Manual Lymphatic Drainage — Vodder Method
MLD is an advanced massage technique which moves the skin over the underlying tissues using repetitive and circular movements. Dr. Emil and Estrid Vodder discovered and then developed the technique in the 1920’s and 1930’s, going on to train others in the late 1940’s. They then worked with, and set up schools with, the Wittlingers in Austria (The Vodder Schule), Casley-Smith in Australia and Asdonk and Foeldi in Germany. These groups in their turn have trained therapists and teachers since the 1950’s.
The Lymphatic system was described around 1654 as "A system which purifies the body and regulates irritation, swelling and oedema". (Thomas Bartholin) By specifically stimulating the minute musculature of the lymph vessel walls an MLD Therapist uses the lymph system itself to cleanse the body, reduce any swelling and strengthen the immune system.
Described as "One of the best kept secrets on the health and beauty scene." (Jane Alexander, Daily Mail Saturday) , MLD’s intensely relaxing effect masks the strength of the treatment itself. An MLD facial is like a facelift without surgery. As the stimulated lymph vessels go to work clearing the loose connective tissue of accumulated excess cells and debris, the skin not only looks clearer and cleaner – it actually is clearer and cleaner, right down to the sub-cutaneous levels.
As no oils or powders are used it is completely safe even for those with sensitive skin. This non-invasive technique simply uses the muscles and structure of the existing lymphatics to clear accumulated fluid. MLD is invaluable for people who are going through a detox or weight loss programme because of its ability to safely remove excess `debris’ from all over the body and to help tighten the skin.
Taken further, it eases the swelling/ inflammation caused by everything from more vigorous treatments, trauma from accidents and on to surgical intervention. As a pre and then post op treatment it is unparalleled in its ability to ease most - and usually all - of the tissue swelling associated with trauma and surgery and so speed the healing rate of damaged structures. Burns, wounds, and scars heal at a faster rate when MLD is administered.
MLD’s role as one of the cornerstones of CDT (Complex (or Combined) Decongestive Therapy) for lymphedema and lipedema comes as no surprise to those who understand the lymphatic system’s amazing ability to regulate swelling and fluid imbalance. It is a vital part of lymphedema treatment, opening up alternative avenues for the dispersal of excess fluid and avoiding the areas affected by lymphatic malfunction.
MLD also has an effect similar to the tens machine in pain control. In reducing the swelling, promoting healing and reducing pain, MLD becomes one the most effective treatments for any trauma, however caused.
It is one of the safest massages available to women who are pregnant . MLD uses no oils or powders so absolutely nothing is introduced to upset the developing fetus. From top to toe there is no need for a pregnant woman to suffer with swelling.
MLD has a strong effect on the immune system. By decongesting the `transit stretch’ of loose connective tissue – clearing out any lingering debris – and making the whole transport system more efficient, MLD helps quicken the transport system of our bodies immune response.
Complete Decongestive Therapy (CDT) and The Treatment of Lymphedema
Secondary Lymphedema before CDT
Over the past decades it became very clear that the therapy of choice for the vast majority of patients suffering from lymphedema is complete decongestive therapy (CDT), sometimes referred to as complex decongestive therapy, or combined physical therapy. CDT as the standard therapy for lymphedema is listed on the web sites of the American Cancer Society, the National Cancer Institute and the International Society of Lymphology) just to name a few.
Secondary Lymphedema after CDT
CDT, when applied correctly by a skilled and certified lymphedema therapist, shows excellent long-term results in both primary and secondary lymphedema. Numerous studies have proven the effectiveness of this non-invasive, safe and reliable treatment approach, which is well established in European countries.
How does CDT work?
