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MANUAL LYMPHATIC DRAINAGE

What is manual lymphatic drainage?
A gentle but very specific type of massage that improves the transport of fluid and waste in the body through the lymphatic system. The lymphatic system drains excess fluid and waste products from the tissues, deals with inflammation and infection, and transports fats and proteins around the body.  A manual lymphatic drainage therapist uses light and rhythmic hand movements on the skin, stimulating lymph nodes and the numerous lymphatic channels.  Usually MLD also incorporates breathing movements.

How often might I need to have manual lymphatic drainage?
This will depend on your individual situation.  Having a regular course of MLD may be more effective than a one-off treatment. Sometimes MLD is used several times a week, alongside treatments such as compression garments or bandages, for example to reduce swelling in people with lymphoedema.  In lipoedema, MLD may be effective as a weekly treatment, and some people find that a monthly treatment or less is enough to get their lymphatic system ‘back on track’.

What effects might MLD have on someone with lipoedema?
In someone with lipoedema, the lymphatics may not effectively drain the enlarged areas of fat tissue, so fluid accumulates.  Fluid gathers in areas where there is inflammation, creating even more inflammation and changing the fat cells.  MLD can help to reduce the fluid accumulation and inflammation, reducing symptoms such as heaviness, swelling and discomfort.  You might feel lighter. Your walking and movement may improve.

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As an added benefit, MLD affects the nervous system (nerves and brain), relaxing you and relieving pain.  Some people say they find the treatment makes them very tired, and others feel energised.  As it helps the body to remove fluid, MLD can make you pass a lot of urine. MLD to the abdomen area improves the work of the lymphatics in the gut (where they collect fat from our digested food). MLD can also help alleviate constipation!

What might I expect if I go for MLD?
An MLD therapist will start by asking questions about your situation, your medical history and symptoms.  If suitable, you may start the treatment that day.  If there is a lot to discuss or the therapist prefers to contact your doctor (for example, if you have a complex medical problem), treatment may be delayed.  

Treatments commonly take about one hour. The MLD therapist will usually ask you to lie on a treatment couch.  Some therapists will also treat you on your bed or in a chair if you are unable to get comfortable on a couch.  The treatment is directly onto the skin, without any oils or creams, so you will need to remove clothing.  Usually, underwear stays on, and you will be well covered with towels or blankets to ensure your privacy and comfort.  It can feel like a very big step to take your clothes off and allow a virtual stranger to touch your skin.  It is important to remember that MLD therapists are very accepting and work on people of all shapes and sizes.  Their aim is to work with you and to support you. You should feel that you can talk to the MLD therapist and feel comfortable in their hands.  If you want to start gradually by keeping your clothes on, tell the therapist so they can adapt the treatment.

Treatment often starts with breathing exercises to help the deep lymph drainage.  Commonly the neck is then treated, followed by the central body such as the abdomen or back, before the legs or arms.  This is so the central lymphatics are cleared, allowing space for fluid to drain from your extremities.  Any part of the body can be treated including legs and buttocks.  You will feel the treatment gently moving your skin but it should not cause undue redness.

Where do I find a reputable MLD practitioner who knows about lipoedema?
Some NHS lymphoedema clinics will see people with lipoedema, and may also provide MLD.   This depends on local services, and many clinics have criteria for prioritising MLD as their resources are limited.  In the UK, there are nurses and allied health professionals such as physiotherapists who have trained in MLD.  There are also many independent massage therapists who are MLD experts.  Some combine MLD with other treatments including compression, kinesiotaping, and advice on nutrition, herbal and other supplements.

It is vital that you check the qualifications of the MLD therapist as some sports and massage schools teach lymphatic drainage techniques that are quite heavy. These are not suitable for a compromised lymphatic system or someone with lipoedema who bruises easily.  Look for the following MLD training school qualifications: Vodder, Foëldi, Casley-Smith, and Leduc.  It takes several months to qualify in MLD, so therapists have had a rigorous training schedule and are expected to update every two years. Check mlduk for more information.

How much does MLD cost if I go to a non-NHS therapist?
This will vary according to your location, and the background of the therapist.  Commonly the cots is around £40-70 per session, but can be over £100 if you are in London.   Check costs before you start and ask if they will offer a reduced rate for a series of treatment sessions.

What self-treatment can I do?
Any self-care such as regular moisturising and protecting your skin from damage is key.  Wearing compression garments before and after MLD is also important.  Some people learn to do self-MLD. This can be easier if you have MLD treatment first so you know what it should feel like.  Self-treatment usually includes breathing, neck and shoulder movements and gentle skin massage along the limb or torso towards the healthy lymph nodes.  Some people use skin brushing, but it is essential that you use a really soft brush to avoid damaging your skin.  Sometimes, exercise such as swimming, walking, stretching and Pilates are just as effective as self-MLD.