Physiotherapy

Physiotherapy and Manual Lymphatic Drainage

Manual lymphatic drainage is a set of specialized techniques designed to support the natural flow of excess fluids collected and purified by the lymphatic system as it passes through the lymph nodes before returning to the bloodstream. Less well known than the venous and arterial systems, the lymphatic system is made up of a dense network of capillaries spread throughout the body. It collects excess fluid and waste from the tissues, carries dietary fats and fat-soluble vitamins, and plays a key role in acquired immunity. Unlike the blood system, the lymphatic system flows in one direction only—from the body’s periphery toward the center. Along this path, the lymph passes through “filtering stations” (lymph nodes), where it is cleared of pathogens before being released back into the bloodstream near the neck.

When the lymphatic system doesn’t work properly

There are several conditions that can impair this essential drainage system:

Cardiovascular, liver, and kidney diseases;
Diabetes;
Lymph node disorders;
Surgical procedures with or without lymph node removal;
Trauma, bruising, or inflammation;
Prolonged immobilization or jobs that require long periods of standing;
Radiotherapy;
Obesity;
Premenstrual phase or pregnancy.

When the lymphatic system is impaired, fluid can build up locally or throughout the body, causing a condition known as lymphedema. It is typically characterized by smooth, tight, and shiny skin and by the presence of the pitting sign (when pressure is applied with a finger, it leaves a temporary indentation of varying depth). This swelling may also be accompanied by itching, heaviness, tightness, and discomfort in the affected area.

Therapeutic approach

Manual lymphatic drainage is considered the first-line therapy for this condition. It involves specific, repetitive movements performed with very gentle pressure and a slow, steady rhythm. Treatment usually starts at the lymph nodes in the neck and abdomen, then progresses to the affected area—working first on the proximal regions before moving distally.

The most well-known and widely used technique is the Vodder method, named after the Danish physiotherapist who pioneered the study of the lymphatic system and developed manual treatment for lymphedema.

Beyond reducing swelling, manual lymphatic drainage also promotes healing of ulcers and skin lesions, supports the immune system, and has a stimulating and regenerative effect on the tissues.

To enhance the effectiveness of manual lymphatic drainage, additional techniques may be used, including elastic compression bandaging, lymph taping, targeted exercises for the affected area, breathing exercises, and nutritional support for fluid retention.

The combination of compression therapy and physical exercise is essential in treating any type of edema, as their joint action promotes the reabsorption and upward movement of excess fluids.

Lymph taping is an excellent complement to lymphatic massage. By creating a gentle “vacuum effect,” it increases the space under the skin, helping to draw interstitial fluid away from congested areas.

Finally, slow and effective diaphragmatic breathing improves fluid circulation and aids in the elimination of toxins stored in the tissues.

The role of the physiotherapist

Manual lymphatic drainage and the complementary techniques described above require specialized knowledge. This is why it is essential to consult a physiotherapist who has specific training and professional experience in this field.

At Polispecialistico Paradiso, we take a holistic approach to this condition, supporting our patients with personalized programs that combine the expertise of multiple professionals and the effectiveness of different therapeutic disciplines.

Lorenzo Villa

Physiotherapist | Owner. A physiotherapist specializing in manual therapy, therapeutic exercise, and sports rehabilitation, Lorenzo Villa adopts a bio-psycho-social approach centered on movement and the individual, with a focus on treating chronic pain as well.