The swelling in lymphedema is caused by an abnormal accumulation of protein and water molecules in the tissue. In order to achieve reduction of this swelling it is necessary to re-route the lymph flow to include these excess protein and water molecules around the blocked area(s) into more centrally located healthy lymph vessels. This goal is achieved by a combination of different treatment modalities, all of which are integral components of CDT and include:
- Manual Lymph Drainage (MLD)
- Compression therapy
- Decongestive exercises
- Skin care
It is important to understand that CDT is performed in two phases. In phase 1, also known as the intensive or decongestive phase, treatments are given by trained lymphedema therapists on a daily basis until the limb is decongested.
The duration of the intensive phase varies with the severity of the condition and averages 2-3 weeks for patients with lymphedema affecting the arm, and 2-4 weeks for patients with lymphedema of the leg. In extreme cases the decongestive phase may last up to six to eight weeks and may have to be repeated several times.
The end of the first phase of treatment is determined by the results of measurements on the affected body part, which are taken by the therapist. Once measurements approach a plateau, the end of phase 1 is reached and the patient progresses seamlessly into phase 2 of CDT, also known as the self-management phase, which for the most part is continued by the patient alone.
Depending on the stage of lymphedema,the involved extremity or body part may have reached a normal size at the end of the intensive phase, or there may still be a circumferential difference between the involved and the uninvolved limb.
Phase 2 is a lifelong process during which patients not only can maintain, but also improve the reduction achieved during phase 1. Regular check- ups with the physician and the lymphedema therapist are necessary.
Elastic Taping in Conjunction with Lymphedema Treatment
By Joachim Zuther, on June 4th, 2012
courtesy of Lymphedema Blog
During the past several years various techniques of elastic taping have become popular adjunct treatment modalities for lymphedema. While elastic taping has been applied for many years to treat conditions such as sports injuries or orthopedic problems, recent studies and patient reports indicate that this technique may also be a useful tool in the treatment and management of lymphedema.
The original technique, Kinesio Taping, was developed in the 1970s by the Japanese chiropractor Kenzo Kase. Based on this original technique a number of other taping variations have evolved, and different taping products were developed by a number of manufacturers. All taping products have very similar properties; manufactured with woven cotton fibers, the material has characteristic stretch properties that closely resemble the stretchability of the skin. It is held in place by a hypo-allergenic and latex-free medical-grade acrylic adhesive, which is heat-activated. Perforated with numerous holes the tape allows air to circulate, and while the tape’s cotton fabric will absorb water, the acrylic adhesive next to the skin is waterproof. This enables the patient to shower and swim with the material in place.
The idea behind the tape is to apply a gentle lift on the skin, which then allows the lymphatic vessels underneath to absorb and drain lymphatic fluid from the edematous area into an area with sufficient lymphatic drainage. The goal of this method is to re-direct the flow of lymph from a congested area into an area with sufficient lymphatic flow, thus reducing the volume of the edematous area.
Elastic tape is available in rolls of various widths, or pre-cut shapes; the length and pattern of the application depends on the individual situation and drainage pattern, and takes into consideration additional barriers such as scars and other defects on the skin.
The tape is applied to the skin with slight stretch (just to the tension required to remove the backing) and with the patient’s skin in stretched position. Once the skin returns to the resting position, the tape rebounds, and if applied correctly, rippling convolutions in the tape will become visible. This desired effect deforms the skin and slightly lifts it from the fascia below in order to create a pull force on the filaments anchoring the small lymph vessels within the tissues. This pull force creates openings in the wall of these vessels, which allows more fluid to enter the lymphatic system and subsequently increase lymphatic flow away from the swollen area. By positioning the tape correctly, it is possible to facilitate and channel the lymphatic fluid in the desired direction without restricting muscle and joint movements.
Additional stimulation of the lymphatic system is achieved as the patient performs movements in daily activities, or performs decongestive exercises as instructed by the lymphedema therapist. The tape can be worn several days as long as there are no negative reactions on the skin.
