ArticlePDF Available

Manual lymphatic drainage: Exploring the history and evidence base

  • Talk Lipoedema

Abstract and Figures

Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited evidence to guide clinical practice. This paper outlines the historical background to MLD and provides insights into the evidence relating to the effect and efficacy of manual lymph drainage, highlighting considerations for lymphoedema practitioners.
Content may be subject to copyright.
S18 Chronic Oedema, April 2010
Over 100 years ago, Winiwarter, a German
surgeon, described the use of massage to
‘promote resorption’ of fluid from swollen
tissues in people with lymphoedema (Winiwarter, 1892:
397). In the present day, manual lymph drainage (MLD),
a type of massage, has become established as an integral
part of lymphoedema treatment. However, the limited
empirical evidence base and lack of consensus on the
use and efficacy of MLD (Devoogdt et al, 2009) means
there is a lack of clarity regarding the application of MLD
for people with lymphoedema. Some lymphoedema
practitioners may have limited knowledge of MLD.
Those who have learned the techniques may have limited
resources or support to continue using them. The current
drive towards cost effectiveness also means that bodywork
treatments such as MLD may be given low priority in the
planning and resourcing of services.
This paper will provide a brief history and outline the
main features and principles of MLD. It will discuss the
evidence around the mechanisms through which MLD
may exert its effect, and then overview the findings from
studies that have examined the clinical and therapeutic
efficacy of MLD. Finally, it will discuss some implications
for clinical practice in lymphoedema treatment and care.
In the 1930s, his ill health forced Emil Vodder to abandon
medical studies and move from Denmark to the French
Riviera. Inspired by a deep interest in anatomy and
bodywork, and a fascination with the lymphatic system, he
intuitively developed a form of massage. Vodder presented
his method of manual lymph drainage at a conference in
Paris (Vodder, 1936), returning to Copenhagen before
the outbreak of World War 2 (Wittlinger, 2004). It was
nearly 30 years later that his lectures drew interest from
doctors and others who greatly admired his work and
recognized that this type of manual massage could benefit
people with lymphoedema (Asdonk, 1966; Fischer,
1967). In 1965, Vodder made a presentation in which he
described his conviction that MLD, along with breathing
and relaxation exercises and improved diet, would play
a key role in lymphatic disorders (Vodder, 1965). His
conviction holds true today.
While Winiwarter had described massage methods
such as ‘petrissage’, ‘efflurage’ and ‘friction’ (Winiwarter,
1892), Vodder’s technique was characterized by gentle,
pumping, circular movements using pressures of around
30mmHg, combined with a ‘zero’ or resting phase.
The aim was to enhance drainage of lymph from the
interstitial tissues without producing increased capillary
filtration (Wittlinger and Wittlinger, 1992). Until his
death in 1984, Vodder worked with many colleagues
from different countries. This collaborative work led to
the development of the conservative physical therapy
approach to lymphoedema management, combining
MLD with compression bandaging, skin care and exercise
(Földi et al, 1985). Inevitably, these techniques have
now developed in various directions, owing to specific
expertise and research. While different schools of MLD
have been established (Table 1), the underlying features
and principles of the MLD technique remain similar
across the different methods (Table 2). Importantly, each
MLD school insists on robust training and updating
methods to ensure practitioners are fully skilled, and use
their hands wisely, in order to achieve a good outcome
for people with lymphoedema and other conditions.
Evidence base
How does MLD exert its effect?
Although one of the first studies of MLD took place
40 years ago (Börcsok et al, 1971), the mechanisms through
which MLD has its effect are not fully established. In part,
this is owing to problems in differentiating the effect of
MLD from those of other interventions such as compression
therapy. Additionally, there are challenges in establishing
valid and reliable means of measuring the changes that
take place in the lymphatic and other systems, as a result of
MLD. Techniques to measure lymph flow can be complex
(Olszewski and Bryla, 1994) and many focus on the uptake
of radio-labelled proteins at lymph nodes (Mortimer et al,
1990; Szuba et al, 2002, Kafejian-Haddad et al, 2006). As
Manual lymphatic drainage: exploring
the history and evidence base
Anne Williams
Anne Williams is PhD Student, Edinburgh Napier University Email:
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment
but there is limited evidence to guide clinical practice. This paper outlines
the historical background to MLD and provides insights into the evidence
relating to the effect and efficacy of manual lymph drainage, highlighting
considerations for lymphoedema practitioners
w Manual lymph drainage (MLD) w Lymphoedema w Evidence for
MLD w Therapeutic effect of MLD
Chronic Oedema, April 2010 S19
such, lymphoscintigraphy has been used in several studies,
for example to measure the rate of flow into lymph nodes
(Szuba et al, 2002) or visualize and describe changes in lymph
drainage patterns (Ferrandez et al, 1996). While this provides
some insights, the studies do not provide information on the
long-term effects of MLD on the anatomical, physiological
or functional aspects of the lymphatic system and other
tissues. Measurement of nodal uptake is also impractical
following lymph node dissection.
Table 3 summarizes reported effects of MLD and
highlights some interesting features. For example, Leduc
et al used lymphoscintingraphy to suggest that proximal
use of the ‘call-up’ technique influenced lymph flow in
distal lymphatics (Leduc et al, 1988). Evidence suggests
that MLD enhances movement of fluid into initial
lymphatics, and influences the contraction rates of pre-
collector and collector lymph vessels, moving lymph
towards deeper drainage trunks. MLD also appears to
influence lymph flow between lymph territories and has
also been surmised to lead to proliferation of collateral
lymphatics (Casley Smith and Casley Smith, 1997). Some
important considerations arise from the findings of
various studies and warrant further research. For example,
it is known that inflammatory mediators, present in
interstitial tissue as a result of lymph stasis, will influence
smooth muscle and alter lymph pumping mechanisms
(von der Weid and Zawieja, 2004). This might suggest
that MLD could have a role in reversing these processes
at an early stage in the development of lymphoedema,
reducing local inflammation and oedema, and restoring
the function of lymphatic vessels even before a clinically
obvious or chronic oedema has developed.
