Massage schools typically focus their curriculum on Swedish massage, which is the modality most of your clients and colleagues will be familiar and comfortable with. However, choosing to focus on certain types of clients by learning specialized techniques targeted to their unique issues is a great way to challenge yourself, offer your clients customized care, and build your business.
One of these specialized techniques is Manual Lymphatic Drainage, or MLD. This light-touch modality can help clients suffering from lymphedema — a lymphatic obstruction that leads to fluid buildup in the extremities — which is often a complication of cancer treatment.
MLD was developed in the 1930s by naturopath Estrid Vodder and her husband, Emil Vodder. In their work with patients with respiratory conditions, noticed that these ill patients’ lymph nodes were often swollen; they started seeing positive results by manipulating the lymph nodes, and began using this technique for various conditions for different patients.
The Vodders’ success was noted by Michael Foeldi, MD, a vascular surgeon, who continued to advance the work; he further developed the technique into complete decongestive therapy, which is used for treatment of patients with lymphedema, an abnormal swelling resulting from cancer surgeries or congenital pathologies. Complete decongestive therapy has four components, and MLD is an integral component of this treatment.
Manual lymphatic drainage is a superficial technique performed with a light touch, used for manipulation of the superficial lymphatic system, which indirectly helps in improving blood circulation and rerouting of the lymphatic fluid.
MLD has four basic strokes: stationary circles, pump, scoop and rotary. All of them have a working phase in which you stretch the skin, redirecting the lymphatic fluid away from swollen areas, followed by a resting phase.
The different strokes used in manual lymphatic drainage are combinations of the four basic strokes.
In many ways, MLD differs greatly from traditional Swedish massage.
Swedish massage consists of gentle manual manipulation of the soft tissue for establishment of homeostasis and restoration of overall well-being. It is typically used to help with relaxation, relieve pain and tension, reduce adhesions and knots in muscles, and improve flexibility.
While MLD may share some indications with Swedish massage, a big difference we noticeably observe is that MLD does not affect the body at a muscular level, as it is a very superficial technique. The superficial lymphatic collectors are located right below the skin in superficial fatty tissue, so the amount of pressure used to treat the structure is very light; hence, there is no manipulation at a muscular level.
Some of the physiologic effects of MLD are to assist with pain management, improve lymph circulation, improve blood circulation and create overall relaxation.
Specific conditions that can be addressed using MLD include lymphedema, fibromyalgia, chronic fatigue syndrome, migraines, cellulite, post-traumatic swelling and post-surgical swelling.
Given that the lymphatic system is the primary defense mechanism of the body, there is speculation that treatment with MLD can also help improve immunity, though there are currently no studies to substantiate this claim.
Any therapist who gains training in MLD will be equipped with a useful tool to provide their clients who may battle the above conditions.
In my physical therapy practice, there are times a patient requests information about massage therapists who can provide MLD for them on a weekly basis after we discharge them. This is a huge market and a big need.
With MLD, your treatment plan will change based on the indications for which you are using it.
A typical MLD session can last anywhere from 45 minutes to an hour. The treatment is focused on repetitive passes on the same location, so if the client wants to emphasize treatment on certain body segments, you can modify the treatment as needed.
There is no specific frequency recommended for MLD as a stand-alone treatment. Depending on symptomatic relief for the client, they may schedule it more or less frequently.
With certain conditions, teaching the client to perform the technique on him or herself can be helpful. For example, with migraines, MLD treatment during the initial onset phase of the migraine helps prevent the progression of the migraine — so educating clients regarding self MLD can help them deal with certain conditions between sessions.
Whatever the specific condition they present with, patients usually report a feeling of generalized relaxation after MLD treatment. As this treatment increases and improves circulation, it may also lead to increased frequency of urination. Ideally, the client should increase their water intake after treatment.
Different schools offer different training programs for becoming MLD certified. Choosing between different schools may seem overwhelming, but you want to choose a school which is approved by the Lymphology Association of North America (LANA).
Usually, the process of learning MLD takes about four days of eight-hour trainings. If you choose to become lymphedema certified, the training usually takes 135 hours.
Manual lymphatic drainage is a highly specialized technique useful for several patient populations. As the acceptance of massage and other complementary therapies in hospitals continues to increase, multidisciplinary care teams will become more common; techniques like MLD can equip the massage therapist to be an integral part of patient care.
Kirat Shah, PT, MPT, WCC, CWS, CLT-LANA, is co-owner of Lymphedema and Rehabilitation Consultants in Richmond, Virginia. He exclusively treats clients with lymphedema/wound care in their homes on an outpatient basis. He is also an instructor with the Academy of Lymphatic Studies, teaching courses nationally and internationally.
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