Manual lymphatic drainage (specialised massage) for lymphoedema

Manual lymphatic drainage (MLD) is a way of reducing swelling (lymphoedema) caused by fluid build up. Lymphoedema can sometimes develop due to cancer or cancer treatment. 

There are different types of manual lymphatic drainage used by lymphoedema specialists. They include Vodder, Földi, Casley-Smith. These are all similar, but massage movements are a little different for each. Your specialist will explain more about this.  

Another type of MLD is Fluoroscopy guided manual lymphatic drainage (FG-MLD).

You should only have MLD from a specially trained therapist in one of these types.

How does manual lymphatic drainage work?

The aim of MLD is to move fluid from the swollen area into a place where the lymphatic system is working normally.

To do this, the specialist first uses specialised skin movements to clear the area that they want the fluid to drain into.

It might seem strange to have skin movements on your chest and neck if you have lymphoedema in your arm. But it means that the fluid has somewhere to drain to when the therapist treats your arm.

How you have manual lymphatic drainage (MLD)

You usually lie down to have MLD. But if you have lymphoedema in your head and neck, you might sit up.

When you have MLD, you feel a gentle pressure. The skin movements are very light, slow, and rhythmic. This helps lymphatic flow and drainage.

The number of treatments you have varies from person to person. This depends on the type of MLD and what you need. Your specialist will work out a treatment plan for you. Taking into account the amount of swelling you have.

After having manual lymphatic drainage

The specialist might bandage the area. They use a specialised bandaging technique called multi-layered lymphoedema bandaging. If it is not possible or necessary to use bandages, you usually wear a compression garment.

Your lymphoedema specialist will regularly check how well your treatment is working. They’ll look at whether the tissues are softening and how much the swelling is going down.

Remember that you are the person who will notice changes in the swelling first. Talk to your specialist about how your treatment is working. Managing lymphoedema is very much about you and the specialist working together.

Simple lymphatic drainage (SLD)

You might have simple lymphatic drainage (SLD) as part of your treatment. It is a type of gentle massage that your specialist can teach you to do yourself. It is sometimes called self massage.

They teach you to do this only in the areas where you don’t have lymphoedema. This frees up space for the lymph fluid to drain to from the swollen area.

You don’t do SLD in the area where you have swelling. The skin movements in the swollen area are more difficult to do. Your therapist will show you how to move the skin in the surrounding areas. Ask them questions if anything is not clear.

The usual routine for SLD is twice a day, for about 20 minutes each time. But this routine might vary. Only apply light pressure as your lymphoedema specialist taught you and always follow the instructions given by your specialist. 

When you shouldn't have MLD or SLD

There are some situations when you should not have MLD or SLD. Your lymphoedema specialist will tell you whether you can or can’t have manual or simple lymphatic drainage. Always check with them if you aren't sure.

You might not be able to have MLD or SLD if you have any of the following:

  • an infection or inflammation in the swollen area
  • a blood clot
  • heart problems
  • cancer in the area

If you are uncertain about having MLD or doing SLD, talk to your doctor or lymphoedema specialist.

  • Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near-Infrared Imaging
    C Lopera and others
    Lymphatic Research and Biology, 2017, Jul 27

  • Manual lymphatic drainage for lymphedema following breast cancer treatment
    J Ezzo and others
    Cochrane Database of Systematic Reviews, 2015. Volume 5. 

  • Commissioning Guidance for Lymphoedema Services for Adults in the United Kingdom

    The National Lymphoedema Partnership, 2019.

  • All-Ireland Lymphoedema Guidelines for the Diagnosis, Assessment and Management of Lymphoedema, 2022.

  • Manual lymphatic drainage: Exploring the history and evidence base

    A Williams

    British Journal of Community Nursing, 2010. Volume 15, Issue 4, supplement S18-24

Last reviewed: 
11 Apr 2023
Next review due: 
11 Apr 2026

Related links