The Efficacy of Manual Lymphatic Drainage

The following is a summary of a recent article in The Journal of Manual & Manipulative Therapy answering the question "Does manual lymphatic drainage actually do what its meant to do?"

Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach (Vairo et al: 2009)

Dating back to at least the days of Andrew Still, the founder of Osteopathy, Manual Lymphatic Drainage Techniques (MLDTs) have been utilized in manual therapy settings in an attempt to theoretically:

• increase lymph circulation, thereby stimulating the lymphatic system,
• facilitate the removal of biochemical wastes,
• reduce edema by way of improving fluid dynamics, and
• decrease bodily stresses

Unfortunately however, as with many manual therapy techniques, the efficacy of MLDTs in the sport medicine realm lacks solid scientific evidence and therefore, must simply be appreciated for its empirical evidence.
Specifically speaking, Vairo et al, recently published their systematic review that can be outlined as follows:

METHODS

• A Participant, Intervention, Comparison, Outcome (PICO) model was used to evaluate the currently available literature
• The authors utilized the following definition of manual lymph drainage, taken from MedlinePlus:

"a light massage therapy technique that involves moving the skin in particular directions based on the structure of the lymphatic system. This helps encourage drainage of the fluid and waste through the appropriate channels."

• Inclusion criteria: systematic reviews, RCTs, and cohort studies. Original research studies, pilot, and case studies were also included due to the paucity of research available.

RESULTS & DISCUSSION

• Nine articles were included: 3 RCTs, 1 pilot study, 2 case studies, and 3 animal-model studies
• RCT 1: MLDT following experimentally, exercise induced muscle damage
• RCT 2: MLDT following radial wrist fracture
• RCT 3: MLDT following an acute ankle sprain

Several modes of MLDTs have been described including the Vodder method, as well as lymphatic pump techniques. From this published review, it was revealed that solid scientific evidence to support MLDTs in sport medicine is lacking and therefore, its use can be attributed primarily to anecdotal evidence. However, to date, the strongest evidence in support of MLDTs, based on this review, lies merely in 3 RCTs; suggesting it potential efficacy in regulating serum levels of enzyme associated with acute muscle damage, as well as reducing edema induced by distal radius fracture and acute ankle sprain. As such, caution must be taken when making definitive recommendations for clinical practice guidelines in the management of sports injuries with manual lymphatic drainage. Yet from a scientific standpoint, a call for consistency of MLDT protocols in intervention research is necessary in order to effectively make comparisons across studies so that the efficacy, optimal treatment durations, and an ideal rate and frequency of MLDTs for sport injuries can be determined.