Lymphatic drainage

Lymphatic drainage is an important part of lympdoedema treatment. It’s a form of massage that helps stimulate the lymphatic system and encourages the flow of lymph fluid. This encourages lymph to drain out of the affected area into an area that drains normally.

Manual lymphatic drainage (MLD) is a specialised massage technique that should only be practised by trained therapists. Manual Lymphatic Drainage UK holds a list of qualified MLD specialists. When you start, MLD is usually given daily for up to an hour, reducing to two or three times a week. The length of the course may vary and is sometimes combined with other treatments.

You can also learn to do a simplified version of MLD at home yourself, called simple lymphatic drainage (SLD). It’s important that you’re taught this by a specialist. SLD helps stimulate the lymph channels and drain excess fluid.

Lymphatic drainage should be used in combination with deep breathing exercises before and after the massage. This helps encourage the drainage.

What is lymphatic drainage?

Lymphatic drainage is a special massage technique that encourages lymph fluid to drain out of an area affected by lymphoedema into an area that drains normally. 

There are two main types of lymphatic drainage: manual lymphatic drainage (MLD) and simple lymphatic drainage (SLD).


Manual lymphatic drainage (MLD)

Manual lymphatic drainage (MLD) is a specialised, gentle type of skin massage which may be used as part of your lymphoedema treatment. The aim is to encourage the extra lymph fluid to move away from the swollen area so it can drain normally. MLD also improves lymph fluid drainage through the healthy lymph vessels, which helps control swelling. Breathing techniques are also an important part of this treatment (see below).

MLD should only be given by a trained and experienced therapist. A number of different techniques can be used.

The different methods are:

  • Casley-Smith
  • FG-MLD
  • Földi
  • Leduc
  • Vodder.

Your therapist should be trained in at least one of these. They will give you further information about the technique they use and what it involves.

MLD may be especially helpful if you have lymphoedema in your:

  • face
  • neck
  • upper arm
  • breast
  • trunk (body)
  • genitals.

MLD is usually combined with compression garments or bandaging to keep the swelling down. But it can be particularly useful in areas where it’s difficult to use compression therapy.

NHS lymphoedema treatment clinics often provide MLD. However, it’s not available at all centres. If you’re having difficulty finding a qualified MLD therapist, contact Manual Lymphatic Drainage UK, who keep a register of their members. Or the British Lymphology Society has a directory on its website that you may find helpful.

Having MLD

MLD works while you are receiving the treatment. To help keep the swelling down you will be taught how to do a simplified version of MLD yourself at home. It’s a type of self-massage called simple lymphatic drainage (SLD) – see below.

When you start, MLD is usually given daily for up to an hour, reducing to two or three times a week. The length of the course may vary and is sometimes combined with other treatments. Before and after MLD, your therapist will do some breathing exercises with you.

You’ll usually be lying down and may have to remove some of your clothing, unless you have lymphoedema of the head and neck area. Your therapist will begin by treating unaffected lymph nodes. They will use some pressure and slow, rhythmical movements. MLD is not used if you have an infection (cellulitis) in the swollen area or if you have certain medical conditions, such as heart problems.


Simple lymphatic drainage (SLD)

Your lymphoedema specialist may suggest simple lymphatic drainage (SLD) as part of your lymphoedema treatment.

This is a simplified version of manual lymphatic drainage (MLD).

It’s important that you’re taught these techniques by a lymphoedema specialist before you start. They will teach you to massage the area where you don’t have lymphoedema. This helps to make some space for the fluid to drain into from the swollen area. You do not massage the swollen area. They can also teach a friend or relative to do it.

Doing SLD

Your lymphoedema specialist will explain how to do the massage and show you the right amount of pressure to apply. This will depend on your individual situation.

The aim of this massage is to stimulate the lymph channels on the body (trunk) to clear the way ahead so excess fluid can drain away. Once these channels have been cleared, the excess lymph from the swollen side will be able to drain away more easily.

It is best to choose a time and a place where you can do SLD in a relaxed way and won’t be interrupted or distracted. Make sure you have everything you need before you start and get yourself into a comfortable position. Remember to do your deep breathing exercises first (see below).

The massage is done without any oils or creams, using your hand very gently to move the skin in a particular direction. The skin is always moved in the direction away from the swollen side. A little talcum powder may be helpful if your skin is sticky and your hand doesn’t move freely. If your skin is red when you’ve finished, then the movement is too hard.

The Lymphoedema Support Network has information on the self-management of lymphoedema and SLD.

Hand-held massagers

Hand-held massagers may be useful for people who have restricted movement of their hands. You should talk to your lymphoedema specialist before buying one. Some people find it helpful to use a soft baby brush as a massager.


Deep breathing exercises

Before and after MLD and SLD massage, breathing exercises can help to encourage lymphatic drainage. Use the following simple exercises:

  • Sit upright in a comfortable chair or lie on your bed with your knees slightly bent.
  • Rest your hands on your ribs.
  • Take slow deep breaths to relax.
  • As you breathe in, direct the air down to your tummy (abdomen), which you will feel rising under your hands.
  • Breathe out slowly by ‘sighing’ the air out. While breathing out, let your abdomen relax in again.
  • Do the deep breathing exercises five times.
  • Have a short rest before getting up, to avoid feeling dizzy.

You might find it helpful to listen to our CD Relax and breathe, which can help with deep breathing. Call our cancer support specialists for more information on 0808 808 00 00  or order it free from our website be.Macmillan.