It appears likely that MLD has local and systemic
effects, for example influencing the autonomic nervous
system (Hutzschreuter and Ehlers, 1986) and producing
significant changes in the secretion levels of serotonin,
histamine, adrenaline and noradrenaline (Kurz et al,
1978). However, the significance of these findings in
terms of using MLD for people with lymphoedema,
have not been established. Some studies have reported a
reduction in limb volume after MLD that did not appear
to correlate with a measurable change or improvement
in lymph flow (Francois et al, 1989; Kafejian-Haddad et
al, 2006), suggesting that changes in other aspects such as
blood flow may be significant. The potential for lymph to
return to the blood circulation at regional lymph nodes
(Levick and McHale, 2003), reflects the importance
of lymph node clearance, an important feature of the
MLD sequence. Additionally, the ways in which MLD
may reduce skeletal muscle spasm, and improve lymph
drainage, through its influence on connective tissue layers,
requires further consideration.
Clinical therapeutic effects of MLD in
Some of the early work into the therapeutic effects of
MLD was published in German and therefore not easily
accessible to an English-speaking audience. Additionally,
much of the work around MLD has been descriptive, or
has evaluated the effects of combined treatments, without
distinguishing the specific effects of MLD. The majority
of studies have been undertaken with women who have
breast cancer-related lymphoedema. Studies also tend
Vodder (Wittlinger and This method uses different hand movements on
Wittlinger, 1992) the skin called ‘pump’, ‘scoop’, ‘rotary’,
‘stationery circle’ and ‘thumb circle’, depending
on what area of the body is being treated (
1, 2
). It includes oedema movements at areas of
Földi (Földi and This method is based on Vodder strokes as above
Strößenreuther, 2003) with emphasis on a ‘thrust’ and ‘relaxation’ phase.
It includes edema strokes such as the ‘encircling
Casley-Smith (Casley- This method uses a slow and gentle ‘efflurage’,
Smith and Casley-Smith, with specific movements using the side of the
1997) hand, over the ‘watershed’ areas between
lymphotomes (skin lymph territories) (
Figure 3
Leduc (Leduc et al, This method uses specific techniques: ‘call up’ (or
1991) ’inciting’) and ‘reabsorption’ movements; this
reflects how lymph is absorbed into initial
lymphatics, then moves through larger pre-
collector and collector lymphatics
Table 1. Some features of different methods of MLD
Hand movements are used to stretch the skin in specific directions and
promote variations in interstitial pressures, usually without the use of oils
Movements are slow, repetitive and soporific, and usually incorporate a
brief ‘resting’ phase, where the skin is allowed to return to its normal
Pressures vary according to underlying tissues but aim to promote lymph
drainage without increasing capillary filtration and hyperaemia
Deeper or firmer movements may be incorporated when treating areas of
fibrosclerosis, with compression therapy usually applied afterwards
The MLD sequence starts proximally and centrally, often with treatment to
the neck (
Figure 4
Functional and healthy regional lymph nodes are treated, for example the
contralateral (opposite side) axilla and ipsilateral (same side) inguinal
nodes (
Figure 5
) in an upper limb lymphoedema, or both axillae in a lower
limb lymphoedema
Proximal areas such as contralateral and non-oedematous lymph territories
or lymphotomes are treated, including the midline or ‘watershed area’
between two skin lymph territories
The ipsilateral trunk and lymphoedematous limb are treated, starting
proximally, often with particular attention given to the root of the limb
Early in the treatment, emphasis may be on treating the anterior and
posterior trunk prior to treating the swollen limb.
Breathing techniques are commonly used with MLD, often combined with
controlled hand pressures by the therapist, to influence drainage in the
deep abdominal lymphatic vessels and nodes
Limb mobilization and relaxation techniques may be incorporated into the
MLD treatment session
Table 2. Features and principles of MLD
S20 Chronic Oedema, April 2010
to focus on changes in limb volume, using varied or
poorly defined ways to measure or calculate limb volume,
negating any opportunity for comparison or meta-
analysis. Other outcome measures such as tonometry to
assess changes in skin and tissues (Harris and Piller, 2003),
or measures of symptom changes or quality of life, also
require further validation as a means to evaluate MLD.
Table 4 highlights a sample of studies that have a particular
focus on MLD in breast cancer-related lymphoedema.
Most draw on small samples and some are not randomized
or controlled. Several studies suggest that in some patient
groups, MLD combined with compression bandaging may
be more effective than using compression bandaging alone
(Johansson et al, 1999; McNeeley et al, 2004). However,
specific details of how MLD was used or the effect
measured are often not made clear (Andersen et al, 2000).
Two studies from the UK investigated MLD and
patient-administered massage (Sitzia et al, 2002; Williams
et al, 2002). Williams et al (2002) undertook a randomized
controlled cross-over study and showed that MLD had
a significant effect in reducing excess limb volume
in women with breast cancer-related lymphoedema
(p=0.013) even without compression bandaging. Similar
results with a trend towards MLD being more effective
were reported by Sitzia et al (2002) although the authors
suggested a larger study sample was required.
