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Lymphedema Decongestive Therapy


Related Terms: Manual Lymphatic Drainage, MLD, Comprehensive Decongestive Therapy, CDT, Complete Decongestive Therapy, Complex Decongestive Physiotherapy, CDP, Simple Lymph Drainage



Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.

This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.

First brought to North America in 1982, the school is located in
Victoria, British Columbia, Canada. Before it was introduced the standard treatment course in North American was either a surgery called debulking or the use of compression machines wherein the limb was literally squeezed by pneumatic air pressure.

The sessions generally last about one hour and will continue for a duration of four to six weeks.

. . . . . . . . .

Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.

Also known as Complete Decongestive Physiotherapy (CDP), this treatment therapy was pioneered in the United States by Dr. Robert Lerner.


From a recent post I made on a lymphedema board 07/14/04


I received an email request to describe what decongestive therapy is since I have mentioned it so many times. It is the treatment of choice presently used for lymphedema. 

To understand how and why decongestive therapy works, first you need to undersand exactly how the lymph system is made up. We generally think of the lymph system as these "channels" the go throughout our body and are connected by lymph nodes. However, it is also comprised of an unblievable network of lymph capillaries that network under and through the skin layers our of body. This almost microscopic network collects fluids and channels it into the lymph veins to be filtered through the lymph nodes and eventually carried out of the body. In lymphedema, because of an impaired lymph system, fluid collects in the interstitial areas (tissues) between cells. This fluid is composed of proteins and electrolytes and even includes the liquid of blood plasma. You normally have about 15 quarts of this fluid in your system. With our condition, this liquid doesn't move as it should and eventually the affected areas swells from the excess fluid, the whole system becomes "clogged."

Decongestive therapy is a massage technique that helps unclog the system. It gently moves this fluid, in the direction of normal body flow so that it can be eliminated. In unclogging the system, the tiny network of lymph capillaries are able to help move the fluid.

There are two basic types of decongestive therapy.

Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.

This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.

Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.

Also known as Complete Decongestive Physiotherapy (CDP) or Complex Decongestive Therapy (CDT).

After each session, your limb will be wrapped in compression bandages to prevent reswelling until the next session. Once the limb is down to the desired size, you will be measure for a custom made compression hosiery type garment and pressure sleeve.


I sound like a broken record on urging everyone to get decongestive therapy, because for me, it came too late. By the time I had heard of this treatment my left leg (the worse one) was already beyond treatment. I have had three lymphedema therapists tell me that there was nothing that even this treatment could do.

Like most hereditary/primary lymhpedema patients (Milroy's Syndrome) my legs are not as large as lot I have seen. They are about twice the normal size. But, the left one is totally fibrotic, literally as hard as a rock. It is the hardest and most grotesque leg you would ever NOT want to have or see. As such, the infections, which have been plentiful and furious, especially during the past two years can only be controlled through months of IV antibiotics. Sometimes, I have even had to use a combination of Unasyn and Gentimycin.

It is also where the first of my two lymphomas appeared. I am now also loosing venous flow to my left foot because of the fibrosis. On my left ankle, I have an ominous and rapidly growing purplish nodular growth (soon to be biopsied). The change in this leg has been more dramatic and intense during the past year than all the other 50 years I have had lymphedema. What ever you do...get that lymphedema diagnosed early and get treatment immediately. I wish with all my heart that none of you have to experience the complications I now face.


Manual Lymph Drainage and it's Role in the Treatment of Lymphedema


The Dr. Vodder School - North America

Manual Lymph Drainage and Combined Decongestive Therapy


For information on Simple Lymph Drainage, which is a simple self administered form of Manual Lymph Drainage contact:




Complex Decongestive Physiotherapy, (CDP) or Complete Decongestive Therapy (CDT)



How Can Lymphedema Be Treated?


Complex Decongestive Therapy (CDT)


Complex Decongestive Physiotherapy


Manual Lymphatic Drainage

This treatment is a gentle light touch massage. This prevents damage to the tissues. It promotes lymph flow through the collateral (superficial) lymph vessels to channel the lymph into the abdominal area ( the "watershed") and into normal functioning lymphatic vessels and nodes. These collateral lymph vessels are usually working normally and the problem lies in the deeper vessels which were damaged and scarred.


The therapist places compression bandaging around the limb. Often foam chip pads are placed under the bandaging to increase pressure on fibrotic area to break down scar tissue. These bandages stay on 24 hours a day throughout the treatment period. They come off only to shower, do skin care, assess the swelling reduction and to do the MLD.

Skin Care

Use a soap with a low pH., unscented and not antibacterial soaps. A good liquid soap is Cetaphil. The skin must be moisturized after bathing. Use a lotion like Eucerin or Nivea. If there are any irritations use an antibacterial cream. Always dry the area very well, and gently, after washing.


