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Manual Lymphatic Drainage

Manual Lymphatic Drainage (MLD), is a very gentle type of treatment technique that addresses swelling (edema) trapped in your body’s tissues. This swelling may be evident in the feet, ankles, legs, arms, etc., when there has been injury or trauma. However, internal swelling, in areas such as the shoulders and spine or even around scar tissue or any post-operative areas, cannot be seen but may be causing symptoms such as pain and stiffness. Because we use a total body balance approach, both internal and external swelling is effectively addressed; we do not need to know exactly where the stagnation is located. MLD consists of gently stretching and directing the skin in order to stimulate the lymphatic system. We prepare the lymph nodes that are easily accessible, to promote whole body (systemic) drainage. This is one of those cases where less is more. The goal is to show the body how to self-correct and move any stagnant fluid that may be having a negative impact on the body.


MLD is most notoriously known for reducing swelling caused by fluid build-up after cancer treatment (lymphedema); it can reduce edema following an injury. It can also reduce fluid retention due to inflammation or a disease process. It is used to decrease pain, reduce stiffness, restore movement, and allow for optimal tissue healing. MLD drains excess fluid from the tissues, while also having a detoxifying effect. Although It is most often used to address medical conditions, it can benefit a healthy person as well. A properly functioning lymphatic system is essential for overall health.


MLD is an advanced type of manual therapy (or medical massage), but it is quite different than classic massage. It consists of gentle, rotating, pumping motions that moves the lymph fluid without increasing the blood circulation. Increasing the blood circulation with deep massage and heat can inhibit the movement of lymph fluid by changing the permeability of the lymph and blood vessels. Do NOT receive a general therapeutic, deep tissue or Swedish Massage in lieu of MLD.

Manual Lymphatic Drainage (MLD) session








20 minutes

30 minutes

45 minutes

50 minutes

The Importance of the Lymphatic System

The lymphatic system is a critical part of the immune system, vital for protecting us from illness, as well as  damaging, disease-causing inflammation. Essentially, the lymphatic system is the body’s inner “drainage system.”  MLD addresses the lymphatic network of vessels and lymph nodes that carries fluids from tissues around the body. The lymphatic system has the primary role of protecting the body against outside threats — such as infections, bacteria and cancer cells — while helping keep fluid levels in balance.


The Lymphatic system is our recycling center and plays an integral role in the immune functions of the body. It is our first line of defense against infection and keeps our body’s waste products and fluids in balance. When this system becomes blocked, our fluid thickens and swelling in the blocked area occurs. The swelling is often internal and cannot be seen or felt. The lymphatic system’s network of tissues and organs can be affectively stimulated by utilizing the specific techniques of MLD. When applied properly it will increase the lymphatic flow, stimulating a malfunctioning or fatigued system and clearing up blockages in areas that are stagnant. It can either be used on specific areas or as a total body-balancing approach. By innervating specific areas with MLD, the entire body can be positively affected, and imaging studies have shown that we can increase the speed of flow by about tenfold.

Signs of a congested lymphatic system may include:

  • Fatigue
  • Swollen glands
  • Puffiness in eyes or face
  • Swelling in the fingers (tight rings) or ankles
  • Bloating or holding on to water
  • Headaches
  • Sinus infections
  • Skin issues, such as dry or itchy skin
  • Soreness or stiffness upon waking
  • Constipation
  • Weight gain and extra belly fat
  • Breast swelling or tenderness
  • A sense of fogginess in the brain
  • Worsened allergies
  • Food sensitivities
  • Increased colds or flu

MLD and symptom control

MLD improves health-related quality of life symptoms. In October of 2017, the first MRI of the brain showing the lymphatic channels was obtained. It indicated that the lymphatic vessels of the brain also drain into the same area as the rest of the body. So, when you innervate the other areas, are we also draining the brain? Good chance!


There are different types of approaches to MLD; they include: Vodder, Földi, Casley-Smith, to name a few. These approaches are quite similar and they all look to attain the same goal.


