Lymphoedema develops when circulation of the lymph fluid through the lymph vessels is blocked. The lymph fluid builds up in the vessels and leaks into the surrounding tissues causing swelling.

As with compression, the purpose of massage for lymphoedema is to help the accumulated fluid to drain. It does this by encouraging lymph to drain out of areas where it’s already moving well. This clears space in the lymph vessels for the lymph from the blocked areas to move into.

There are two types of massage for lymphoedema. The first is manual lymphatic drainage (MLD), which is carried out by a lymphoedema therapist. As we mentioned last week, it’s sometimes used alongside bandaging.

MLD consists of light pressure and slow regular movements of the skin. This encourages the lymph to move out of the unaffected areas. You may also be asked to do some gentle movements. The therapist may then carry out some treatment to the swollen areas to encourage the fluid to move into the space created by the massage.

You will usually have MLD five times a week to start with, reducing to two or three times as treatment progresses. A course of bandaging and MLD usually lasts about three weeks

There is also a type of MLD that uses an injection of dye and an infra-red camera to ‘map’ your lymphatic system and find out where the lymph is moving well and where it is blocked. The mapping procedure is not available on the NHS and would need to be done by a private clinic. You can ask your GP about a referral.

Once the map has been created, your lymphoedema therapist can use it to massage the areas where it will be most effective. This is called Fluoroscopy guided manual lymphatic drainage (‘FG-MLD’). Some NHS and private therapists are specially trained in this.

The second type of massage is simple lymphatic drainage (SLD), which you can do yourself or ask a friend or relative to do for you. Your therapist will show you how to massage yourself at home to help maintain the circulation of lymph between appointments or after you finish treatment.

SLD is only carried out on the unaffected areas. It starts and ends with breathing exercises and consists of gentle stroking or pumping motions on the skin that you do twice a day for about 15-20 minutes. You can see a video of a patient being taught SLD here.

It may not be possible for you to have MLD or SLD if you have:

• Infection or inflammation of the swollen area

• A blood clot

• Heart problems

• Cancer in the area

If you’re not sure, check with your doctor or lymphoedema specialist before any treatment. There is a shortage of lymphoedema therapists in the UK, so it can be difficult to find a specialist in your area. There is a directory of therapists, including those trained in FG-MLD, on the Lymphoedema Training Academy website.

You can find more information about lymphatic drainage through:

The Lymphoedema Support Network

Macmillan

Cancer Research UK (MLD)

Cancer Research UK (FG-MLD)

If you would like to share your experiences of lymphatic drainage or have any tips on it, please comment on this post. If you would like information or support, please contact our Support Line on 0800 008 7054 or email [email protected]