An individualized exercise program will be given by the therapist to each patient. They will improve muscular contractions and joint mobility. There will also be strengthening exercises for the limb that will reduce muscle atrophy. Muscular contractions along with the low-stretch bandages provide constant counter pressure to keep the lymph fluid moving.



Dr Vodder's Manual Lymphatic Drainage (MLD) is an advanced therapy in which the practitioner uses a range of specialized and gentle rhythmic pumping techniques to move the skin in the direction of lymph flow.

This stimulates the lymphatic vessels which carry substances vital to the defense of the body and removes waste products.
The first visit will include a consultation and the therapist will outline the number and frequency of sessions. Each session will last approximately one hour.

Where appropriate the therapist will work in conjunction with your medical practitioner.

The History Of Manual Lymphatic Drainage [MLD]

During the early 1930's Dr Emil Vodder created a unique range of movements which brought relief from chronic conditions such as sinus congestion and catarrh.

Since Vodder's pioneering work, Manual Lymphatic Drainage has spread world-wide and has become a popular treatment in many European hospitals and clinics.

MLD is now beginning to gain acceptance in the U.K. as a component in the treatment and control of lymphoedema.

The Benefits Of Manual Lymphatic Drainage

Manual Lymphatic Drainage:

is both preventative and remedial and can enhance your well-being
is deeply relaxing

promotes the healing of fractures, torn ligaments, sprains and lessens the pain

can improve many chronic conditions: sinusitis, rheumatoid arthritis,scleroderma, acne and other skin conditions.
may strengthen the immune system

relieves fluid congestion: swollen ankles, tired puffy eyes and swollen legs due to pregnancy

is an effective component of the treatment and control of lymphoedema and assists in conditions arising from venous insufficiency

promotes healing of wounds and burns and improves the appearance of old scars minimizes or reduces stretch marks


Links - Manual Lymphatic Drainage



Manual Lymphatic Drainage - United Kingdom


Manual Lymphatic Drainage Therapy


What is manual lymphatic drainage ?


Dr Vodder's Manual Lymphatic Drainage


Manual Lymphatic Drainage: The Benefits


Traditional Massage Therapy in the Treatment and Management of Lymphedema


To find a qualified and trained CDT/MLD lymphedema therapist in your area, in addition to information on training programs, and some helpful links, visit: The American Society of Lymphology Resources (aka Lymphedema Therapist International)

When looking for a therapist, you should ask the following questions:

1. Where did you get your training?

2. What approach do you use? Vodder, Foeldi, Casley-Smith etc.

3. How many hours of training have you had? (120 to 160 hrs. or more is good)

4. Are you an OT., PT., MT. ? Where did you get your degree?

5. How long have you been doing CDT/MLD ?

6. What certification do you have?

7. How many times a week will I have treatment and for what length of time?

8. How long will my consultation be?

9. Will there be a therapist on call at all times?

10. Is there a doctor, APRN, or nurse connected with the facility? How often will I be seen by them?

For more information on choosing a lymphedema therapist, go to the

National Lymphedema Network's Resource Guide

Choosing a Lymphedema Therapist


Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema.

Szuba A, Cooke JP, Yousuf S, Rockson SG.

Stanford Lymphedema Center, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.

PURPOSE: A prospective evaluation was undertaken to assess the efficacy of intensive, short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema. METHODS: The therapeutic responses of 79 patients with lymphedema were analyzed prospectively. Each patient received intensive, short-term decongestive lymphatic therapy, with quantification of the extent and durability of the clinical response. Decongestive lymphatic therapy was performed by therapists trained in these techniques. The mean (+/-SD) duration of therapy was 8+/-3 days. Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient's treatment. The mean period of follow-up was 38+/-52 days. Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb. RESULTS: The mean short-term reduction in limb volume was 44%+/-62% of the excess volume in the upper extremities and 42%+/-40% in the lower extremities. At follow-up, these results were adequately sustained: mean long-term excess volume reductions of 38%+/-56% (upper extremities) and 41%+/-27% (lower extremities) were observed. CONCLUSION: Decongestive lymphatic therapy, combined with long-term self-management, is efficacious in treating patients with lymphedema of the extremity.

PubMed - National Library of Medicine


Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema.

Liao SF, Huang MS, Li SH, Chen IR, Wei TS, Kuo SJ, Chen ST, Hsu JC.

Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan.

BACKGROUND AND PURPOSE: Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema. METHODS: Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume. RESULTS: The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients. CONCLUSIONS: Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese

PubMed - National Library of Medicine


The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema.

Comment in:

Weiss JM, Spray BJ.

Cox Regional Center for Sports Medicine and Rehabilitation, Springfield, Missouri 65807, USA.