MLD is used to treat a variety of conditions, such as: lymphedema, burns, fluid retention, lymph node removal, allergies, chronic fatigue syndrome, chronic mastitis, headaches and is a commonly requested therapy following liposuction.


It is also believed to aid in the healing of fractures, torn ligaments and relieves fluid congestion, swollen ankles, puffy eyes, headaches and swollen legs during pregnancy. Chronic conditions such as rheumatoid arthritis, sinusitis and fibromyalgia may also improve after receiving MLD. Chronic and acute pain sufferers have found MLD very helpful as well.


The amount of sessions needed can vary based upon many different factors. Very often 2-3 sessions are recommended, although sometimes just having a single session can be tremendously effective. In the case of severe swelling or following surgery, it is not uncommon to need 6-12 sessions.

The MLD Treatment Session

After an initial consultation, you will undress, lie down on a massage table in the face-up position, covered modestly with a sheet. The atmosphere is the same as a massage treatment room with dim lighting and soft music.  Although you are in a massage setting, it is important to understand that MLD is a specific form of bodywork designed to efficiently move lymph fluid in your body. MLD is completely different from a deep tissue, Swedish or relaxation massage that you may be expecting or have had in the past. Stimulation of the Lymphatic System activates the para-sympathetic nervous system producing an automatic physiological relaxation response. Many clients fall asleep. Only the area being worked on is undraped at any time. Gentle, rotating, pumping motions with the therapist’s hands and fingertips begin at the collarbone area, then focus on areas where there is a concentration of lymph nodes…the underarms, abdomen, groin and back of the knees. Usually the entire session is performed with you lying in the face-up position because all the areas of lymph nodes that need to be decongested are generally located on the front of the body.,


We recommend booking the first session for 50 minutes. The follow-up sessions should be booked for 30 minutes, although if we can shorten the session without compromising your care, we will. A 50- minute session is $100. A 30-minute session is $60 and a 20- minute session is $40.00.


MLD can be done every day. In some countries it is done 3 times a day. How often you need to come is based on your condition and general health. We can discuss this during the initial consultation. Generally, we see patients 2-3 times a week for non-controlled swelling and less often for maintenance and well-being.

MLD For Specific Conditions

+ Lymphedema

Health conditions can interrupt the normal flow of lymph, causing lymph fluid to build up in a specific area of the body, often in the arms or legs, where it can cause swelling. This condition is called lymphedema. People can develop lymphedema as a result of infections, cancer treatments (that involve the removal of lymph nodes), and any condition that damages the lymphatic system. Here at Hands On, we only treat controlled Lymphedema. Please note that we have a listing of Lymphedema clinics on our Referral Page. They are best equipped to help you get your Lymphedema under control with bandaging, compression garments, skin care and exercise.

+ Augmentation Mammoplasty (breast augmentation)

MLD after breast augmentation helps to prevent the formation of excessive scar tissue, both in the incision and around the implant. It is designed to relieve congestion, swelling and discomfort. This treatment will encourage symmetry, restore pain-free range-of-motion and helps prevent capsular contracture.

Many other breast surgery patients find MLD helpful in their recovery.


+ Post-Surgical Liposuction

Manual lymphatic drainage (MLD) massage is frequently recommended by plastic surgeons during the recovery phase following cosmetic liposuction. There is often a considerable amount of bruising and swelling and MLD can help speed up the recuperation period. The tunnels created by the surgical instrument fill with fluid and become swollen with fluid and left-over fat. This fluid and left-over fat tends to begin to harden between one week and three weeks after surgery. There is a risk that the swelling and inflammation could turn into fibrosis, which is a permanent hardening of the area. MLD helps to move the fluid by gently directing it back into the lymph passages and it can greatly reduce healing time by cleansing the extracellular spaces where these substances are trapped. The faster the excess fluid is excreted, the quicker the skin can retract, and corrugations and unevenness can be avoided.