Implications for practice
Asdonk, a German GP who was one of the first to use
MLD extensively in his practice, highlighted the broad
Stretching effect on lymph collectors and local smooth muscle, increased the frequency of contraction of lymphangions/
lymph vessels and increased lymphatic transport capacity (Hutzschenreuter and Brümmer, 1988; Hutzschenreuter and
Herpertz, 1993)
Lymph flow increased (as measured by lymphoscintigraphy) possibly owing to increased rate of contraction of
lymphatics (Francois et al, 1989)
Variations in interstitial pressures led to enhanced filling and emptying of initial lymphatics (Casley-Smith and Björlin,
‘Call-up’ technique propelled lymph in the collecting lymphatics and exerted a suction effect on distal lymphatics; the
‘reabsorption’ technique moved proteins from a subcutaneous tissue injection site (Leduc, 1988)
Proximal MLD treatments produced a reduction in distal tissue pressure (Deryden et al, 1994)
‘Accessory routes’ within the lymph drainage system appeared to be ‘stimulated’ (Ferrandez et al, 1996)
Reduction in limb volume occurred, but was not consistent with increased lymph transport as measured by
lymphoscintigraphy (Kafejian-Haddad et al, 2006)
Blood flow increased in superficial blood circulation and peripheral arteries (Hutzschenreuter et al, 1989)
Blood flow increased through the femoral vein (Deryden et al, 1994)
The influence of MLD on the autonomic nervous system produced a calming effect (Hutzschenreuter and Ehlers, 1988)
Skin circulation improved (Hutzschenreuter et al, 1992)
Urinary secretion of serotonin, histamine, adrenaline and noradrenaline increased (Kurz et al,1978)
Breathlessness decreased and sleep improved (Williams et al, 2002)
• Microlymphatic hypertension reduced (Franzeck et al, 1997), although this appeared to be a combined effect of MLD and
compression bandaging
Table 3. Evidence summary: reported effects of MLD
Figure 1: MLD across the back using rotary technique: Vodder
Figure 2: Thumb circles to the dorsum of the hand: Vodder
Chronic Oedema, April 2010 S21
Authors Design Findings and comments
Johansson et al (1999) Non-randomized consecutive Data on 35 women showed:
Effects of
sample of women with breast At end of Part 1 - mean reduction in excess
cancer-related lymphoedema. volume of 26%
bandaging with or
Part 1- women with limb volume At end of Part 2:
without manual
excess of >10% received 2 weeks o Group 1 (CB/MLD) had further 11%
lymphatic drainage
of CB Part 2 - divided into 2 groups reduction in excess volume
in patients with
Group 1 had a further 1 week o Group 2 (CB) had further 4% reduction
post-operative arm
of CB/MLD (Vodder MLD method) in excess volume
. Group 2 had 1 week of CB alone Both groups had improvement in symptoms
but MLD group had a significant reduction in
Setting: Sweden pain (p<0.03)
Andersen et al (2000) Prospective randomized study comparing Data on 42 patients showed:
Treatment of breast
standard treatment with custom-made No evidence of treatment effect from MLD
information versus standard treatment and Forty-eight percent reduction in absolute oedema
lymphedema with or
MLD (Vodder method ) with 8 MLD treatments volume at 3 months in MLD group
without manual lymphatic
over 2 weeks, in women with limb volume of <30% Sixty percent reduction in same in non-MLD group
drainage. A randomized
No difference in symptom scores between groups
. Complex method of calculating limb volume
Quality of life measured but data not reported
Setting: Denmark
Sitzia et al (2002) Prospective study of 28 women with unilateral Data from 28 women showed:
Manual lymphatic
arm lymphoedema . Women randomized to Group 1- 33.8% reduction in excess limb volume
drainage (MLD) compared
two groups: Group 2- 22% reduction in excess limb volume
with simple lymphatic
Group 1- 2 weeks CB/MLD (Leduc method) Initial excess volumes of 68.3% in Group 1 and
drainage (SLD) in the
given by therapist 58.5% in Group 2
treatment of post-
Group 2- 2 weeks CB/SLD (a simple form of MLD) Small pilot study suggested that MLD was more
mastectomy lymphoedema
. given by therapist effective than SLD but neither results were
A pilot randomised trial
significant and larger sample of 56 participants
required to achieve significance
Setting: UK
Williams et al (2002) Prospective cross-over study of 31 women with Data from 31 women showed:
A randomised controlled
limb volume excess of >10% (mean 35% excess) MLD achieved a significant reduction in excess
crossover study of manual
Women randomized to two groups: volume (p=0.013)
lymph drainage (MLD)
Group A: 3 weeks (15 treatments) MLD (Vodder MLD achieved a significant reduction in dermal
therapy in women with
method) combined with standard treatment of depth in the upper arm (p=0.03)
breast cancer-related
compression hosiery and information MLD achieved a statistically significant
. Group B: 3 weeks of daily patient self-administered improvement in emotional function, dyspnoea,
massage combined with standard treatment with sleep disturbance and pain sensation
Setting: UK compression hosiery and information. Self-administered massage had no statistically
‘Wash-out’ period of 6 weeks then participants significant effects
crossed over to: MLD was used without CB in an attempt to isolate
Group A: 3 weeks SLD and compression hosiery the effect of MLD
Group B: 3 weeks MLD and compression hosiery Longer than 3 weeks is required to evaluate self-
Measurement of change in excess limb volume, massage
dermal depth using skin ulstrasound, caliper ‘creep’ Outcome measures such as caliper creep and
to assess trunk oedema and quality of life skin ultrasound need further validation
McNeeley et al (2004) Sample of 50 women who had lymphoedema Data on 45 women showed:
The addition of manual
after breast cancer randomized to 4 weeks of daily Significant reduction in lymphoedema volume in
lymph drainage to
treatment with MLD (Vodder method) and both groups (CB and MLD/CB) with most benefit
compression therapy for
compression bandaging (CB) or CB alone. seen in the initial 2 weeks
breast cancer-related
Measurement of limb volume reduction expressed Statistically significant greater limb volume
lymphedema: a randomized
as percentage change in excess limb volume reduction with MLD/CB in those with early
controlled trial
lymphoedema (p < 0.05)
Better outcome with MLD/CB in those with mild
Setting: USA lymphoedema (<15% excess volume) than in any
other groups (p < 0.05)
Range of movement and other aspects of quality
of life or symptoms not assessed
Table 4. Evidence: examples of studies of the therapeutic effect of MLD in women with breast
cancer-related lymphoedema
Figure 3. MLD across the midline or ‘watershed’ between two
skin lymph territories: Casley-Smith method
Figure 4: MLD to the neck: Casley-Smith method
Figure 5: MLD clearance of superficial inguinal lymph nodes
S22 Chronic Oedema, April 2010
range of conditions for which MLD may be indicated,
including post-thrombotic syndrome, degenerative
nervous system and inflammatory conditions (Asdonk,
1975). Recent papers report on MLD in sports medicine
(Vairo et al, 2009), conditions such as fibromyalgia (Ekici
et al, 2009) and reflex sympathetic dystrophy (Duman
et al, 2009). A potential role for MLD as part of a
lymphoedema prevention programme is also highlighted
(Torres Lacomba et al, 2010).
However, for those using MLD within their daily
practice, a number of questions arise concerning how
MLD should be used with different groups. As yet, the
evidence to inform these decisions is limited and as a
result, it is important that practitioners reflect critically on
their practice in using MLD. Measurement of outcomes
using standardized, valid and reliable methods is crucial,
as is the sharing of results in terms of ‘successes’ and
It is likely that some patient groups may respond
better to MLD than others. For example, there is some
indication that MLD may be more effective in those with
‘mild’ lymphoedema (McNeeley et al, 2004). Certainly
it is possible that the presence of fibrosclerotic tissues
influences the effect of MLD, rendering it less effective
and indicating that compression therapy in the form of
bandaging may more effective as a first line treatment in
some groups. Equally this may be an indication for early
intervention with MLD to reverse the changes that may
lead to long-term tissue fibrosis.
