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PurposeBreast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies.FindingsRisk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful.ConclusionProgress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.

Simple lymphatic drainage (SLD) is a self-administered technique for managing lymphedema; however, its efficacy in preventing lower limb lymphedema (LLE) following pelvic lymphadenectomy remains unclear. This prospective study evaluated the preventive effects of SLD at a single institution. A total of 224 patients were enrolled who underwent gynecological cancer surgery with pelvic lymphadenectomy between April 2011 and May 2012. After excluding patients with deep vein thrombosis, age ≥ 80 years, refusal to participate, and those with uncertain malignancy, 190 patients remained. A subset of 87 patients without adjuvant therapy was divided into two groups based on their preference: 24 in the SLD group and 63 in the control group. SLD group patients performed daily SLD for one year, and a 5-year follow-up was conducted. No significant differences were observed between groups in the change ratio of the lower limb circumference and the impedance method for the extracellular water: total body water ratio. The 5-year cumulative incidence of lymphedema (ISL stage I or more) was 37.5% in the SLD group and 23.5% in the control group, with no significant difference between the two groups. SLD does not contribute to the prevention of LLE following gynecological cancer surgery with pelvic lymphadenectomy.

Background Breast cancer related lymphoedema (BCRL) is a common side effect of cancer treatment. Recently indocyanine green (ICG) fluorescent lymphography has become a popular method for imaging the lymphatics, however there are no standard protocols nor imaging criteria. We have developed a prospective protocol to aid in the diagnosis and therapeutic management of BCRL. Methods Lymphatic imaging procedures were conducted in three phases. Following initial observation of spontaneous movement of ICG in phase one, manual lymphatic drainage (MLD) massage was applied to facilitate ICG transit via the lymphatics in phase two. All imaging data was collected in phase three. Continuous lymphatic imaging of the upper limb was conducted for approximately an hour and lymphatic drainage pathways were determined. Correlations between the drainage pathway and MD Anderson Cancer Centre (MDACC) ICG lymphoedema stage were investigated. Results One hundred and three upper limbs with BCRL were assessed with this new protocol. Despite most of the patients having undergone axillary node dissection, the ipsilateral axilla drainage pathway was the most common (67% of upper limbs). We found drainage to the ipsilateral axilla decreased as MDACC stage increased. Our results suggest that the axillary pathway remained patent for over two-thirds of patients, rather than completely obstructed as conventionally thought to be the case for BCRL. Conclusions We developed a new ICG lymphography protocol for diagnosing BCRL focusing on identification of an individual patient’s lymphatic drainage pathway after lymph node surgery. The new ICG lymphography protocol will allow a personalised approach to manual lymphatic drainage massage and potentially surgery.

Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity, making it essential to assess the effectiveness of various physiotherapy treatments. This study aimed to determine the clinical and electrodiagnostic improvement in mild-to-moderate carpal tunnel syndrome patients through manual lymphatic drainage (MLD) versus an orthosis alone. This is a prospective randomized controlled study. The sample consisted of a total of 36 patients who met the inclusion criteria. Experimental group received MLD and orthosis, and the control group received only orthosis. The patients were evaluated with electrodiagnostic tests, Visual Analog Scale, algometer measurements (pressure pain threshold), Boston Carpal Tunnel Syndrome Questionnaire before and after treatment. Evaluations were made before and after treatment (4 weeks later). Boston Carpal Tunnel Syndrome Questionnaire scores improved significantly with both treatment methods in both the experimental (p < 0.001, d = 2.0) and control groups (p < 0.001, d = 1.5). The pressure pain threshold significantly increased in the experimental group at the level of the transverse carpal ligament (p = 0.02, d = 0.86, 95% Confidence Interval (CI) = −0.08 to 1.2). At the distal radioulnar joint and extensor digitorum communis muscle levels, the pressure pain threshold similarly increased for two groups after treatment (p = 0.65, d = 0.31, 95% CI = −0.44 to 1.2), but the post-treatment increase in the experimental group was significant (p = 0.007, d = 0.31). In the experimental group, motor velocity (p = 0.001, d = 0.98), amplitude (p = 0.002, d = 1.5), and latency (p = 0.002, d = 0.60) and sensory velocity (p = 0.03, d = 0.91) and latency (p = 0.001, d = 1.2) significantly improved, while in the control group, there was a significant change only in motor velocity and amplitude (p = 0.047, d = 0.59). The post-treatment sensory improvement was significantly higher in the experimental group (p = 0.01, d = 0.81, 95% CI = −0.78 to −0.49). MLD significantly improved sensory conduction velocity, amplitude, and latency of the median nerve. Additionally, MLD and orthosis increased the pain pressure threshold and led to functional improvement. This is listed with study ID: NCT05394870 •Manual lymphatic drainage (MLD) significantly improved sensory conduction the median nerve.•MLD and orthosis increased the pain pressure threshold and functionality.•MLD can be a new option for conservative treatment in carpal tunnel syndrome.

