M.lymphatic Manipulation

LYMPHATIC
MANIPULATION
By
V.MANOJ
MPT ORTHOPEDIC
INTRODUCTION
• Lymphatic drainage is a form of gentle massage that encourages the
movement of lymph fluids around the body. The fluid in the lymphatic
system helps to remove waste and toxins from the bodily tissues
LYMPHATIC SYSTEM
• The Lymphatic system is a network of tissues, vessels and organs
that works together to move a colorless, watery fluid called LYMPH
back into the circulatory system
• Lymphatic system collects the excess fluids from tissues which is left
from veins and moves it until it returns to bloodstream
The Lymphatic System Is An Important
Component Of
• Circulatory System
• Immune System
• Metabolic system
FUNCTIONS
• Maintains fluid levels in our body: Lymphatic system collects excess
fluid that drains from cells and tissue throughout the body and returns
it to the bloodstream, which is then recirculated through the body.
• Absorbs fats from the digestive tract: Lymph includes fluids from
the intestines that contain fats and proteins and transports it back to the
bloodstream.
• Protects our body against foreign invaders: The lymphatic system is
part of the immune system. It produces and releases lymphocytes
(white blood cells) and other immune cells that monitor and then
destroy the foreign invaders such as bacteria, viruses, parasites and
fungi that enter the body.
COMPONENTS
• Lymphatic fluid – a protein rich fluid that flows through the
lymphatic system and surrounds all tissues and it is
composed of white blood cells, triglycerides, bacteria, cell
debris, water, and protein.
• Lymphatic vessels - reabsorbs interstitial fluid from the
periphery and return it to the intravascular space, which
prevents fluid build up in peripheral tissues.
• Lymphatic cells – includes macrophages, dendritic cells,
lymphocytes.
LYMPHATIC MANIPULATION
• Lymphatic drainage is a manual massage technique that works on the

lymphatic system, stimulating it to work quickly by moving the lymph
to the lymph nodes
• Its main function is to accelerate the process of removing the

accumulated liquid between the cells and their catabolic residues,
directing them to the capillary vessels through specific movements.
Manual Lymphatic Drainage
• Manual Lymph drainage (MLD), is a technique developed by the
Vodders in 1936 in Paris for treatment of swollen lymph nodes.
• MLD is a light, skin-stretching massage that helps promote the
movement of lymphatic fluid out of the swollen limb.
• It should not be confused with a traditional massage.
• MLD is specifically focused on the lymph vessels to help the
flow of lymphatic fluid.
• MLD helps open the remaining functioning lymph collectors
and move protein and fluid into them, as well as to help
speed up lymph fluid flow through the lymphatics.
• MLD also increases blood flow in deep and superficial veins.
MLD Is Composed Of Four Main Strokes:
• Stationary circles
• Scoop technique
• Pump technique
• Rotary technique.
The Stationary Circle Method
• The fingers are placed flat on the skin and it is moved either
in the same place as stationary circles or in continuous
spirals.
• The manipulations are used mainly for treating the neck, face
and lymph nodes.
• Stationary circles are varied on the body and extremities by
making circles – 5 circles in one spot, hand on hand or with
either fingers placed next to each other.
• In the latter case the fingers turn together in the same
direction to move the skin in circles or alternating.
• The direction of pressure is determined by the lymph drainage.
• Each of these circles is performed with a smooth increase of pressure
into the tissue and a smooth decrease of pressure.
Pump Technique
• With this technique the palms are face downward. The fingers
are outstretched; the fingertips have no function in this
technique. The wrist moves like a hinge.
• The thumb and fingers move together in the same direction,
moving the skin oval circles.
• The movement of thumb and fingers is controlled by the
exaggerated movements of the wrist.
• The forward motion of the fingers is carried with pressure [as
the wrist drops], the forward motion of the wrist is without
pressure.
Scoop Technique
• In contrast to the pump technique with the scoop technique the palm is
facing upward.
• Vodder describes the movement as ‘giving motion’. The rotating wrist
creates a corkscrew movement of the wrist-hand unit.
• The fingers are outstretched and swing towards the body during the
pressure phase.
• Pressure is on the inward part of the stroke with no pressure on the
outward stroke.
• The pivot point is the metacarpal-carpal joint of the index finger, all
the metacaro-phalangeal joints are in contact with the skin during the
pressure phase.
Rotary Technique
• This is used on relatively flat areas of the body and consists of various individual
movements. The wrist moves up and down.
• As it moves down it swings from the outside towards the inside.
• The whole palm lies on the skin and turns it on an inward spiral.
• The thumb also makes circular movements in the direction of the lymph drainage
of the skin.
• These are performed during the pressure phase
• In the pressure less phase the wrist is raised and the four outstretched fingers move
on and the thumb slides inward.
• Wrist moves down, the whole hand touches the skin and it begins to apply pressure.
Different Methods / Approach
• Vodder method - Different kinds of hand motions are used on
the body depending on the part being treated.
The VT differs in the use of adapted pressure and its
application
The constant change in pressure optimizes the results, moving
fluid in the skin and softening fibrosis with positive side effects of
reducing pain and relaxing muscle tense
• Foldi method - Based on the Vodder technique, this method lays
emphasis on thrust and relaxation. It helps in management of
edema through 'encircling strokes'.
• Casley-Smith method - This method involves use of small and gentle
effleurage movements with the side of the hand.
• Leduc method - It involves use of distinctive technique and
'reabsorption' movements which reflet how lymph is absorbed first in
the initial lymphatics and then into larger lymphatics.
Principles
1. The skin is stretched in specific directions using hand movements to
promote variations in interstitial pressure without the use of oils.
2. Slow repetitive movements are used which incorporate a resting phase
allowing skin to return to its normal position.
3. The pressure is varied according to the underlying tissue with the aim
to promote lymphatic drainage.
4. Areas of fibrosis are treated using deeper and firmer movements in
combination with Compression therapy.
5. The lymphatic drainage starts centrally and proximally with
treatments usually starting around the neck.
6. Functional and healthy lymph nodes are treated first, followed by
proximal and contralateral areas and then ipsilateral and
lymphoedematus areas.
7. There is emphasis on treatment of anterior and posterior trunk in the
early phases before the swollen limb is treated.
8. Breathing techniques used are combined with pressure by the
therapist's hands which promotes drainage of deep abdominal lymph
nodes.
9. Limb mobilization and relaxation techniques are often combined
with lymphatic drainage.
Techniques
• There are various techniques for MLD including the
- Vodder
- Foldi
- Leduc
- Casley-Smith methods.
Often, MLD is recommended as a component of the