While MLD is frequently used in combination with
bandaging, some groups will require MLD as the first-line
treatment. For example, those with oedema of the trunk
and midline are a particular priority for MLD and there
are papers describing the use of MLD in genital oedema
(Katz et al, 2004), breast oedema (Mondry et al, 2002)
and head and neck oedema (Figure 6) (Reiss and Reiss,
2003). Clinical experience suggests that women who have
breast oedema after breast cancer treatment will respond
readily to MLD, with good long-term outcomes. This is
a particular group who may be motivated towards self-
management approaches and may be taught self-massage
of the breast area during a course of MLD. Importantly, the
use of MLD in this group may highlight how bodywork
provides a means through which health professionals can
enable people to adjust to and accept changes in their
body after cancer treatment.
The theoretical debate that MLD may somehow promote
metastatic cancer is not substantiated in the minimal
literature (Preisler et al, 1998), nor in clinical practice.
However, this highlights the need for lymphoedema
practitioners to work closely with medical colleagues
to ensure that MLD is appropriately given. It is usually
advisable to delay MLD treatments if someone is receiving
cytotoxic chemotherapy, particularly as the chemotherapy
itself may alleviate an obstructive oedema by reducing
tumour bulk. However, if the focus of care is palliative, it
may not be appropriate to delay lymphoedema treatment,
as swelling may become poorly controlled. In these
situations, MLD can also play an important role in the
management of other symptoms such as pain, dyspnoea
and constipation.
While MLD should not be used in the presence of
acute infection, once antibiotic therapy has begun and
systemic symptoms have passed, MLD can be considered.
MLD is also useful in those with chronic inflammatory
conditions. If recurrent infection has been a problem,
antibiotic therapy may be indicated during the MLD
period as temporary exacerbation of symptoms can
MLD has a long history and a limited, but growing
evidence base to guide practice. This paper has identified
some of the principles and possible effects of MLD and
discussed some implications for lymphoedema practice.
The effects and efficacy of MLD will depend on
various factors relating to the person, the nature of their
lymphoedema, and the way the practitioner uses the MLD
techniques in combination with other interventions such
as compression therapy and self-management support.
There is still much to learn about how MLD should best
be used in order to ensure effective and equitable treatment
for all individuals with lymphoedema. However, fundamental
to this is the need for collaborative working and research.
Good quality information about MLD is also required for
people with lymphoedema, other colleagues, and those
involved in managing and developing services. Practitioners
should be aware of the current evidence around MLD and
ensure they are appropriately educated in the techniques and
supported with applying them in practice. BJCN
Andersen L, Højris I, Erlandsen M et al (2000) Treatment of breast-cancer-relat-
ed lymphedema with or without manual lymphatic drainage. A randomised
study. Acta Oncologica 39(3): 399–405
Asdonk J (1966) Lymphdrainage, eine neue massagemethod. Physik Med U Reha
7 Jahrg: 39–42
Asdonk J (1975) Manuelle lymphdrainahe, ihre wirkungsart, Indikation und
Kontraindikation. Z Algern Med 51: 751–3
Figure 6: MLD to the head and neck region: Leduc method
(Coutesy of Leduc UK)
Chronic Oedema, April 2010 S23
S24 Chronic Oedema, April 2010
gesting therapy on positive interstitial pressure and on lymphangiomotor
activity. In: Progress in Lymphology; Elsevier Science Publishers: 557–60
Hutzschenreuter P, Brümmer H, Ebberfeld K (1989) Experimental and clini-
cal studies of the mechanisms of effect of manual lymph drainage therapy. J
Lymph 13(1): 62–4
Hutzschenreurter P, Brümmer H, Kurz I, Witlinger D (1992) Changes in
microcirculation during MLD technique according to Vodder. Topical
Contributions to MLD 44–52. ISBN 3-7760-1259-5
Hutzschenreuter P, Ehlers R (1986) The effect of manual lymph drainage on
the autonomic nervous system. Zeitschrift für Lymphologie 19: 58–60
Hutzschenreuter P, Herpertz U (1993) Primary and secondary lymphedema in
children treated with manual lymph drainage and compression therapy. Eur
J Lymphology and related problems 4(14): 51–7
Johansson K, Albertsson M, Ingvar C et al (1999) Effects of compression band-
aging with or without manual lymph drainage treatment in patients with
post-operative arm lymphedema. Lymphology 32(3): 103–10
Kafejian-Haddad AP, Perez JMC, Castilioni MLV et al (2006) Lymphoscintigraphic
evaluation of manual lymphatic drainage for lower extremity lymphedema.
Lymphology 39(1): 41–8
Katz EE, Lyon MB, Davis D et al (2004) Manual lymphatic drainage for the
treatment of acute genital lymphedema. Journal of Urology 172(1): 157–8
Kurz W, Wittlinger G, Litmanovitch YI et al (1978) Effect of manual lymph
drainage massage on urinary excretion of neurohormones and minerals in
chronic lymphedema. Angiology 29: 764–72
Leduc O, Bourgeois P, Leduc A (1988) Manual lymphatic drainage: scinti-
graphic demonstration of its efficacy on colloidal protein reabsorption. In:
Progress in Lymphology 551 - 4, Elsevier Science Publishers
Leduc A, Caplan I, Lievens P et al (1991) Le traitment physique de ‘oedème du
bras. Monographies de Bois-Larris Masson.
Levick JR, McHale N (2003) The physiology of lymph production and propul-
sion. In: Browse N, Burnand KG, Mortimer PS eds. Diseases of the Lymphatics.
