When people talk about “lymphatic drainage” these days, they may be thinking of two quite different things: Manual Lymphatic Drainage (MLD) performed by a trained therapist, and machine-based lymphatic treatments, such as pressotherapy suits or compression devices.
Both approaches aim to support the lymphatic system– the body’s natural waste and fluid management network– but they work in different ways, have different training requirements, and are best suited to different situations.
My aim isn’t to say that one is “better” than the other, but to help you understand when and why each might be used.
What is Manual Lymphatic Drainage (MLD)?
MLD is a specialist hands-on technique developed nearly 100 years ago by Dr. Emil Vodder. It uses gentle, rhythmic, and very specific movements on the skin to stimulate the flow of lymph.
One of the unique aspects of MLD is that we always begin at the neck and collarbone area (where the subclavien veins meet the lymphatic system). This is also known as the lymphatic terminus, and by opening this pathway first, we create space for lymph from the rest of the body to drain more effectively.
MLD is particularly helpful for:
• After Surgery (to support healing, reduce swelling, and soften scars)
• Cancer-related lymphoedema management
• Chronic conditions such as lipoedema or long-term swelling
• Relaxation and immune support, thanks to its calming effect on the nervous system.
It requires extensive training. A short course might introduce the basic theory and techniques, but methods like Vodder, Casley-Smith, or Foldi involve 100’s of hours of study, case work, and assessments to ensure safety and precision– especially when working with complex clients.
What are Machine-Based Lymphatic Treatments?
You may have seen clinics offering compression suits, boots, sleeves or jackets, that use gentle wavews of pressure to move fluid up the body. These devices are sometimes called pressotherapy or mechanical lymphatic drainage.
The principle is: by rhythmically squeezing from the extremeties (like the hands or feet) towards the torso, they encourage fluid to move back towards the body’s centre.
Machines are often used for:
• General swelling in the legs or arms
• Sports recovery, helping to reduce muscle soreness
• Aesthetic purposes, such as reducing puffiness or fluid retention
• Adjunct therapy for people with mild Lymphoedema (under professional supervision)
Unlike MLD, machines do not treat the neck area, because it is too delicate and full of vital structures (carotic arteries, jugular veins etc). Instead they assume the lymphatic terminus is already functioning well, and simply move fluid towards it.
Training for machine-based therapy is usually much shorter often 1-4 days and provided by the manufacturer– since the therapist is learning how to use the equipment, rather than mastering anatomy and manual techniques
When might you choose one over the other?
. • After surgery (including cancer surgery, cosmetic surgery, or orthopeadics)– MLD is generally recommended, because it is gentle, precise, and safe when delivered by a properly trained therapist. It also addresses scar tissue and pain sensitivity, which machines cannot.
• For sports recovery or mild swelling– A machine-based treatment might be convenient, accessible, and cost-effective, particularly for people without complex medical needs.
• For ongoing medical conditions (like lymphoedema)– MLD is often the cornerstone, with machines sometimes used as an adjunct to support long-term management, but usually under professional guidance.
• For relaxation and nervous system support– nothing quite replaces the human touch of MLD– its calming, parasympathetic effect is one of its greatest benefits.
What does the research say?
Several studies have compared MLD with machine-based treatments such as intermittant pneumatic compression (IPC):
• Post-surgical breast cancer-related lymhoedema– Johansson et al. (1998) carried out a randomised trial comparing MLD with sequential pneumatic compression. Both groups experienced reduced arm swelling, with no significant difference between them. However, women receiving MLD reported greater relief of heaviness and tension in the arm.
• Lower-limb secondary lympheodema– In a more recent head-to-head study, Schiltz et al. (2024) found no significant differences in swelling or symptom relief when comparing MLD and IPC. Patients, however, tended to prefer MLD.
• Breasdt cancer-related lymphoedema (alternative protocols)– Gurdal et al (2012) compared IPC plus self -drainage with MLD-based complex decongestive therapy. Both approaches were effective, with some domains of quality of life showing greater improvement in the MLD group.
• Maintenance therapy– Mendoza and Amsler (2023) explored MLD, IPC and a combination of both during maintenance therapy. They found no major differences in limb volume redcution across groups, although quality of life outcomesleaned towards IPC, and a small added effect was seen when both methods were combined.
Overall takeaway: Both manual and mechanical lymphatic approaches can be effective in reducing swelling. The research does not show one as being universally superior, but suggests they may suit different situations. MLD appears to offer additional comfort, adaptability, and scar-related benefits after surgery, while IPC can be a helpful adjunct for ongoing or maintenance care.
Why the neck matters
One of the biggest differences is the neck sequence. In MLD, therapists always begin by gently stimulating the lymphatics at the collarbone and neck, because this is where lymph empties into the bloodstream. Without this preparation, there’s a risk of pushing fluid towards and area that isn’t “ready” to recieve it.
Machines avoid the neck for safety reasons– the structures are too sensitive for mechanical pressure. This makes sense from a design perspective, but its also why MLD can often achieve more nuanced results, especially in post-surgical recovery or oncology care.
S0…
Both manual and machine-based lymphatic treatments have their place. For some people, a compression suit may be a helpful wellness or recovery tool. For others– especially after cancer treatment, or with chronic lymphatic issues– the depth of training and adaptability of a skilled MLD therapist is invaluable.
The key is choosing the right approach for your needs– and making sure that whoever supports you understands your medical history, goals, and complexity of the lymphatic system.
And references…
• Gurdal, S.O, Kostanoglu, A., Cavdar, I., Ozbas, S., Cabioglu, N. and Ozcinar, B., 2012. Comparison of intermittant pneumatic compression with manual lymphatic drainage for treatment of breast cancer-related lymphoedema. Lymphatic research and biology, 10(3), pp. 129-135
• Johansson 1998. A randomised study comparing manual lymohatic drainage with sequential pneumatic compression for treatment of post-operative arm lymphoedema. Lymphology, 31(2), pp.56-64
• Mendoza, E. and Amsler, F., 2023. Effectiveness of manual lymphatic drainage and intermittant pneumatic compression in lymphoedema maintenance therapy. Vasa, 52(6), pp.423-431
• Schiltz, D. 2024. Therapist vs machine- immediate effects of manual vs mechanical lymphatic drainage in patients with secondary lymphoedema. Journal of clinical medicine, 13(5), 1277
To book a Manual Lymphatic Drainage Session or ask me about it, call 07767 384983 or email me fi@therapyinmotion.co