Manual Lymphatic Drainage (MLD)is a specialised manual therapy that uses a gentle rhythmic pumping technique that torques the skin in the direction of lymph flow. The Vodder method of MLD stretches the skin in two directions that opens up the overlapped endothelial cells, allowing fluid in the tissues to drain into the initial lymph vessels. Once the the pressure in the lymphatic system builds it creates a vacuum effect, speeding up lymphatic flow and drainage from the tissues.
MLD has a relaxing and calming effect on the nervous system as the soothing rhythmic stimulations of the skin lowers the activity of the sympathetic nervous system. This also has a pain reducing affect as it stimulates the mechanoreceptors in the skin by releasing inhibitory hormones that counterbalance the transmission of nociceptors (pain receptors). Pain is also reduced through the removal of chemical “danger” signal stimulators such as lactic acid or by products of histamines in the tissues.
Manual lymphatic drainage (MLD) is integral to smooth wound healing and recovery from trauma and surgeries. Swelling and inflammation is part of the healing process which the lymphatic system plays an important role as it supports the removal of debris and eliminating antigens which assists the immune system.
Failure to control micro-circulation and removal of macro molecules (debris) leads to pollution of the tissues as excessive protein debris builds up.
Damaged tissues have reduced ability to remove excess fluid, MLD enables the fluid to be removed quickly therefore reducing recovery time. Pollution of the tissues impairs the wound healing process which will lead to infection and disease as the disrupted flow can not follow the normal route.
Slow healing and complications in the healing process leads to fibrosis, loss of muscle function, loss of fascial bio-tenstegrity and adhesions.
There are two types of Lymphedema - Primary Lymphedema and Secondary Lymphedema, both of which are caused by mechanical insufficiency of the Lymphatic Vascular System.
Primary Lymphedema is a chronic congenital transport disorder of the lymphatic vessels and nodes that exist at birth but may not manifest until later in life.
Secondary Lymphedema is a chronic disease with a known cause such as lymph vessel or node removal that may have been damaged or removed by surgery, cancer, radiation or trauma. Secondary lymphedema may not appear at first but must be treated as it tends to get worse with time.
Combined Decongestive Therapy is the most effective therapy to manage the disease by combining –
There are two stages of treatment to CDT therapy, Intensive phase followed by the maintenance phase.
The intensive stage normally requires a minimum of two or three MLD sessions per week for two to three weeks along with multi-layered bandaging everyday to achieve the best results. After the two to three week’s intensive phase, the reduced limb size is measured and custom made compression garments will be ordered for the maintenance phase.
The maintenance phase requires daily wearing of the custom made compression garment to retain the limb at the reduced size. Other aspects of the maintenance phase include diet, exercise and occasional MLD treatments to help control the fluid balance.
MLD helps relieve heavy painful legs and makes wearing compression garments easier which helps control the disorder.
Lipedema is a chronic disorder that occurs mainly in women which can be very painful and if left untreated can result in lipo-lymphedema. It causes symmetrically impaired fatty tissue distribution between the top of the hips to the ankles, the feet are characteristically not affected.
Women affected by lipedema usually complain of heaviness and tightness in the legs which are also sensitive to touch and bruise very easily due to the increased permeability and fragility of the blood capillaries. The disorder normally begins during puberty and is characterised by larger hips and heavy lower legs. It is an inherited condition with disproportionate swelling of the legs in relation to the trunk (pear shaped).
Lipedema has nothing to do with obesity so it therefore can not be improved with diet although a healthy diet is required to help manage the condition. Early diagnosis, referral for treatment and self care are essential to reduce the significant impact of lipedema on quality of life.