Arnold, London
McNeeley ML, Magee DJ, Lees AW et al (2004) The addition of manual lymph
drainage to compression therapy for breast cancer related lymphedema:
a randomised controlled trial Breast Cancer Research and Treatment 86(2):
Mondry TE, Johnstone PA (2002) Manual lymphatic drainage for lymphedema
limited to the breast. J Surg Oncol 81: 101–4
Mortimer PS, Simmonds R, Rezvani M et al (1990) The measurement of
skin lymph flow by isotope clearances- reliability, reproducibility, injection
dynamics and the effect of massage. J Invest Derm 95: 677–82
Olszewski Wl, Bryla P (1994) Lymph and tissue pressures in patients with
lymphedema during massage and walking with elastic support. In: Witte MH
et al eds. Progress in Lymphology X1V. Elsevier Science Publishers: 512–6
Preisler VK Hagen R Hoope F (1998) Indications and risks of manual lymph
drainage in head-neck tumors. Laryngo-Rhino-Otologie 77(4): 207–12
Reiss M, Reiss G (2003) Manual lymph drainage as therapy of edema in the
head and neck area. Schweiz Runsch Med Prax 92(7): 271–4
Sitzia J, Sobrido L, Harlow W (2002) Manual lymphatic drainage compared
with simple lymphatic drainage in the treatment of post-mastectomy lym-
phoedema. A pilot randomised trial Physiotherapy 2: 99–107
Szuba A, Strauss W, Sirsikar SP et al (2002) Quantitative radionuclide lym-
phoscintigraphy predicts outcome of manual lymphatic therapy in breast
cancer-related lymphedema of the upper extremity. Nucl Med Commun
23(12): 1171–5
Torres Lacomba M, et al (2010) Effectiveness of early physiotherapy to prevent
lymphoedema after surgery for breast cancer: randomised, single blinded clini-
cal trial BMJ 340: b5396
Vairo G.L Miller SJ, McBrier NM, BuckleyWE (2009) Systematic review of
efficacy for manual lymphatic drainage techniques in sports medicine and
rehabilitation; an evidence-based practice approach. The Journal of Manual and
Manipulative Therapy 17(3): E80–89
Vodder E (1936) Le drainage lymphatique, une nouvelle methode therapeutique.
Santé pour tous. Paris.
Vodder E (1965) Lymphdrainage ad modum Vodder. Aesthetic Medizin 6: 190–1
von der Weid PY., Zawieja DC (2004) Lymphatic smooth muscle; the motor unit
of lymph drainage. Int J Biochem Cell Biol 36(7): 1147–53
Williams AF, Vadgama A, Franks P, Mortimer PS (2002) A randomized controlled
crossover study of manual lymphatic drainage therapy in women with breast
cancer-related lymphoedema. Eur J Cancer Care 11(2): 254–61
Winiwarter A (1892) Die elephantiasis. In: Deutsche Chirugie, Enke, Stuttgart
Wittlinger H, Wittlinger G (1992) Introduction to Dr Vodder’s manual lymph drainage
volume 1: basic course. 4th edon, Haug Publishers, Heidelberg, Germany.
Wittilinger H (2004) Emil Vodder; his life and work. Personal communication.
Walschee, Austria
General MLD information, training and therapist details:
Casley-Smith method:
Leduc method:
Vodder method:
USA-based school for Földi method:
Further information
Börcsök E, Földi K, Wittlinger G, Földi M (1971) Zur therapeutischen
Beeinflussung des akuten experimentellen lymphostatischen Ödems mit
Vitaminen, vitaminartigen Naturstoffen sowie mittels Massage. Angiologica
8: 31–42
Casley-Smith JR, Casley Smith JR,. (1997) Modern Treatment for Lymphoedema
5th edn. The Lymphoedema Association of Australia Inc, Australia
Casley Smith JS, Björlin MO (1985) Some parameters affecting the removal of
oedema by massage - mechanical or manual In: Casley-Smith JR, Piller NB
eds. Progress in Lymphology X. University of Adelaide Press, 182–4
Derdeyn A, Aslam M, Pflug JJ (1994) Manual lymph drainage- mode of action
Progress in Lymphology. Conference Proceedings, Elsevier: 527–9 Devoogdt N,
Van Kampen M, Geraerts I et al (2009) Different physical treatment modali-
ties for lymphoedema developing after axillary node dissection for breast
cancer: a review. Eur J Obstet Gynecol doi.10.1016/j.ejogrb.2009.11.016
Duman I, Ozdemir A, Tan AK, Dincer K (2009) The efficacy of manual lym-
phatic drainage therapy in the management of limb edema secondary to
reflex sympathetic dystrophy. Rheumatology International 29(7): 759–63
Ekici G, Bakar Y, Akyrak T et al (2009) Comparison of manual lymph drain-
age therapy and tissue massage in women with fibromyalgia: a randomized
controlled trial J Manipulative Physio Ther 32: 127–33
Ferrandez JC, Laroche JP, Serin D et al (1996) Lymphoscintigraphic aspects of
manual lymphatic drainage. J Ma Vasc 21(5): 283–9
Fischer M (1967) 30 years of manual lymphatic drainage according to Vodder.
A special form of massage for decompression of the tissue. Landarzt 43:
Földi E, Földi M, Weissleder H (1985) Conservative treatment of lymphedema
of the limbs. Angiology 36: 171–80
Földi M, Strössenreuter RHK (2003) Foundations of manual lymph drainage 3rd
edn. Elsevier Mosby, Missouri
Francois A, Richaud C, Bouchet JY et al (1989) Does medical treatment of
lymphedema act by increasing lymph flow? VASA Band 18(4): 281–7
Franzeck UK, Speigel I, Fischer M et al (1997) Combined physical therapy
for lymphedema evaluated by fluorescence microlymphography and lymph
capillary pressure measurement. J Vasc Res 34(4): 306–11
Harris R, Piller N (2003) Three case studies indicating the effectiveness of
manual lymph drainage on patients with primary and secondary lymph-
edema using objective measuring tools. Journal of Bodywork and Movement
Therapies 7(4): 213–21
Hutzschenreuter P, Brümmer H (1988) Influence of complex physical decon-
KEY pOInts
w Manual lymphatic drainage (MLD) is often used in combination with
compression bandaging, exercises, skin care and self-management
support in the management of lymphoedema
w Manual lymph drainage has a long history but a limited empirical evidence
w Different schools of MLD have been established, but the underlying
principles of the MLD techniques remain similar across the various
w Research studies have described many different ways in which MLD may
exert its’ effect on lymphatic, vascular and other systems
w Hands-on treatment to the body, such as MLD, can be important in helping
individuals to adjust to body changes after cancer treatment
Copyright of British Journal of Community Nursing is the property of Mark Allen Publishing Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.
... However in biomechanics, models are developed to characterize the posture and / or to quantify the torques and the reaction forces. Many models have been proposed in the literature to study postural control (12), sitting posture subjected to vibrations (13) or vehicle entry / exit (14). This model-based approach is almost non-existent in ergonomics, particularly in the interaction tasks study with a smartphone. ...
