A very specialised type of massage called manual lymphatic drainage (MLD) is an important part of the treatment of lymphoedema. To be effective in treating lymphoedema, it is important to use the correct technique. The aim of the massage is to stimulate or move the excess fluid away from the swollen area so that it can drain away normally. Massage also encourages and improves drainage in the healthy lymphatics (which helps keep fluid away from swollen areas).

Manual lymphatic drainage differs from ordinary massage - it is very gentle and aims to encourage movement of lymph away from swollen areas. MLD is particularly useful if there is swelling in the face, breast, abdomen, genitals or elsewhere on the trunk.

As this is a specialised form of massage, it should be given only by a trained therapist. There are some other different techniques including the Vodder, Földi, Leduc or Casley-Smith methods. Therapists should be trained in at least one of these.

Increasingly, MLD is provided by the NHS at lymphoedema treatment clinics. However, it is not yet available at all centres. If you are having difficulty finding a qualified MLD therapist, you can contact MLD UK, who keep a register of their members.

Once you have been taught the techniques you can do a simplified version of MLD yourself at home. This is sometimes called simple lymphatic drainage (SLD). You use your hand very gently to move the skin in a particular direction. The massage is done without any oils or creams. If your skin is sticky and your hand does not move freely, a little talcum powder may be helpful. If you find that the skin is red when you have finished, then the movement is too hard.

It is often easier if your partner or a friend also learns the technique, so that they can help you in any areas you cannot reach. Your lymphoedema therapist, physiotherapist or nurse will be able to show you or your partner (or friend) the technique.

The diagrams and explanations below should also help. They are intended as a guide only when you are doing your SLD. You must be properly taught these techniques before you start.

Massage 1 - for both arm and leg swelling

The massage aims to stimulate the flow of lymph in the body generally.

• Place your fingers, relaxed, on either side of your neck at position 1.
• Gently move the skin in a downwards direction, towards the back of your neck.
• Repeat 10 times at position 1, 2 and 3.
• At position 4 (on the top of your shoulder) use a gentle movement around the front of your neck in towards the top of your breastbone (where the collarbones meet).
• Repeat 5 times.
• If you have a short neck you may not be able to massage the neck in four places. If this is the case, miss out position 3.

Massage 2 - for swelling of one arm

The aim of this massage is to stimulate the lymph channels on the trunk to clear the way ahead so excess fluid can drain away.

The skin is always moved away from the swollen side. You will find it easier to start with one hand, and then swap to the other as you move across the body.

• Starting in the armpit on the non-swollen side (position 1), use light pressure to gently stretch the skin up into the armpit. Your hand should be flat and not slide over the skin. Repeat 5 times.
• Next, at position 2, use a light gentle movement with the whole of the hand to slowly stretch the skin towards the non-swollen side, with a slow rhythm. Repeat in the same area 5 times.
• Repeat the same movements at position 3.
• Swap hands, and repeat the movements 5 more times at position 3 with your other hand, as this position is very important for lymphatic drainage. This time, the movement with your fingers is a slight pull to move the skin towards the non-swollen armpit.
• Repeat movements 5 times at position 4, then 5.
• If you have the help of a partner or friend the massage can be repeated across the back, starting again from the non-swollen side (position 1).

Massage 3 - for swelling of one leg

The aim of this massage is to clear a path ahead of the affected leg to allow excess fluid to drain away.

• Starting at the armpit on the same side as your affected leg (position 1), use light pressure to stretch the skin up gently into the armpit. Your hand should be flat and gently resting on the skin, not sliding over the skin. Repeat 5 times.

• Repeat 5 times each at chest level (position 2), waist level (position 3), then at your lower abdomen (position 4). Each time you will be gently pushing the skin up towards the armpit on the same side as the swelling.

Hand-held massagers may be useful for people who have restricted movement of their hands, perhaps due to arthritis. However, it is a good idea to talk to your lymphoedema therapist before buying a massager.

Before and after MLD and SLD, breathing exercises can help to stimulate lymphatic drainage. Use the following simple exercises:

• Sit upright in a comfortable chair or lie on your bed with your knees slightly bent. Rest your hands on your ribs.
• Take deep breaths to relax.
• As you breathe in - direct the air down to your abdomen, which you will feel rising under your hands.
• Breathe out slowly by 'sighing' the air out. While breathing out, let your abdomen relax in again.
• Do the deep breathing exercises 5 times. Have a short rest before getting up to avoid getting dizzy.