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Lymphedema + Manual Lymph Drainage

This section is designed to further explain the treatment for Lymphedema using Manual Lymph Drainage (MLD®) and Combined Decongestive Therapy (CDT). Every part of the CDT process contributes to the treatment and, under the direction of a Vodder-trained therapist, excellent results can be obtained.

What is Lymph?

Lymph is a colorless fluid, which forms in the body tissues and drains into the blood through a network of vessels and nodes. Major components of lymph include:

  • 95% Water
  • Proteins - from blood
  • Fats - from digestion
  • Cells - white blood cells, dead cells, cancer cells, broken cells, and pathogens

Once these components have been picked up from the tissue spaces by the lymphatic vessels, it is referred to as Lymph.

Lymph Nodes

600 - 1000 nodes in the human body function to:

  • Filter and concentrate lymph
  • Store pathogens and waste material
  • Store white blood cells

Lymph Pathways

  • In contrast to the circulatory system, which functions to circulate blood throughout the body, the lymphatic system drains the tissues.
  • Lymph is formed in tissue spaces all over the body and is gathered into small lymph vessels that return it centrally to the venous system.
  • All lymph eventually enters into either the Thoracic Duct or the Right Lymphatic Duct. Each terminates at the junction of the internal jugular and subclavian veins where the lymph re-enters the bloodstream.
  • An anatomically and functionally intact lymphatic system responds to an edema and the subsequent increased amount of fluid with a greater transport capacity. The lymphatic system will fail to cope with the increased amount of protein and water and LYMPHEDEMA results.


Lymphedema is a protein-rich swelling (edema) caused by a problem with the lymphatic system. This problem may be organic or functional in origin. Functional lymphedemas are reversible once the underlying cause is resolved. Organic lymphedemas are usually irreversible and are what this info referrs to.

Signs & Symptoms

  • An early sign of lymphedema is a feeling of heaviness or aching in the affected area.
  • Swelling may occur gradually or have a rapid onset brought on by an infection, injury or overuse of the affected arm or leg.
  • Lymphedema may occur immediately after surgery or radiation or may appear many years later.
  • Odd sensations such as pins and needles, numbness, temperature changes, and aching may be a sign of lymphedema.
  • As the edema progresses, jewelry or clothing may become tight or wristbands may leave marks.

If these symptoms persist, seek advice from your medical team. The earlier lymphedema is diagnosed and treated, the more successful the results.

Organic Lymphedema - Two Categories

  • Primary LE usually results from a lack of formation of lymph vessels or nodes during fetal development.
  • Secondary LE results from blockage or damage to nodes or vessels, often due to radiation or surgery.

It is also possible for lymphedema to combine with other forms of edema (e.g. venous or lipedema) which is referred to as mixed edema.

Stages of Lymphedema

Stage I

  • Edema is soft and pitting
  • Elevation reduces edema.

Stage II

  • Edema is harder and non-pitting.
  • Proteins form fibrosis, skin changes.
  • Elevation does not reverse edema.

Stage III

  • Edema is advanced, hard and fibrotic.
  • Skin changes and discoloration occurs.
  • Pain may be present.

Combined Decongestive Therapy

  • Management therapy to reduce and maintain the reduced edema volume.
  • Not a cure for Lymphedema.
  • Involves physician, therapist, patient and 'tools' such as compression, creams, exercises and Manual Lymph Drainage (a light massage technique).
  • Treatment protocol depends on severity of edema, willingness of patient, time and cost.

Dr. Emil and Estrid Vodder developed Dr. Vodder's Manual Lymph Drainage techniques in the 1930's. Therapists trained by the internationally recognized Dr. Vodder School International complete an extensive 160-hour course on MLD® and CDT including pathology instruction and examination with the medical director of the school. To maintain their certification the therapists must re-certify every 2 years by attending a 25-hour course.

More info: www.vodderschool.com

The Emotional Impact

A broad range of emotions may accompany LYMPHEDEMA, including fear, sadness, grief, depression, isolation, frustration and anger. Please remember that these feelings are normal reactions to an abnormal situation.

Emotional Well-being: Emotions have strong effects on the physical body, especially the immune system. It is important to:

  • Acknowledge and validate your feelings.
  • Have a healthy emotional outlet.
  • Create a support network.

Emotional Support Will:

  • Help you deal with your lymphedema.
  • Help you deal effectively with your relationships.

The Challenge

Although this is easier to suggest than to create, having an optimistic outlook and positive lifestyle will help. For example, taking an active role in your health care will help you feel empowered and good about yourself. Becoming informed will help ease some of your initial fears.

Being informed is especially important where you may face conflicting advice regarding your lymphedema. Trust your instincts. Ask whatever questions you need to better understand your treatment options.

One Day at a Time: Managing lymphedema may also include daily exercise and stress management as well as regular treatments. At this point in time there is no cure for lymphedema. It is necessary to take each day one step at a time. Through experience, you will gain a comfort level in performing your daily living activities without causing a worsening of your symptoms.

Be Kind to Yourself: It is normal to feel disheartened about the lymphedema or its treatment. At these times, patients have reported that talking to someone in their support network is particularly helpful in validating their feelings and experiences. Please be compassionate towards yourself at all times.

Common feelings after the onset of Lymphedema include hopelessness, frustration, depression, isolation, regret, shame, anger, grief, and/or fear. These feelings are also common responses to the realization that lymphedema may involve:

  • Daily inconveniences.
  • Difficulty and expense of finding and getting treatment.
  • A Commitment to a treatment plan.
  • Conflicting information about treatment plan options.

Advanced Stages of Lymphedema May Cause:>

  • Feelings of fear about the possibility of infection and further swelling.
  • Decreased self-esteem and increased self-consciousness.
  • Withdrawal from daily activities that you once enjoyed.
  • Avoidance of people or situations.
  • Dissatisfaction with body image.

Please do not give up hope. Feelings can be powerful motivators for constructive and positive change in our lives. It is possible to get some control over your lymphedema and to feel good about yourself.

Manual Lymph Drainage Resources

DR. Vodder's Manual Lymph Drainage and Combined Decongestive Therapy information reproduced with permission from the Victoria MLD® Group. To obtain permission to use, reproduce, or distribute, please phone 250.598.9862