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Highlights of the Manual Lymphatic Drainage Massage Page

A look at your lymphatic system, lymph nodes and watersheds. (Photos courtesy of Klose Training and Consulting, Inc.)

What is Manual Lymphatic Drainage Massage (MLD)

What Does MLD Involve and How do I Prepare for It

The MLD Massage

After the MLD Massage

Learning Self MLD

On-Line Instructional Videos and Books


Treatment of Lymphedema Pages

Manual Lymphatic Drainage Massage
Sleeves.Gauntlets and Gloves
Breast Compression
Night Time Garments
Swell Spots, Foam Padding, Chip Bags
Skin and Nail Care
Patient Education--Self-Management
Kinesio Taping
Compression Pumps
Nutrition and Diet
Low Level Laser Therapy
Lymph Drainage Gas Ionization
Alternative Medicine
Other Unproven Modalities







Standard Treatment of Lymphedema-Manual Lymphatic Drainage Massage

Illustrations by Permission of Klose Training and Consulting, Inc.

Manuel Lymphatic Drainage Massage


Manual Lymphatic Drainage (MLD) is the part of lymphedema treatment that patients usually refer to as "massage."   Some therapists prefer to call it "manipulation,"  to distinguish it from the more usual sort of massage done to relieve muscle tightness, or simply for relaxation at a spa. 

The manipulation involved in MLD uses very light pressure to stimulate the lymph vessels that lie just beneath the skin.  Since these vessels are small and thin, firm pressure in any one area can actually shut them down momentarily, so the gentleness of the pressure is essential.  Some therapists visualize this process as pushing the lymph fluid in the desired direction, while others see it as directing the flow by pulling the skin slightly ahead of the lymph flow. Either way, MLD is an important technique for moving lymph fluid out of the congested area and back into circulation in the center of the body. 

The direction and order of MLD manipulation is as important as the gentle stroke.  First the areas of the body where nodes are concentrated (neck, axilla, or groin) are stimulated in order to ready them to receive more fluid. Then the therapist begins, close to the nodes, moving fluid toward them with slow and rhythmic strokes. The massage continues with the therapist's hands moving farther away from the cleared nodes by degrees, but always directing the fluid back toward them. 

For a therapist, every patient is a new challenge.  The length, condition and location of surgical scars, the amount and position of any fibrotic (hard) areas, the condition of the skin, the number and location of lymph nodes that were removed, and the extent of cancer treatment each individual received is taken into account to determine the most efficient route for directing the lymph fluid.  Because no one massage pattern will work for everyone, it's important to learn MLD from a well-trained and experienced therapist, rather than from a video or book.

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On days when you will be having MLD, avoid using lotions or other skin lubricants after your bath or shower, since friction on the skin is important to manipulating lymph flow.   Wear comfortable, loose-fitting clothing that is easy to get on and off.  

Your therapist will work hard to make you comfortable, as relaxation improves the effects of lymph manipulation. Dimming the lights is standard procedure, and some therapists add music or scented candles to enhance the mood of rest and quiet.   Most patients find this helpful, but for others these mood-enhancers may create anxiety.  If you are uncomfortable with these preparations, don't hesitate to let your therapist know. 

For MLD therapy you will need to strip to the waist.  Your therapist will provide a pillow, comfortable support for your knees, and a sheet or robe to drape your upper body. Throughout the massage you will remain modestly draped, with only those areas being worked on at the moment exposed.  Again, if you become uncomfortable it's important to talk to your therapist about your feelings so she or he can make the necessary accommodations.

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Lymph fluid cannot move through hardened (fibrotic) areas, whether the fibrosis was caused by surgery, radiation, or the lymphedema itself.   If you have areas of fibrosis blocking lymph flow, your therapist will begin with a deeper massage designed to break up the hardness over time. 

Then the gentler MLD massage can begin, with some instruction in deep, abdominal breathing, followed by special motions to clear the nodes in your neck and axilla or groin (depending on where the therapist plans to move the lymph fluid.)   Your therapist will then proceed with the massage pattern, moving to your chest, shoulder, arm, back and side.   Your part in it all is to relax, breathe deeply – and don't worry if you fall asleep!

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When you first begin MLD, you may find it hard to believe that the kitten-petting gentle strokes of the massage can have any positive effect at all.  In fact, it may seem like hocus-pocus and a waste of your time.   But most patients are pleasantly surprised at the quick response of their body to this external means of moving the fluid trapped inside. 

When stagnant lymph fluid is successfully moved back into circulation in your body, the result is that more fluid is available to be processed by your kidneys, so you may experience an urgent need to urinate following MLD. You'll want to be sure to use the bathroom before heading for home. 

Occasionally, MLD that moves a lot of fluid can result in feelings of nausea or a deep aching. It is usually a passing effect and leaves no lasting problems, but do let your therapist know if you develop any unusual symptoms so your treatment can be adjusted.


Besides the therapist's hands-on MLD, you will learn an MLD routine you can do yourself. The hand motions and steps will be similar to those your therapist does, but simplified to make it easier to perform and remember. That's why self-MLD is sometimes called "simple MLD," even though it can be difficult to learn.

It can help to bring along a spouse or significant other, or a close relative or friend, to learn along with you. This person, who will be your MLD partner, can begin by watching and taking notes, or by recording the process with a video camera or cell phone for future reference. Your MLD partner will be able to help you with daily care by massaging those areas that are difficult for you to reach. They can also provide needed relief for those times when self-MLD is tiring, or encouragement when it becomes boring.

If you have no one to partner with you in learning self-MLD, don't worry. Your therapist will help you manage all the necessary steps alone, and should provide you with written information to help you remember all the important points.

Be sure you understand the hand movements, the direction of massage, and the order of the massage steps before beginning self-treatment. Ask your therapist to observe and correct your own self-massage and that of your MLD partner (if you have one).

Just as patients are all different, so are therapists. Some recommend self-MLD daily, some only as needed, and others prefer that patients not do it at all, since without frequent review and correction you may not be performing it correctly. Whatever yours prefers, insist on learning it anyway, as it can be an important tool for maintaining control of your condition, especially at those times when your therapist may not be easily available.

 MLD videos (such as those on-line at Northwest Lymphedema Center) and books (such as Burt and White's "Lymphedma: a Breast Cancer Patient's Guide to Prevention and Healing") can help refresh your memory about the important aspects of self-MLD. Just be sure to follow the specific and individualized instructions your therapist gave you when using these memory helps.

The Universitiy of Michigan has prepared the following helpful videos on self manual lymphatic drainage and exercises.

Michigan State University: Lymphedema Self Massage

Michigan State University: Lymphedema Upper Extremity Home Program

Michigan State University: Lymphedema Lower Extremity Home Program


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Page Last Modified 09/29/2015

All medical information presented on this page is the opinion of our Editorial Board and Experts.  See our "About us"  and "Resources" pages.