The fact that elastic tape can be worn underneath compression bandages and garments makes it an attractive addition to the gold standard for the treatment of lymphedema, complete decongestive therapy. It is particularly useful in areas affected by lymphedema where bandaging is difficult, or not possible, such as lymphedema affecting the head and neck (see also link “Use of elastic taping in the treatment of head and neck lymphedema” below).
As with any treatment modality for lymphedema, it is important to understand that the tape should be applied by a trained therapist with a thorough understanding of lymphedema. Local contraindications, such as adverse reactions to the tape, radiation fibrosis, wounds, lymphatic cysts and fistulas, as well the risk of damaging the fragile skin of lymphedema patients is a concern to be considered when using elastic taping.
The therapist will instruct the patient to properly remove the tape after several days. The adhesive bond of the tape is best broken by holding up an edge of the tape and gently pushing down on the skin to dislodge it from the adhesive. The use of oil helps to neutralize the adhesive, and removal of the tape in direction of the body hair minimizes the risk of skin irritation.
Manual Lymph Drainage and its Role in the Treatment of Lymphedema
By Joachim Zuther, on December 21st, 2011
Manual lymph drainage (MLD) is one of the main components of complete decongestive therapy (CDT). In combination with compression therapy, skin and nail care and decongestive exercises, MLD performs the crucial role of re-routing stagnated lymphatic fluid, which is essential in the treatment and management of primary and secondary lymphedema. This gentle manual treatment technique is based on four basic strokes, which were first described by Dr. Emil Vodder (1896-1986), PhD.
The goal of MLD is to stimulate healthy lymph vessels and lymph nodes, which generally are located adjacent to the area of non-functioning or blocked lymphatic drainage, and to re-route the lymph flow around these blocked areas into more centrally located healthy lymph vessels and nodes. This is achieved with specific stretches and manipulations – a common denominator in all MLD strokes – to the skin and those structures located directly beneath the skin, the subcutaneous tissues.
The resulting increase in lymphatic activity in the healthy areas creates a “suction effect”, which stimulates the accumulated fluid present in lymphedema to move into an area with normal lymphatic drainage.
What is the difference between MLD and traditional massage?
It is unfortunate that the term massage is often wrongly used to describe MLD. The origin of the word massage is derived from the Greek massain (to knead) and is used to describe such techniques as effleurage, petrissage, vibration, etc. Massage techniques traditionally are applied to treat ailments in muscle tissues, tendons and ligaments, and in order to achieve the desired effect, these techniques are generally applied with considerable pressure.
Cross section through skin,
subcutis and muscle layer
MLD on the other hand is a very gentle manual technique, designed to have an effect on fluid components and lymphatic structures located in superficial tissues, i.e. the skin and the subcutis. Lymphedema almost exclusively manifests itself in the subcutis, which is a layer of connective tissue between the skin and muscle tissues.
The only commonality between MLD and traditional massage is that both techniques are applied manually. There are significant differences in technique, pressure and indications for which these two therapeutic measures are used.
There are a number of reasonable explanations why MLD and massage are often confused with each other. One is that there is a tendency to call any hands-on manual therapeutic technique a form of massage; the other is that massage can be very helpful if applied to treat edema.
However, lymphedema and edema are two very different conditions and it is important to understand the differences. Although both conditions involve swelling, edema and lymphedema have very different causes and are treated differently.
The Role of Manual Lymphatic Drainage in Fibromyalgia
By Joachim Zuther, on November 15th, 2012
Fibromyalgia, also known as fibromyalgia syndrome, fibromyositis and fibrositis, is one of the most common chronic pain conditions, affecting millions of individuals in the United States and worldwide. While numbers on the prevalence of fibromyalgia in the literature vary considerably, the American College of Rheumatology (2008) estimates the number of individuals affected in the U.S.to be 5 million1. The National Fibromyalgia Association (NFA) estimates the number to be 10 million in the U.S., and 3-6% of the world population2.
While fibromyalgia can occur in women and men of all ethnic groups and ages, the condition is more common in middle-aged women (80%) and those women who have a family member affected by fibromyalgia are more likely to develop the condition themselves (American College of Rheumatology, 2004).