Full-text available
New portable technologies such as smartphones are developing in a very important way and their use rate is increasing every year. Faced with this growth, it is relevant to consider the risks of developing musculoskeletal disorders related to their increasing utilization. The objective of this study was twofold: 1) to propose a predictive model of the upper body joint angles, torques and reaction forces during smartphone interaction in seated position based on subject’s anthropometric data, environmental conditions and interaction strategies in the sagittal plane; 2) to propose risk scales for joint torques provided by the model and which could be integrated with information on posture as part of the musculoskeletal disorders prevention. One of the original aspects of the predictive model was to consider postural strategies between the trunk and the neck during smartphone interaction. The validation was carried out by comparing experimental data collected from 12 subjects who had to perform texting and web browsing task while sitting on a chair with or without support and the data simulated by the model under the same conditions. The results showed a satisfactory ability of the model to reproduce the subjects' posture. However, more marked differences were observed for reaction forces and for shoulder and elbow flexion when trunk flexion was significant. A validity domain for each parameter was computed for different seat and support heights according to the subjects' body mass index. From these data, joint torques risk scales have been constructed, to characterize the risks incurred by the users. Key words: Predictive Model, Musculoskeletal disorders, Risk scale, Sitting, Posture, Torque/Force.
... It may, however, be difficult for some patients due to lack of mobility, assistance, or ability to perform the task of MLD appropriately, and it is contraindicated in patients with inflammation or leakage (Level VII evidence) [7,31,[80][81][82]. In addition, the benefit of MLD as a monotherapy is controversial and requires further delineation [79,83,84]. ...
Full-text available
Lymphedema is a chronic disorder of the lymphatic system characterized by the accumulation of interstitial fluid in tissues. It affects millions of individuals worldwide, resulting in significant disability and morbidity. Despite its prevalence, it is often an underappreciated clinical entity. In this narrative review, we critically examined and synthesized currently available peer-reviewed literature on the global epidemiology, pathophysiology, and societal burden of lymphedema. Most patients have a secondary cause of lymphedema, such as lymphatic filariasis, mostly prevalent in Asia, South America, and Africa. A smaller proportion of lymphedema is secondary to malignancy or post-oncological treatment. Breast cancer, prostate cancer, cervical cancer, and melanoma are most often associated with causing lymphedema secondary to nodal involvement. Several tools have been developed to assess the effect of lymphedema on quality of life which can cause personal and financial impacts on those affected. Lymphedema is a globally prevalent but underappreciated disease in the developed and developing world. Lymphedema causes a significant burden on quality of life and financial stability to patients. Therefore, awareness among the healthcare team and patient education on prevention and minimizing morbidity are crucial. Level of Evidence: Not gradable.
... CDT is divided into two phases; the aim of the first phase is maximum limb volume reduction and is based on skincare, manual lymphatic drainage (MLD), compression therapy, and exercises [49,50]. MLD promotes the absorption of fluids and proteins from the interstitium into the lymphatic capillaries, increases the contractility of the lymphatic collectors, and increases the amount of fluid returning to the venous system [51]. Compression therapy is performed with multilayer bandages, adjustable compression devices, and elastic garments and favors the reabsorption of interstitial liquids, improves muscle pumping and venous return, and promotes the release of anti-inflammatory mediators. ...
Full-text available
Lymphedema is a chronic progressive disorder that significantly compromises patients’ quality of life. In Western countries, it often results from cancer treatment, as in the case of post-radical prostatectomy lymphedema, where it can affect up to 20% of patients, with a significant disease burden. Traditionally, diagnosis, assessment of severity, and management of disease have relied on clinical assessment. In this landscape, physical and conservative treatments, including bandages and lymphatic drainage have shown limited results. Recent advances in imaging technology are revolutionizing the approach to this disorder: magnetic resonance imaging has shown satisfactory results in differential diagnosis, quantitative classification of severity, and most appropriate treatment planning. Further innovations in microsurgical techniques, based on the use of indocyanine green to map lymphatic vessels during surgery, have improved the efficacy of secondary LE treatment and led to the development of new surgical approaches. Physiologic surgical interventions, including lymphovenous anastomosis (LVA) and vascularized lymph node transplant (VLNT), are going to face widespread diffusion. A combined approach to microsurgical treatment provides the best results: LVA is effective in promoting lymphatic drainage, bridging VLNT delayed lymphangiogenic and immunological effects in the lymphatic impairment site. Simultaneous VLNT and LVA are safe and effective for patients with both early and advanced stages of post-prostatectomy LE. A new perspective is now represented by the combination of microsurgical treatments with the positioning of nano fibrillar collagen scaffolds (BioBridgeTM) to favor restoring the lymphatic function, allowing for improved and sustained volume reduction. In this narrative review, we proposed an overview of new strategies for diagnosing and treating post-prostatectomy lymphedema to get the most appropriate and successful patient treatment with an overview of the main artificial intelligence applications in the prevention, diagnosis, and management of lymphedema.
... 9 Conventional methods of MLD generally commence centrally and proximally, before moving distally down the affected extremity in segments with massage performed in the direction of lymphatic drainage. 10 Traditionally, the MLD instruction for upper extremity lymphedema has generally been initial circular lymph node clearance or activation massage in the neck, then contralateral axilla with lymphatic massage across the chest and back. This is followed by massage of the ipsilateral inguinal nodes with lymphatic drainage performed from the axilla down to the ipsilateral inguinal nodes before treating the arm. ...
Background: The axillo-inguinal (or inguino-axillary) is a compensatory lymphatic drainage pathway regularly utilized by lymphedema therapists when applying manual lymphatic drainage (MLD) for upper and lower extremity lymphedema. However, there is limited evidence of the frequency of this pathway and the characteristics of patients with lymphedema in which this pathway is present. Indocyanine green (ICG) lymphography is an imaging technique that has the capability to identify lymphatic drainage pathways in lymphedema when combined with MLD. In this study, we used ICG lymphography in patients with upper and lower extremity lymphedema to investigate the presence of this pathway and its clinical characteristics. Methods and Results: A retrospective cohort audit of 563 patients with lymphedema (285 with upper extremity and 278 with lower extremity) who underwent ICG lymphography was conducted in combination with MLD. Compensatory lymphatic drainage was investigated. Patients demonstrating the axillo-inguinal pathway were identified, and their clinical characteristics were recorded. The axillo-inguinal pathway was not demonstrated in any patient with upper extremity and only five patients with lower extremity lymphedema. Of these five patients, all were female with a history of secondary cancer-related lymphedema following gynecological cancer. The majority (four) had bilateral lymphedema extending to the lower abdomen and presented with a greater severity of lymphedema. Conclusions: These findings suggest that the axillo-inguinal pathway is an infrequent compensatory drainage pathway in lower extremity lymphedema and rare in upper extremity lymphedema. Our findings have clinical implications for lymphedema management, in particular, the sequence in which MLD is applied.
