Manual Lymphatic Drainage: An Old Therapy with a Modern Twist
- Catharine Burt RN, BScN, RMT, CDT
- Sep 30
- 2 min read
Manual Lymphatic Drainage (MLD) has been part of lymphedema care for almost a century. First developed in the 1930s, it was revolutionary at the time— a gentle, hands-on method to stimulate the lymphatic system and mobilize stuck tissue fluid.
Since then, research has continued to evolve, and today we know more about the lymphatic system than ever before. With this new knowledge comes fresh debate: does MLD still play a central role in lymphedema treatment, or have compression and exercise surpassed it?
As someone who’s treated clients with lymphedema for 20 years, I’ve seen firsthand that MLD is still valuable—but perhaps not in the way people imagine.
What the Research Says
Several modern studies, including a 2018 trial in breast cancer patients, found that CDT without MLD was just as effective at reducing limb size as CDT with MLD. Meta-analyses also show inconsistent results.
That’s why international guidelines now emphasize self-management: compression, exercise, skin care, and education. These remain the foundation for long-term volume control.
Why MLD Is More Than “Gentle Strokes”
When most people think of MLD, they picture feather-light hand movements designed to encourage fluid flow. That’s certainly part of it—but in clinical practice, MLD is more than that.
For many clients, I use what I call tissue remodeling techniques—methods that go beyond gentle lymph stimulation:
Softening fibrosis (hardened tissues that block fluid movement)
Loosening scars that restrict skin and underlying fascia
Releasing muscle tension that compresses lymphatic pathways
Using deeper techniques for deeper edema formation
These techniques help create a “clearer highway” for lymph to flow, making compression and exercise much more effective.
Where MLD Still Shines
Despite mixed research on volume reduction, MLD continues to prove its worth in areas that matter deeply to people with lymphedema:
Targeting stubborn congestion in tricky areas
Relieving heaviness, pain, and tightness
Preparing tissue so compression and exercise routines work more effectively- essentially, working smarter, not harder
Supporting relaxation, anxiety reduction, and better sleep
My Approach in Clinic
In my practice, I use MLD strategically—not as the sole treatment for swelling, but as a precision tool. Compression and exercise remain the base of care, but MLD treatments change depending on the presentation of the lymphedema. Light and gentle strokes are just not effective to soften fibrosis and reach the deeper edema formations and are a waste of time and money for my clients. At the same time, I focus on teaching my clients to perform MLD at home based on self-evaluation of their lymphedema in the moment which has shown successful outcomes because these practical techniques keep progress going between visits.
The Future of Lymphedema Care
The conversation around MLD is shifting—not to abandon it, but to refine how we use it. As research grows, we’re learning that MLD is most effective when combined with compression, exercise, and self-care, and when applied with advanced tissue techniques.
So yes, MLD still matters. In my experience, it’s not just about moving fluid—it’s about restoring tissue health, relieving symptoms, and giving people the tools to live well with lymphedema.
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