Manual Lymph Drainage (MLD, CDT) Massage Modalites

Training:

All our Manual Lymph Drainage therapists are Registered Massage Therapists that have completed the full specialization of the Dr. Vodder Manual Lymph Drainage program. Dr. Vodder School is the most extensive and thorough program on Manual Lymph Drainage(MLD®) and Combined Decongestive Therapy (CDT). The Dr. Vodder School International- teaches the original Dr. Vodder method of Manual Lymph Drainage, a full lymphedema management program and many more applications for MLD. The total training is 160 hours of classroom education which is the most extensive available and exceeds the requirements of the Lymphology Association of North America (LANA). Combined Decongestive Therapy (CDT) is a combination of the Dr. Vodder method of Manual Lymph Drainage, remedial exercise therapy, compression bandaging (or compression garments in the maintenance phase) and therapeutic skin care. It may also include breathing and aquatic exercises, adjunct therapies such as low-level laser as well as dietary measures. According to the International Society of Lymphology, this is the treatment of choice for lymphedema. Results of scientific research have been documented and published in peer-reviewed Journals.

What is Lymphedema?

Lymphedema occurs when there is an underlying mechanical insufficiency of the lymphatic system. The rate of absorption is lower than normal causing and imbalance in the tissues. This results in an accumulation of protein rich fluid in the interstitium causing lymphedema. There are two types of Lymphedema Primary and Secondary. Primary is when there is a development disorder of the lymphatic system. Secondary is when the lymphatic system has been damaged due to a known cause. The most common secondary causes are lymph node dissection, radiation, infection, trauma, or malignancies in the lymphatics.

Conditions treated:

Primary Lymphedema:

Two main types of Primary Lymphedema:

Meige Type (90-96% of cases)

• Sporadic onset
• Mostly starts in feet/ankles and progresses up legs.
• Congenital but manifests during puberty or later
• Lymphedema Praecox: Manifests before age 35
• Lymphedema Tardum: Manifests after age 35

Nonne- Milroy Type (4-10 % of cases)

• Hereditary
• Present at birth or shortly after
• Mostly effects lower extremities

In the case of infants, starting MLD treatment and educating the caregiver on ways to encourage lymph drainage outside of treatment is taught. Compression garments and bandaging is available when advised by the physician. When treating children, we start MLD treatment as soon as possible. Children who can verbally communicate, can be bandaged and fitted with compression garments with approval of treating physician. Adults are treated with CDT. The earlier the diagnosis and treatment begins the better prognosis and management will be for the future.

Secondary Lymphedema:

• Post cancer edemas i.e. mastectomies, prostate etc.
• Lipedema
• Trauma related edemas
• Surgery (pre-operative and post-operative) edemas
• Sinus congestions and chronic sinusitis
• Concussions
• Eye surgeries
• Orthopedic/surgical/trauma-related disorders i.e. whiplash, burns, keloids
• Lactation disorders
• Stroke, multiple sclerosis, downs syndrome
• Autonomic nervous conditions i.e. severe anxiety, stress, burn – out
• Pre/post cosmetic surgeries

Contraindications for MLD/CDT:

• Active Malignant disease, tumor recurrence or metastases
• Acute inflammation/infection
• Acute thrombosis
• Cardiac Insufficiency
• Acute allergy

Treatment:

Treatment involves an Initial phase and a maintenance phase, along with patient education. For successful, long-term results.

Initial Phase (also known as reduction phase):

MLD- Manual Lymph Drainage

MLD is a combination of gentle massage techniques that increases lymphangiomotoricity (pulsation of the vessel) and is performed to reduce edema in the affected area. The affected area is measured and treatment is performed regularly until the therapists no longer sees a change in limb circumference or volume. MLD reduces edema and increases microcirculation encouraging the healing of tissues and wounds.

Bandaging-

Short stretch compression bandaging or coban is applied after each treatment if required and tolerated to maintain the new limb volume. Bandaging is left on until the next treatment day. Patients are encouraged to learn to self bandage for successful long term results.

Kinesiotaping-

Some patients may require kinesiotaping to encourage lymph flow of more difficult edema areas.

Areas such as abdomen, genitals, and face are difficult to add compression, therefore kinesiotaping is an option.

Maintenance phase:

Reduction has taken place and patient is measured for an appropriate compression garment if needed.

MLD treatments are reduced and patient is monitored and educated on long term care.

Patient will be educated on the following:

• Types of compression garments
• Skin care (to avoid and recognize infections)
• Self massage
• Water exercises
• Kinesiotaping (teaching kinesiotaping to patients when possible)
• Land exercises
• Nutrition

Self Bandaging classes available (available to anyone within or outside our clinic)

Our goal is to help our patients reduce their edemas during the difficult stages but then encourage them to be independent active participants in their ongoing care. Our patients are encouraged to live an active independent life and are given as many tools as possible to achieve this.