If you have been told you have lymphedema, or you are watching an arm or leg for swelling after cancer treatment, you have probably heard of manual lymphatic drainage (MLD). It is a gentle technique, and many people find it comfortable. Here is what MLD is, what the research says, who should check with a doctor first, and who offers it at The Healing Oak.
What is lymphedema?
Lymphedema is swelling caused by lymph fluid building up in the tissues, most often in an arm or leg. The Canadian Cancer Society lists causes that include surgery that removes lymph nodes, radiation therapy to lymph nodes, cancer that spreads to the lymph nodes, and infection, inflammation or injury that damages lymph vessels or nodes. According to the US National Cancer Institute (NCI), it may appear soon after cancer treatment or years later.
Lymphedema needs a diagnosis from your doctor or cancer care team, and NCI notes it is easier to control when treatment starts early. Watch for signs of cellulitis, a skin infection that is a common complication: pain, tenderness, redness or warmth in the swollen area, or a fever. If you notice these, NCI advises calling your doctor right away.
What is manual lymphatic drainage?
MLD is a light, slow, rhythmic massage. The Canadian Cancer Society describes it as a special kind of light massage, usually done by a massage therapist or physiotherapist with special training in treating lymphedema. The therapist lightly rubs, taps and strokes the soft tissues to help clear the main lymph pathways and improve drainage from the limb.
It feels very different from a deep tissue massage. The pressure is gentle, and your therapist can also teach you techniques to use at home.
Where MLD fits in lymphedema care
MLD is rarely used on its own for lymphedema. The Canadian Cancer Society describes complex decongestive therapy (CDT), also called complete decongestive therapy, as a combination of manual lymph drainage, skin care, compression bandaging, exercises and compression garments, managed by a specially trained massage therapist or physiotherapist. The therapist gives many treatments over a short time to help clear swelling, and then you continue the program at home.
If you already wear a compression sleeve or stocking, keep wearing it unless your care team tells you otherwise. Cleveland Clinic notes that lymphatic massage should not be your only treatment.
What does the research say?
A 2015 Cochrane review looked at six trials of MLD for lymphedema after breast cancer treatment. It found MLD was safe and well tolerated, and that it may add some benefit to compression bandaging for reducing swelling. When MLD was added to a compression sleeve, results were less consistent. People with mild to moderate lymphedema may benefit most from adding MLD, but the reviewers said this still needs to be confirmed, and the trials were small.
Evidence for MLD outside of lymphedema is thinner. Cleveland Clinic notes that if you do not have lymphedema, you may not see meaningful results. If you are booking for another reason, ask your therapist what they expect it to do for you.
Who should check with a doctor before MLD?
MLD is gentle, but it is not right for everyone. Cleveland Clinic advises avoiding lymphatic drainage massage if you have:
- •A blood clot or deep vein thrombosis (DVT)
- •Cellulitis or another infection, or a fever
- •Heart disease
- •Kidney failure
- •Had a stroke
It also notes that providers will not do lymphatic drainage directly over cancerous tissue or skin damaged by radiation therapy. If any of this applies to you, or you are in active cancer treatment, talk to your doctor or cancer care team before booking, and tell your therapist at your first visit.
What to expect at an MLD session
Your therapist will ask about your health history, any surgery or cancer treatment, and your medications. Expect light, repetitive strokes. Many therapists start with areas closer to the trunk to clear the main lymph pathways before moving to the swollen area. Session lengths vary.
There is no set number of sessions. Some people have a short, intensive course as part of CDT and then switch to self-care at home. Your therapist will talk through a plan that fits your situation.
Manual lymphatic drainage at The Healing Oak
Two of our practitioners offer manual lymphatic drainage:
- •Dr. Raj Salaria, DOMP, a manual osteopathic practitioner, at our Chilliwack and Abbotsford clinics
- •Jason Scott, RMT, a registered massage therapist, at our Chilliwack clinic. Jason also offers complete decongestive therapy.
You do not need a doctor's referral to book with us, though some extended health plans ask for one before they reimburse a claim. Session lengths vary. Fees vary by practitioner. Confirm the fee when you book. Direct billing depends on the practitioner. Ask when you book.
Learn more about manual lymphatic drainage at The Healing Oak, or book at our Chilliwack or Abbotsford clinic.
Resources
- •Canadian Lymphedema Framework: What is lymphedema?
- •BC Lymphedema Association
- •Canadian Cancer Society: Lymphedema
This article is general information, not medical or psychological advice. For advice about your situation, talk to a qualified practitioner.