Lymphoedema – Manual Lymphatic Drainage

Introduction to Lymphoedema

The lymphatic system is a network of channels and glands throughout the body that help fight infection and remove excess fluid from the body.

There are two causes of lymphoedema: Primary and Secondary.

PRIMARY LYMPHOEDEMA is caused by mutations in the genes responsible for the development of the lymphatic system. This means that parts of the lymphatic system responsible for draining fluid do not develop properly or work as they should do.

SECONDARY LYMPHOEDEMA can develop for a number of reasons, the most common being; surgical treatment of cancer, radiotherapy, infections, inflammation, venous disease, obesity, trauma and injury and immobility. Read more about these causes below.


How can Physio2go help?

    Physio2go are now delighted to be able to offer treatment for Lymphoedema in the form of specialised manual lymphatic drainage with Susanne Rifflelmacher.

    This page explains the types of treatment that Susanne can provide. If you have any further questions about Lymphodema and the treatment methods, please contact us.


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Causes of Secondary Lymphoedema

Surgical Treatment of cancer

Cancer cells can spread through the body via the lymphatic system. If your cancer has spread to the lymph nodes then the surgeon will remove those containing the cancerous cells.

There is a particular risk of lymphoedema as a complication in the treatment of breast cancer, melanoma (skin cancer), Cervical or vulval cancer and prostate and penile cancer.


There is a risk that the high energy radiation may damage the lymphatic system.


Cellulitis is a bacterial infection that can cause lymphodema.


Certain conditions that can cause tissues to become inflamed may also permanently damage the lymphatic system. These can include rheumatoid arthritis and eczema.

Venous Disease

The abnormal or damaged veins can result in excess fluid leaking from the blood vessels into the surrounding tissue spaces. This can occur with varicose veins or a DVT (deep vein thrombosis)


It is not known why but people who are severely obese have an increased risk of developing lymphoedema. It is thought that it may be due to increased fatty deposits surrounding the lymph vessels the muscular contraction (that helps the lymph flow) may be impeded.

Trauma & injury

In a very small number of cases lymphoedema can be caused by accidental damage to the lymphatic system where there may have been extensive soft tissue loss or bruising.


Movement and exercise helps lymph drainage as muscle contraction surrounding the lymph vessels massage and help move the fluid along, as there is no pump unlike in the circulatory system where there is the heart.



The recommended treatment for lymphoedema is decongestive lymphatic drainage ( DLT) which has 4 component parts

  • Compression bandages
  • Skin care
  • Exercises
  • Specialised massage techniques

DLT may begin with an intensive phase of therapy, depending on the severity of your lymphoedema, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part.

This is followed by the second phase, known as the maintenance phase. During this, you will be encouraged to take over your own care by carrying out simple self-massage techniques, wearing compression garments and continuing to exercise. This phase of treatment aims to maintain the reduced size of the affected body part.

You may then have reviews every few months to check how your treatment is progressing.

Compression bandages

Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system uses the massaging effect of surrounding muscles to move the fluid.

If you have lymphoedema, you may have special bandages or garments (such as sleeves, gloves, stockings or tights) to wear over the affected limbs. These will support the affected muscles during exercise and encourage them to move fluid out of the limb.

These may also be applied after a session of MLD, to prevent fluid accumulating in the limb again. This use of compression bandages and garments is known as multilayer lymphoedema bandaging.

Velcro wraps may be used instead of bandages and have the advantage that the person with lymphoedema can apply them themselves.

Skin Care

Taking good care of your skin is important, because it will reduce your risk of developing an infection, such as cellulitis.

Movement and exercises

Your physiotherapist will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage. They will also help you to lose weight, if you are overweight. This will be tailored to your individual requirements and ability.

Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking.


You may receive specialised massages called manual lymphatic drainage (MLD) – to move fluid from the swollen areas into working lymph nodes, where it can be drained.

Your specialist physiotherapist will also teach you a range of simpler massage techniques that you can use during the maintenance phase of treatment, to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD).

Contact Information

Clinic Opening Times

Physio2go Ltd, York Lodge, St Peters Street, St Albans, AL1 3HD

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