These numbers clearly indicate that fibromyalgia is a common condition; it is a syndrome rather than a disease, which includes a number of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause.
The most prevalent symptom is chronic widespread pain and tenderness (sensitivity to touch), in muscles, joints and soft tissue, fatigue and sleep disturbances.
These main symptoms of fibromyalgia are identical with those of many other conditions, explaining why fibromyalgia is difficult to diagnose. Physicians often have to rule out other potential causes of these symptoms before making the diagnosis of fibromyalgia. The absence of diagnostic laboratory tests and no generally accepted, objective test for fibromyalgia present additional stepping stones in making the correct diagnosis.
Some physicians unfortunately may not be able to proper diagnose this condition and tell the patient there is little that can be done.
Specific causes for fibromyalgia are unknown, but it is thought that a number of factors may be involved that could trigger fibromyalgia, which may include
- Physical or emotional trauma
- Abnormal pain response, i.e. problems with how the central nervous system (brain and spinal cord) processes pain – areas in the brain that are responsible for pain may react differently in fibromyalgia patients
- Infection, such as a virus – however, none has yet been identified
Diagnosis of Fibromyalgia
Physicians have to rely on the patient’s self-reported symptoms, the history and a physical examination, which includes checking of specific manual tender points.
This examination is based on criteria set by the American College of Rheumatology (ACR) for the diagnosis and classification of fibromyalgia3.
Fibromyalgia tender points
To receive a diagnosis of fibromyalgia, the patient must meet the following diagnostic criteria:
- Widespread pain in all four quadrants of the body for a minimum duration of three months. The four quadrants include both sides of the body, above and below the waist line
- Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see illustration)
Individuals affected by fibromyalgia may feel pain at other sites as well, however, those 18 standard possible sites on the body are the criteria used for classification.
Due to the difficult nature of fibromyalgia, treatment requires a team approach including the patient, physicians familiar with the condition (rheumatologists, internists), physical-, massage- and occupational therapists, and other health care professionals.
The main goal is the relief of pain and other symptoms associated with fibromyalgia and helping the affected individual to cope with the condition.
Treatment may include physical therapy, stress-relief methods, including light massage and manual lymph drainage, and medication for pain and sleep management.
More information on these various treatment approaches is available on various online resources4, 5.
Manual Lymph Drainage & Fibromyalgia
Several studies on the effectiveness of manual lymph drainage (MLD) in the treatment of fibromyalgia indicate that MLD yields positive results in terms of pain relief, stiffness, sleep and general health status6, 7, 8.
The result of a randomized controlled trial comparing manual lymph drainage with connective tissue massage in the treatment of women affected by fibromyalgia suggests MLD to be more effective in the treatment of fibromyalgia than massage6.
The Difference between MLD and Massage
As readers of this blog know, massage and manual lymph drainage are two very different manual treatment modalities. It is unfortunate that the term massage is often wrongly used to describe MLD. The origin of the word massage is derived from the Greek massain (to knead) and is used to describe such techniques as effleurage, petrissage, vibration, etc.
Compared to traditional massage, the pressure applied with manual lymph drainage is much lower in intensity. The goal of these techniques is to manipulate the lymphatic structures located in the subcutaneous tissues. In order to achieve the desired effect, the pressure should be sufficient enough to stretch the subcutaneous tissues against the fascia (a structure separating the skin from the muscle layer) located underneath, but not to manipulate the underlying muscle tissue. The amount of pressure needed in MLD is sometimes described as the pressure applied stroking a newborn’s head.
- Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: a randomized controlled trial: http://www.ncbi.nlm.nih.gov/pubmed/19243724
- Manual lymph drainage therapy using light massage for fibromyalgia sufferers: a pilot study: http://www.orthopaedic-nursing.com/article/S1361-3111(03)00084-0/abstract
- Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755111/