... Manual lymphatic drainage by massaging is a well-established therapy for lymphedema patients. This method increases both the transport capacity of the lymphatics and peripheral circulation [39]. One study reported that manual lymphatic drainage improved ankle joint mobility in venous ulcer patients with but did not improve wound healing [40]. ...
Defined as an ulceration in a lower extremity caused by venous hypertension, venous ulcers are a common condition which are known to affect approximately 1% of the population. They cause substantial socioeconomic burden and significant impact on patients’ quality of life. Although a number of diagnostic procedures are applicable in diagnosis of venous ulcers, color-flow duplex ultrasound remains the gold standard. For therapeutic options, compression therapy remains the mainstay. Adjunct therapies such as physiotherapy, manual lymphatic drainage, or phlebotonics can be considered to provide symptomatic relieve. This article aims to provide an overview of the anatomy and pathophysiology of venous ulcers as well as their conservative treatment.
... Manual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment of lymphedema. 4 MLD may be administered alone but is usually performed as a component of complex decongestive therapy (CDT), which is the principal therapy for lymphedema. 5 The current best practice for LLLE is a 2-phase CDT program. ...
The contralateral inguinal pathway (CIP) to the inguinal nodal region of the contralateral limb has been described in lower-limb lymphedema (LLLE). This audit aimed to use indocyanine green (ICG) lymphography to determine characteristics of patients with CIP to inform conservative therapy. Patients with confirmed LLLE (n = 278) were categorized into secondary cancer-related (n = 82), secondary non–cancer-related (n = 86), or primary (n = 110). Patient characteristics, limb volume and bioimpedance spectroscopy (BIS) extracellular fluid ratio, and ICG lymphography of lymphatic pathways and dermal backflow areas were recorded. Forty-seven patients (16.9%) had movement of ICG dye via CIP. Of these, 30 (63.8%) had secondary cancer-related, 8 (17.0%) had secondary non–cancer-related, and 9 (19.1%) had primary LLLE. Cancer-related LLE (P < .001) and unilateral LLLE (P = .017) were significant indicators of CIP, with 36.6% of patients with cancer-related LLLE demonstrating this pathway. CIP was significantly associated with dermal backflow in shin (P = .016), calf (P = .006), thigh (P < .001), inguinal (P < .001), pubic (P < .001), and abdominal regions (P = .001). Patients with CIP had significantly higher volume differences between limbs (P < .001), severity of lymphedema (P < .001), and BIS measurements (P < .001) than patients without CIP. A compensatory lymphatic drainage pathway from the affected limb to the contralateral inguinal lymph node region was evident in 16.9% of patients with LLLE. This pathway was most observed in unilateral cancer-related lymphedema, particularly where edema was present in proximal thigh, inguinal, pubic, and lower abdominal regions. Directing manual lymphatic drainage to the contralateral inguinal drainage region should be considered especially for patients with cancer-related LLLE.
Full-text available
Surgery is the main treatment method in breast cancer treatment. Depending on the stage of the tumor, chemotherapy and / or radiotherapy is often applied as part of the treatment. Although the combination of these therapies increases survival, it may cause some locomotor complications. The most common complications; shoulder dysfunction, upper extremity muscle weakness and lymphedema. Lymphedema (LE) is a chronic and progressive condition which is an abnormal retention of protein-rich fluid in the interstitial space because of inadequate lymphatic drainage. One of the most important complications of breast surgery is LE that can occur in the arm, hand and trunk. The incidence of breast cancer associated LE is reported 6-30%. The most important risk factors of LE are the type of axillary surgery and amount of chemotherapy and/or radiotherapy exposure after surgery. For diagnosis of LE; clinical properties such as the unilateral or asymmetric character of edema, normal skin color, positive Stemmer sign, increased density of edema and extremity pain should be considered. After diagnosis, assessment of the patient includes obtaining information about anamnesis, physical tests, metastasis and risk of deep vein thrombosis. Treatment of the condition can be summarized under the topic of medical treatment, surgery and physiotherapy. Complex Decongestive Therapy (CDT) is accepted as the golden standard for LE treatment. CDT concept consists of four basic components (manual lymph drainage, skin care, compression treatment, therapeutic exercise) and two phases. Finally it should not be forgotten and should be kept in mind that LE is a chronic condition that needs lifelong care. In this review; incidence , risk factors, approaches for protection of this factors, assessment methods and therapy options for LE are discussed.
Full-text available
Lymphedema is a severe debilitating disease characterized by the accumulation of excessive protein-rich fluid in the interstitial space. Given the severe morbidity associated with this disease process, various surgical and nonsurgical treatment modalities have been developed to attempt to reduce the incidence and symptoms associated with lymphedema. Manual lymphatic drainage (MLD) is a component of complete decongestive therapy on-surgical treatment which has demonstrated benefit in reducing the development of lymphedema following surgery. Here we provide a review of literature on MLD and its potential mechanism of action. This paper aims to educate patients, physicians, and surgeons about MLD regarding its efficacy and utility in the treatment paradigm for lymphedema and to translate concepts from the treatment of lymphedema to cosmetic procedures. Level of Evidence: 5
Metastasis to distant organs is the most important factor related to cancer survival. Tumor cells spread via blood and lymphatic vessels, systems responsible for transporting fluid and cells. Besides its structural role in cancer metastasis, the lymphatic system displays a critical functional interaction with developing tumors. In clinical settings, full evaluation of the lymphatic system involvement is crucial for treatment and prognosis in cancer patients. Comprehension of physiological and pathological processes involving the lymphatic system is a continuously growing field of basic and clinical research due to recent advances in molecular Lymphology. However, the most interesting biological aspects of lymphatic metastasis of cancer are beyond our objective in this chapter. Here we will focus on the consequences of cancer spread and therapeutic approaches and their impact on the lymphatic system. The knowledge of basic function, structure and distribution of the lymphatic system is essential to diagnosis and treatment in Oncology. In this chapter we will highlight relevant aspects of lymphatic anatomy as well as current topics in conservative and surgical treatment of lymphedema.
