Manual Lymphatic Drainage (MLD)


The lymphatic system is made of lymph vessels, lymph nodes, and organs. Lymph nodes act as the garbage cans of the body and catch all the ‘bad stuff. CDT allows the body to flush out that bad stuff and it helps to keep us healthy. CDT is the most effective treatment for chronic extremity lymphedema. Primary lymphedema (congenital) and secondary lymphedema (due to a damaged lymphatic system) respond extremely well to this gentle, non-invasive and highly-effective therapy.

Sandra Serrano

Physiotherapist/Nutrition Coach  

Elena Naranjo



Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Causes include:

Surgery: Lymphedema can develop if your lymph nodes and lymph vessels are removed or cut. For instance, surgery for breast cancer may include the removal of one or more lymph nodes in your armpit to look for evidence that cancer has spread. If your remaining lymph nodes and lymph vessels can’t compensate for those that have been removed, lymphedema may result in your arm.

Radiation treatment for cancer: Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels, restricting flow of lymph fluid.

Cancer: If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumour growing near a lymph node or lymph vessel could become large enough to block the flow of the lymph fluid.

Infection: An infection of the lymph nodes can restrict the flow of lymph fluid and cause lymphedema. Parasites also can block lymph vessels. Infection-related lymphedema is most common in tropical and subtropical regions of the globe and is more likely to occur in developing countries.

CDT is sometimes referred to as Complete Decongestive Physiotherapy (CDP). CDT consists of the following four steps:

1. Manual Lymphatic Drainage (MLD)

MLD is a gentle manual treatment which improves the function of the lymphatic system throughout the body. The techniques of MLD were first introduced in the 1930s by Dr. Emil Vodder, PhD, MT, of Denmark. MLD is widely recognized in the United States as an effective treatment for post-surgical swelling, post-traumatic edema (as with sports injuries), migraine headaches, rheumatoid arthritis, fibromyalgia, and other conditions involving edema. When used to treat lymphedema, MLD re-routes lymph flow around blocked areas and into healthy lymph vessels which drain into the venous circulation.

These are further health benefits of the lymph massage (MLD):

Against Cellulite / Lipoedema

It works best in earlier stages. The ideal case is to start the treatment during the teenage years. Cellulite appears when the fat deposits compress the lymph vessels, reducing the lymph flow. If the intervention is not rapid, the tissue fills with liquids and toxins and the fat deposits tend to turn harder, producing the “orange peel skin”. When the cellulite is on its incipient stages, it is easy to activate the flow of the accumulated waste and definitively solve the issue. Normally, just three months are enough to get satisfactory results.

Swollen, heavy and Edematose feet, legs and arms

Lymph flows from the periphery of the limbs to their center. When this path is interrupted, the lymph falls back due to the action of gravity, flooding the foot tissues and causing swelling. The lymph drainage helps lymph to complete its route, making it the treatment of choice. In 3-4 weeks, the problem is improved. If it’s chronic, the doctor will decide the ideal frequency of the massage.

Pregnancy and PMS syndrome

The drainage is very effective in both cases but as a preventive method. The hormonal changes during pregnancy determine liquid retention and a decrease in the tonus of the vein and lymph vessels. The drainage can be started from the third month of pregnancy, up until the delivery. It is also effective against the swelling experienced by many women a few days before their menstruation. In this case, the massage is made immediately after the end of the cycle for a week.


If during the scarring process of a wound interstitial liquid accumulates forming an edema, a hypertrophic (cheloid, swollen) scar forms. The lymph draining has a “planning” effect on the scar, it is even effective on older scars because it activates the lymphocytes, which are involved in reconstructing the tissue.

2. Compression Therapy:

Compression therapy improves the efficiency of the muscle and joint pump and increases tissue pressure. Multi-layered compression bandages are applied between MLD treatments to help prevent re-accumulation of evacuated fluid. Once the patient’s limb is sufficiently decongested through repeated treatments, they can be fit with compression garments.

3. Exercises:

Exercises are performed with compression bandages in place to activate the muscle and joint pumps of the affected extremity. This results in an increase in lymphokinetic activity and further reduction of the swollen limb over time.

4. Skin Care:

Skin care and general hygiene are essential to eliminate bacterial and fungal growth which can cause repeated attacks of cellulitis or erysipelas. Infections are very common complications of lymphedema so meticulous skin and nail care is vital.