treatment plan known as Complete Decongestive Therapy (CDT),
although it may be used in combination with other treatments.
Complete Decongestive Therapy
• MLD is often given as part of Complete Decongestive Therapy (CDT).
• CDT is the most effective treatment for lymphedema, as it reduces the

symptoms of lymphedema and improves patients’ functionality,
mobility, and quality of life.
• CDT is a combination of four methods (manual lymphatic drainage,

lymphedema rehabilitation exercises, compression therapy, skin care).
It can achieve a 45-70% reduction in lymphedema volume.
Components of CDT
• MLD
• Skin care
• Special light exercises designed to encourage the

flow of lymphatic fluid out of the affected limb.
• Wear compression garments such as long sleeves

or stockings designed to compress the arm or leg
and encourage lymphatic flow out of the limb.
• The duration of treatments
varies depending on the stage
of lymphodema
• eg: intensive treatment may be
for 2-4 weeks and less intensive
treatments could last for
months or for years .
Different Approaches
• Vodder - Different kinds of hand motions are used on the body depending on the part
being treated. It also includes treatment of fibrosis
• Foldi - Based on the Vodder technique, this method lays emphasis on thrust and
releaxation. It helps in management of edema through 'encircling strokes'.
• Casley-Smith - This method involves use of small and gentle effleurage movements with
the side of the hand.
• Leduc - It involves use of special 'call up' (or enticing) and 'reabsorption' movements
which reflet how lymph is absorbed first in the initial lymphatics and then into larger
lymphatics.
Indications
• Primary or secondary lymphedema
• Lipedema
• Phlebo-lymphostatic edema
• Postoperative edema
• Posttraumatic edema
• Chronic venous insufficiency
• Effective for reducing intracranial pressure in severe cerebral diseases.

Contraindications
 Absolute Contraindication:  Relative Contraindication:
• Decompensated cardiac • Malignant lymphedema caused

insufficiency by active cancer
• Untreated Congestive heart
• Renal dysfunction
failure (CHF - cardiac edema)
• Acute renal failure
• Acute deep venous thrombosis

(DVT)
THANK YOU…!!!

M.lymphatic Manipulation

Uploaded by

Copyright:

Available Formats

M.lymphatic Manipulation

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Read this document in other languages

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

M.lymphatic Manipulation

Uploaded by

Copyright:

Available Formats

LYMPHATIC

• Lymphatic drainage is a manual massage technique that works on the

• Its main function is to accelerate the process of removing the

Often, MLD is recommended as a component of the

• CDT is the most effective treatment for lymphedema, as it reduces the

• CDT is a combination of four methods (manual lymphatic drainage,

• Special light exercises designed to encourage the

• Wear compression garments such as long sleeves

• Chronic venous insufficiency

• Effective for reducing intracranial pressure in severe cerebral diseases.

• Decompensated cardiac • Malignant lymphedema caused

• Acute renal failure

• Acute deep venous thrombosis

You might also like