Related Terms: Manual Lymphatic Drainage, MLD, Comprehensive Decongestive Therapy, CDT, Complete Decongestive Therapy, Complex Decongestive Physiotherapy, CDP, Simple Lymph Drainage
Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.
This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.
First brought to North America in 1982, the school is located in Victoria, British Columbia, Canada. Before it was introduced the standard treatment course in North American was either a surgery called debulking or the use of compression machines wherein the limb was literally squeezed by pneumatic air pressure.
The sessions generally last about one hour and will continue for a duration of four to six weeks.
Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.
Also known as Complete Decongestive Physiotherapy (CDP), this treatment therapy was pioneered in the United States by Dr. Robert Lerner.
From a recent post I made on a lymphedema board 07/14/04
DECONGESTIVE THERAPY
I received an email request to describe what decongestive therapy is since I have mentioned it so many times. It is the treatment of choice presently used for lymphedema.
To understand how and why decongestive therapy works, first you need to undersand exactly how the lymph system is made up. We generally think of the lymph system as these “channels” the go throughout our body and are connected by lymph nodes. However, it is also comprised of an unblievable network of lymph capillaries that network under and through the skin layers our of body. This almost microscopic network collects fluids and channels it into the lymph veins to be filtered through the lymph nodes and eventually carried out of the body. In lymphedema, because of an impaired lymph system, fluid collects in the interstitial areas (tissues) between cells. This fluid is composed of proteins and electrolytes and even includes the liquid of blood plasma. You normally have about 15 quarts of this fluid in your system. With our condition, this liquid doesn't move as it should and eventually the affected areas swells from the excess fluid, the whole system becomes “clogged.”
Decongestive therapy is a massage technique that helps unclog the system. It gently moves this fluid, in the direction of normal body flow so that it can be eliminated. In unclogging the system, the tiny network of lymph capillaries are able to help move the fluid.
There are two basic types of decongestive therapy.
Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.
This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.
Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.
Also known as Complete Decongestive Physiotherapy (CDP) or Complex Decongestive Therapy (CDT).
After each session, your limb will be wrapped in compression bandages to prevent reswelling until the next session. Once the limb is down to the desired size, you will be measure for a custom made compression hosiery type garment and pressure sleeve.
WHAT HAPPENS WHEN LYMPHEDEMA IS NOT TREATED?
I sound like a broken record on urging everyone to get decongestive therapy, because for me, it came too late. By the time I had heard of this treatment my left leg (the worse one) was already beyond treatment. I have had three lymphedema therapists tell me that there was nothing that even this treatment could do.
Like most hereditary/primary lymhpedema patients (Milroy's Syndrome) my legs are not as large as lot I have seen. They are about twice the normal size. But, the left one is totally fibrotic, literally as hard as a rock. It is the hardest and most grotesque leg you would ever NOT want to have or see. As such, the infections, which have been plentiful and furious, especially during the past two years can only be controlled through months of IV antibiotics. Sometimes, I have even had to use a combination of Unasyn and Gentimycin.
It is also where the first of my two lymphomas appeared. I am now also loosing venous flow to my left foot because of the fibrosis. On my left ankle, I have an ominous and rapidly growing purplish nodular growth (soon to be biopsied). The change in this leg has been more dramatic and intense during the past year than all the other 50 years I have had lymphedema. What ever you do…get that lymphedema diagnosed early and get treatment immediately. I wish with all my heart that none of you have to experience the complications I now face.
TREATMENT FOR LYMPHEDEMA
Complex Decongestive Physiotherapy, (CDP) or Complete Decongestive Therapy (CDT) Manual Lymphatic Drainage
This treatment is a gentle light touch massage. This prevents damage to the tissues. It promotes lymph flow through the collateral (superficial) lymph vessels to channel the lymph into the abdominal area ( the “watershed”) and into normal functioning lymphatic vessels and nodes. These collateral lymph vessels are usually working normally and the problem lies in the deeper vessels which were damaged and scarred.
Bandaging
The therapist places compression bandaging around the limb. Often foam chip pads are placed under the bandaging to increase pressure on fibrotic area to break down scar tissue. These bandages stay on 24 hours a day throughout the treatment period. They come off only to shower, do skin care, assess the swelling reduction and to do the MLD.
Skin Care
Use a soap with a low pH., unscented and not antibacterial soaps. A good liquid soap is Cetaphil. The skin must be moisturized after bathing. Use a lotion like Eucerin or Nivea. If there are any irritations use an antibacterial cream. Always dry the area very well, and gently, after washing.
Exercises An individualized exercise program will be given by the therapist to each patient. They will improve muscular contractions and joint mobility. There will also be strengthening exercises for the limb that will reduce muscle atrophy. Muscular contractions along with the low-stretch bandages provide constant counter pressure to keep the lymph fluid moving.
MANUAL LYMPHATIC DRAINAGE
Dr Vodder's Manual Lymphatic Drainage (MLD) is an advanced therapy in which the practitioner uses a range of specialized and gentle rhythmic pumping techniques to move the skin in the direction of lymph flow.
This stimulates the lymphatic vessels which carry substances vital to the defense of the body and removes waste products.
The first visit will include a consultation and the therapist will outline the number and frequency of sessions. Each session will last approximately one hour.
Where appropriate the therapist will work in conjunction with your medical practitioner.
THE HISTORY OF MANUAL LYMPHATIC DRAINAGE (MLD)
During the early 1930's Dr Emil Vodder created a unique range of movements which brought relief from chronic conditions such as sinus congestion and catarrh.
Since Vodder's pioneering work, Manual Lymphatic Drainage has spread world-wide and has become a popular treatment in many European hospitals and clinics.
MLD is now beginning to gain acceptance in the U.K. as a component in the treatment and control of lymphoedema.
The Benefits Of Manual Lymphatic Drainage
Manual Lymphatic Drainage:
is both preventative and remedial and can enhance your well-being is deeply relaxing
promotes the healing of fractures, torn ligaments, sprains and lessens the pain
can improve many chronic conditions: sinusitis, rheumatoid arthritis,scleroderma, acne and
other skin conditions.
may strengthen the immune system
relieves fluid congestion: swollen ankles, tired puffy eyes and swollen legs due to pregnancy
is an effective component of the treatment and control of lymphoedema and assists in conditions arising from venous insufficiency promotes healing of wounds and burns and improves the appearance of old scars minimizes or reduces stretch marks