Lymphedema is a chronic disorder which can adversely affect quality of life (QOL). The purpose of this study was 1) to evaluate whether QOL was improved in patients with lymphedema following Complete Decongestive Therapy (CDT), and 2) whether limb volume change as a result of treatment correlated with change in QOL. Thirty-six patients with peripheral lymphedema from varying causes were enrolled in the study. The QOL of each participant, with regard to physical, functional, and psychosocial concerns, was measured by pre- and post-treatment questionnaires. Percent edema volume reduction was calculated for each patient with only one affected limb. QOL pre- and post-treatment scores were assessed by multivariate repeated measures analysis. QOL scores differed significantly (p<0.05) between pre- and posttreatment in all areas of inquiry. Patients with lower extremity lymphedema had significantly greater mean improvement in QOL scores compared with patients with upper extremity lymphedema (p=0.02). There was no correlation between percent edema volume reduction and post-treatment QOL improvement. This study suggests that significant improvements are made in the QOL of patients exhibiting peripheral lymphedema following CDT, which is not necessarily correlated with limb volume reduction.

PMID: 12081052 [PubMed - indexed for MEDLINE]


Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema.

Johansson K, Albertsson M, Ingvar C, Ekdahl C.

Department of Physical Therapy, Lund University Hospital, Sweden.

Comment in:

We examined the effects of low stretch compression bandaging (CB) alone or in combination with manual lymph drainage (MLD) in 38 female patients with arm lymphedema after treatment for breast cancer. After CB therapy for 2 weeks (Part I), the patients were allocated to either CB or CB + MLD for 1 week (Part II). Arm volume and subjective assessments of pain, heaviness and tension were measured. The mean lymphedema volume reduction for the total group during Part I was 188 ml (p < 0.001), a mean reduction of 26% (p < 0.001). During Part II the volume reduction in the CB + MLD group was 47 ml (p < 0.001) and in CB group 20 ml. These differences were not significant (p = 0.07). A percentage reduction of 11% (p < 0.001) in the CB + MLD group and 4% in the CB group was significantly different (p = 0.04). In both the CB and the CB + MLD group, a decrease of feeling of heaviness (p < 0.006 and p < 0.001, respectively) and tension (p < 0.001 for both) in the arm was found, but only the CB + MLD group showed decreased pain (p < 0.03). Low stretch compression bandaging is an effective treatment giving volume reduction of slight or moderate arm lymphedema in women treated for breast cancer. Manual lymph drainage adds a positive effect.

Publication Types:

PMID: 10494522 [PubMed - indexed for MEDLINE]


Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy.

Mondry TE, Riffenburgh RH, Johnstone PA.

Breast Health Center, Naval Medical Center, San Diego, California 92134-1005, USA.

PURPOSE: Lymphedema is a well-described complication of therapy for breast cancer. Patients who present with lymphedema may experience pain and body image issues and are at increased risk for developing cellulitis. Complete decongestive therapy (CDT) is a four-component therapy for lymphedema. Data regarding CDT as an intervention in the immediate after the diagnosis period and prolonged follow-up are limited; we prospectively analyzed results of CDT in this cohort of patients. MATERIALS AND METHODS: Twenty patients were enrolled in CDT immediately after their diagnosis of lymphedema. The Functional Assessment of Cancer Therapy quality of life (QoL) measure and a visual analogue scale for pain were completed before, on the 10th day of, and on the last day of treatment. Each patient underwent a daily 60- to 90-minute treatment session, 5 days per week for 2-4 weeks. Treatment consisted of skin and nail care, manual lymphatic drainage, a multilayer compression bandage, and therapeutic exercise. Edema of the affected limb was reassessed weekly. On reaching a measurement plateau, the patient was discharged from active treatment and began a maintenance phase. The patient was reassessed for girth, volume, and body weight at 3 months. These measurements plus the QoL and pain measures were also reassessed at 6 months and 1 year after treatment. RESULTS: Patients completed 2-4 weeks of treatment (median, 2 weeks). Those classed as severe decreased from 7 to 1. Median girth reduced 1.5 cm and median volume reduced 138 mL. Decreasing girth correlated significantly with decreasing visual analogue scale scores for pain, but not with increasing QoL. Increasing grade correlated significantly with girth reduction and volume reduction. Compliance with the treatment regimen at home decreased with time on the program. During follow-up, girth and volume reverted slightly but stabilized at about 1 cm and 100 mL below baseline, respectively. Although the increase in QoL was not significant, it was noted that during the entire treatment and follow-up period, QoL consistently increased, ending about 5% above baseline, and pain scores gradually decreased, ending with 54% (and median) of patients at 0 pain. CONCLUSIONS: CDT is effective in treating lymphedema. Success in girth reduction contributes to less pain. Grade is a useful indicator of severity; class is not. Increased number of treatment sessions provides marked improvements in girth, volume, and weight but result in poorer compliance. Longer latency more successfully reduces girth, volume, and pain and increases QoL. QoL and pain are improved by treatment and continue to improve after treatment has ended.

Publication Types:

PMID: 15000494 [PubMed - indexed for MEDLINE]



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Reviewed Jan. 15, 2012