This procedure works well and has been demonstrated to show positive results after only a couple of treatments. However, most patients need 4 to 6 treatments to move most of the excess fluid. Although many patients report a significant difference after only one session, most patients can expect noticeable relief from swelling after the 6th treatment. We recommend one 50-minute session followed by 3-6, 20-30 minute sessions.

MLD is often recommended following Smart-lipo, CoolSculpting, Zerona, Velashape, Warmsculpting, etc.

+ Facial Procedures and Face Lifts

While many cosmetic procedures can benefit from MLD very soon after completion, facial procedures may require more time before beginning any manual therapy.  As with any surgery or procedure, please obtain permission from your doctor before beginning any post-treatment.

Manual Lymphatic Drainage can often expedite recovery. A specific series of light, rhythmic strokes to reduce swelling and improve the return of lymph to the circulatory system.

+ Other Cosmetic Procedures

MLD is often recommended following these procedures:

  • Tummy Tuck (Abdominoplasty)
  • VASER Liposuction
  • Buttock and Hip Augmentation with Fat (BBL)
  • Mommy Makeover

+ Edema and Swelling Due to Injury or Inflammation

Edema is the body’s general response to injury or inflammation and is the result of fluid from “leaky” blood vessels being released into nearby tissues. This fluid accumulates and causes the tissue to swell. MLD encourages the natural movement of the excess lymph fluid. MLD will improve the severity of the edema and the symptoms and pain associated with it. These conditions can occur for myriad reasons, including post-operatively (especially for cancer treatments that require lymph node removal), acute injury, orthopedic trauma and some autoimmune conditions, to name a few.

Other Common Health Conditions

The authors of a 2015 systematic review concluded that lymphatic massage might be more effective than connective tissue massage in relieving certain conditions.

It is easy to see a swollen ankle, hand, arm, etc. that has been injured or has undergone a surgical procedure. What may not be so easy to see, is internal swelling at a joint, accompanying scar tissue, etc.


We often recommend patients for MLD that have that have:

  • Fibromyalgia
  • Stiffness
  • Depression
  • Swelling or edema
  • Skin disorders
  • Fatigue
  • Insomnia
  • Stress
  • Digestive problems
  • Arthritis
  • Migraine episodes
  • Allergies
  • Pain

Lymphatic drainage is credited with preventing swelling and bruising, healing acne and wrinkles, relieving fatigue and sports injuries, and generally enhancing the immune system, to name a few other benefits.

MLD for Wellness

MLD is a systemic, rhythmic method of purposefully stretching the skin to produce an increase in the volume of flow of the lymph fluid through the filtering system of the body. There is often a tendency for the lymph system to become sluggish for a multitude of reasons such as stress or even spending too much time on the couch or eating unhealthy processed foods. We often describe an MLD session as a needed tune-up that everyone can benefit from. It’s like getting a tune-up for your body. It’s great for the brain giving us of us a much-needed reboot!


Talk to your doctor and make sure you get their approval for a Manual Lymph Drainage session if you have or had congestive heart failure, blood clots, kidney problems, infections, or circulation problems.

Types of Practitioners

MLD is often implemented by specially trained therapists, known as a Certified Lymphatic Therapist (CLT). CLT Therapists not only perform MLD but they are also trained in Complete Decongestive Therapy, which also includes many other treatment approaches. These practitioners are certified, and include Physical Therapists, Occupational Therapists, Licensed Massage Therapists and other Licensed Healthcare Professionals. At a minimum, 135 class hours are required for certification. Marla, a Licensed Massage Therapist and the director, has been a CLT since 2006 and was recertified in 2018.


MLD Certification is also available through some of the same reputable schools that offer CLT certification. Our Certified Manual Lymph Drainage Therapists at Hands On, have completed a 5½ day MLD Certification course based on the techniques developed by Dr. Emil Vodder, Ph.D., MT. They have completed their training through Klose Training.


It is always important to verify the credentials of anyone who claims they do MLD.

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