In an experimental study on rats and sheep we demonstrated by means of light reflexion rheography and laser doppler fluxmetry that manual lymphatic drainage therapy causes vessel narrowing followed by increased blood flow in the arterioles, capillaries and venulae of the skin as well as in peripheral arteries and an increased lymph flow in lymphatic collectors. A clinical pilot study on patients with obliterative arterial diseases who underwent eight lymph drainage treatments over a four-week period under clinical conditions confirmed this observation.
Manual lymphatic drainage is used in physiotherapy of limb lymphedema in combination with other physical techniques. In order to assess the effectiveness of the method, 47 patients with upper limb lymphedema after radiosurgical therapy for breast cancer underwent lymphoscintigraphy. The examination was performed after subcutaneous injection of technicium-labeled colloid via the fourth and first interdigital space on the hand of the limb with lymphedema. The level of the technicium label was compared on scintigraphies performed before and after manual lymph drainage. Results were analyzed as a function of the clinical characteristics of the edema. Manual lymphatic drainage produced an effective progression of the label in 25 cases (53.2%), independent of radiotherapy. Contralateral lymph nodes were reached in 5 cases and the homolateral internal mammary nodes in 2. These nodes were visualized only after manual lymphatic drainage. The visualization of the drainage routes in unexpected areas demonstrated the effectiveness of the technique in stimulating accessory routes useful for resorption of lymphedema. The use of two injection sites on the hand is also discussed. This study demonstrated the effect on a single session of manual lymphatic drainage and should be completed with an assessment of a complete series of manual lymphatic drainages.
A prospective randomized study was carried out to investigate whether the addition of manual lymphatic drainage (MLD) to the standard therapy could improve treatment outcome in women with lymphedema of the ipsilateral arm after breast cancer treatment. Forty-two patients were randomly assigned to receive standard therapy or standard therapy plus MLD 8 times in 2 weeks and training in self-massage. The standard therapy consisted of use of a compression garment, exercises and information about lymphedema and skin care. The efficacy of treatment was evaluated by reduction in lymphedema volume during treatment and by improvement in symptoms potentially related to lymphedema. The patients were followed-up for a total of 12 months. The study showed that both groups obtained a significant reduction in edema and that MLD did not contribute significantly to reduce edema volume.
Hintergrund: Nach der Operation und Bestrahlung von Kopf-Hals-Tumoren kommt es in diesem Bereich häufig zur Ausbildung von sekundären Lymphödemen, die durch ihre exponierte Lokalisation die Lebensqualität der Patienten stark mindern. Als Therapie kommt die manuelle Lymphdrainage in Frage, deren Einsatz wegen theoretisch möglicher Tumorzellverschleppung aber kontrovers diskutiert wird. Patienten: In einer retrospektiven Studie wurden 191 Patienten, die wegen Kopf-Hals-Tumoren behandelt worden waren, anhand eines Fragebogens auf den Einsatz der manuellen Lymphdrainage und den Erfolg der Behandlung untersucht. In die Auswertung gingen die Rezidivrate, das Tumorstadium, die Histologie und die in sano/non in sano Resektion des Primärtumors ein. Ergebnisse: Von den 191 Patienten hatten 100 manuelle Lymphdrainage nach der onkologischen Therapie erhalten, 91 zählten zum Kontrollkollektiv. 37 Patienten hatten ein loko-regionäres Rezidiv, von denen 18 manuelle Lymphdrainage erhalten hatten. Die Inzidenz war bei Tumoren der Tumorstadien 3 und 4 in beiden Gruppen am höchsten. Besonders häufig rezidivierten Tumoren mäßiger und vor allem geringer Differenzierung, mit Lymphangiosis carcinomatosa und bei non in sano Resektion des Tumors. Dabei bestand zwischen der Therapie- und Kontrollgruppe kein signifikanter Unterschied, eine erhöhte Rezidivrate durch Anwendung der manuellen Lymphdrainage ergab sich nicht. Schlußfolgerung: Zurückhaltung beim Einsatz der manuellen Lymphdrainage ist bei einer Lymphangiosis carcinomatosa und der non in sano Resektion des Tumors zu empfehlen, da hier eine Verschleppung von Tumorzellen und eine Aktivierung des Tumors denkbar ist. Bei allen übrigen in sano operierten Kopf-Hals-Tumoren ist die manuelle Lymphdrainage eine für die Lebensqualität gewinnbringende Maßnahme und wichtiger Bestandteil in der Rehabilitation der Patienten. Summary Background: Secondary lymphedema of the head and neck can develop as a result of obstruction of lymphatic channels following the surgical removal of lymph nodes and fibrosis due to irradiation. This can be treated with manual lymphatic drainage. An increase of tumor recurrence due to this therapy is at controversial discussion. Patients: In a retrospective study 191 patients treated for head and neck cancer were questioned on occurrence of lymphedema and therapy with manual lymphatic drainage. Results: 100 patients had received lymphatic drainage, whereas 91 patients belonged to the group without lymphatic drainage therapy. In 37 cases a tumor recurrence or local metastases were reported, 18 of whom had received lymphatic drainage and 19 belonged to the control group. Among these 37 patients neither the group with lymphatic drainage nor the control group differed significantly concerning stage of cancer, histopathological grading, the in sano/non in sano resection of the primary tumor and a lymphangiosis carcinomatosa. An increased recurrence rate among patients who underwent a lymphatic drainage therapy could not be found. Conclusion: A lymphatic drainage therapy for patients presenting with lymphedema after the oncological therapy does not increase the rate of local recurrencies. Moreover it improves the quality of life after the cancer therapy. As only few data are available for cases with non in sano surgery and tumors with lymphangiosis carcinomatosa these cases should be excluded from a lymphatic drainage therapy. A spreading of occult tumor cells in these patients might be possible.
Selon son origine, un oedeme peut etre traite par medicament ou par diete. Dans certains cas, principalement en cas d'oedemes combines, un drainage lymphatique manuel peut etre efficace. Dans certaines formes d'oedemes, seul un drainage lymphatique d'apres Vodder, Asdonk et Kuhnke est indique puisque les medicaments n'ont pas d'effets sur le systeme lymphatique. Le drainage lymphatique manuel est une methode speciale de massage. Ce travail traite des lymphoedemes primaires ou secondaires de la sphere oro-faciale. Les lymphoedemes secondaires sont causes par un traitement chirurgical ou antitumoral, par une irradiation ou par une tumeur respectivement par une metastase. Le drainage lymphatique manuel est palliatif selon la maladie primaire.