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Manual Lymphatic Drainage (MLD)

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Manual lymphatic drainage (MLD), sometimes called manual lymphatic therapy, uses light touch to move excess lymph and fluid out of the tissues and back into the lymphatic vessels. Although often referred to as a type of massage, MLD is very different from traditional forms of massage that rely on deep and rigorous rubbing. MLD is much gentler and should feel as if the skin is being brushed, not rubbed or kneaded. One session of MLD typically takes about 20-45 minutes.

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. Research studies haven’t clearly proven the effectiveness of MLD, but they have shown that CDT is effective — and CDT usually includes MLD. Many insurance plans cover MLD because it’s done during an office visit with your lymphedema therapist. However, you’ll need to check the details of your own insurance plan.

It often takes many hours of training in MLD, combined with years of hands-on experience, for a lymphedema therapist to become truly skilled. If your lymphedema therapist recommends MLD, ask about his or her training and experience. Training programs can vary widely in their requirements — all the way from just a couple of hours of class time with no recertification needed, to more than 130 hours of instruction and hands-on training with recertification required every 2 years. You might consider talking to other patients who’ve had MLD with your therapist.

“To become good at MLD takes years, and it really is highly dependent on the skill of the individual,” notes Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at Mayo Clinic. “Someone who is highly skilled can work wonders with a limb and bring the swelling down — but overall, the quality of MLD treatments can vary widely.”

If you’re having MLD during or after radiation treatments, your therapist should take care to avoid any irritated areas on the skin. MLD is considered safe if you have metastatic breast cancer (cancer that has spread beyond the breast).

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