Management of the Upper Extremity or Arm - Manual lymph drainage is a gentle massage which is intended to encourage the natural drainage of lymph, which carries waste products away from the tissues and back toward the heart. In patients...
Manual lymphatic drainage was pioneered by Danish Drs. Emil Vodder and Estrid Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders. While working on the French Riviera treating patients with chronic colds, the Vodders noticed these patients had swollen lymph nodes. In the 1930s, the lymphatic system was poorly understood. The Vodders were not deterred by this and, in 1932, began to study the lymph system, developing light, rhythmic hand movements to promote lymph movement. In 1936, they introduced this technique in Paris, France, and after World War II, they returned to Copenhagen to teach other practitioners to use this therapy.
About 20 years, a new concept of manual lymphatic drainage, based on linear movements on the path of the lymphatic vessels towards the corresponding lymph nodes was developed by Godoy & Godoy. This technique was adapted later to the treatment of the secondary lymphedema where the main type of movement is the metorization of an intermittent compression therapy, specifically in lymphedema after treatment of breast cancer. [5-7]
Current practice
Therapists can today receive certification through special classes conducted by various organizations specializing in MLD, or through a complete lymphedema treatment certification course. Scientific studies show mixed results regarding the efficacy of the method in treating lymphedema and further studies are needed. A 2009 meta-analysis of studies in the area of sports medicine and rehabilitation showed best evidence of effectiveness for Manual lymphatic drainage treatment to "enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema [swelling] around broken bones." A 2013 systematic review of manual lymphatic drainage with regard to breast cancer related lymphedema found no clear support for the effectiveness of the intervention in either preventing limb edema in at-risk women or treating women for the condition.
References
5-Godoy MFG, Godoy ACP, Godoy JMP. Manual Lymphatic Therapy: The Godoy & Godoy Concept. Kindle Edition (Amazon). São Jose do Rio Preto: THS, 2013. 167p. 6-De Godoy JMP, de Godoy ACP, Maria de FGG. Evolution of Godoy & Godoy manual lymph drainage. Technique with linear Movements. Clinics and Practice. 2017;7(4):1006. doi:10.4081/cp.2017.1006. 7-Maria de Fátima Guerreiro Godoy , Henrique José Pereira de Godoy, Jose Maria Pereira de Godoy. Transdisciplinary approach to rehabilitation of breast cancer-related lymphedema. United State: Amazon 2016. 220p.