Background Carpal tunnel syndrome (CTS) is a common neuropathy caused by median nerve compression, leading to pain, numbness, and functional impairment. While surgical decompression remains the definitive treatment for severe cases, non-surgical approaches are often utilized for symptom management. Lymphatic drainage techniques, including manual lymphatic drainage (MLD) and Kinesio taping, have been proposed as potential therapies for CTS by reducing edema and nerve compression. However, their efficacy remains uncertain. This study aimed to evaluate the effects of lymphatic drainage techniques on symptom severity, functional outcomes, nerve conduction parameters, and pain relief in patients with CTS. Methods This meta-analysis was conducted following PRISMA guidelines. A comprehensive search of PubMed, Scopus, and Web of Science databases was performed up to February 2025. Studies assessing the effects of lymphatic drainage techniques (MLD, Kinesio taping, or compression therapy) on CTS-related outcomes were included. Two meta-analytical approaches were used: (1) between-group differences comparing intervention and control groups and (2) within-group changes pre- and post-intervention. Primary outcomes included the Boston Symptom Severity Scale (BSSS), Boston Functional Status Scale (BFSS), Visual Analog Scale (VAS), median nerve cross-sectional area (CSA), hand grip strength, and nerve conduction studies. Results Twelve studies met the inclusion criteria, with a total of 479 participants. The between-group meta-analysis revealed significant pain reduction (VAS: SMD = -0.31, 95% CI: -0.51 to -0.12, p  < 0.05) and improvements in CSA (SMD = 0.39, 95% CI: 0.10 to 0.68, p  < 0.05). Median nerve motor and sensory velocities also improved significantly ( p  < 0.05). However, BSSS and BFSS did not show significant differences between groups. The within-group analysis demonstrated significant improvements in symptom severity (BSSS: MD = -10.80, 95% CI: -14.73 to -6.78, p  < 0.05) and functional status (BFSS: MD = -6.44, 95% CI: -8.78 to -4.09, p  < 0.05). The subgroup analysis showed that treatment benefits were sustained over time, with no significant differences between short-term and long-term follow-ups. Conclusions Lymphatic drainage techniques offer a promising non-invasive approach for CTS, decreasing pain, reducing edema, and enhancing nerve conduction. While intra-group improvements were notable, limited between-group differences were observed.

Cellulite is one of the complications post liposuction. Cellulite causes changes in the lymphatic system. Manual lymphatic drainage is utilized as an effective treatment for enhancing cellulite. To compare between Vodder Manual Lymphatic Drainage (MLD) Technique and -Smith MLD Technique for cellulite after liposuction. Thirty female patients with cellulite grade 3 after thigh liposuction participated in the study, and they were randomly divided into two equal groups: Group (A) that received Vodder MLD Technique and Bandage and Group (B) that received Casley-Smith MLD Technique and Bandage. The duration of the intervention was 8 weeks per participant, and each participant received 3 sessions per week. The results revealed that there was a significant improvement in both groups by using two different methods of treatment ( < 0.001), but there was no significant difference between the two study groups ( > 0.05). Both Vodder technique and Casley-Smith technique are effective in treatment of cellulite after thigh liposuction but there is no difference between them, hence any technique of MLD is recommended to achieve better improvement in this case.

Lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in the tissues, causing swelling primarily in the limbs, though other body parts can also be affected. It commonly develops after lymph node removal, or radiation therapy, or due to congenital lymphatic system defects. Effective management is essential due to its significant impact on physical function and quality of life. Complete Decongestive Therapy (CDT) is the primary treatment for lymphedema. This comprehensive approach combines manual lymphatic drainage (MLD), compression bandaging, skincare, and exercise. An early diagnosis and initiation of CDT are critical to preventing irreversible damage to the lymphatic system and worsening symptoms. Successful outcomes depend on timely treatment, patient adherence, and the consistent use of all CDT components, with compression therapy and exercise playing particularly vital roles. Recent research highlights how skin and fat tissue characteristics, such as increased skin thickness and adipose tissue accumulation, complicate lymphedema management, especially in advanced stages. In these cases, where fibrosis and fat deposition are more prominent, traditional CDT may need to be supplemented with advanced treatments like liposuction or enhanced compression techniques. This study explores the factors influencing the success of decongestive therapy, including the stage of lymphedema at the diagnosis, treatment protocols, and individual patient characteristics like skin and fat tissue properties.

PurposeManual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment for lymphedema. This systematic review aims to examine the methodologies used in recent research and evaluate the effectiveness of MLD for those at-risk of or living with lymphedema.MethodsThe electronic databases Embase, PubMed, CINAHL Complete and Cochrane Central Register of Controlled Trials were searched using relevant terms. Studies comparing MLD with another intervention or control in patients at-risk of or with lymphedema were included. Studies were critically appraised with the PEDro scale.ResultsSeventeen studies with a total of 867 female and two male participants were included. Only studies examining breast cancer-related lymphedema were identified. Some studies reported positive effects of MLD on volume reduction, quality of life and symptom-related outcomes compared with other treatments, while other studies reported no additional benefit of MLD as a component of complex decongestive therapy. In patients at-risk, MLD was reported to reduce incidence of lymphedema in some studies, while others reported no such benefits.ConclusionsThe reviewed articles reported conflicting findings and were often limited by methodological issues. This review highlights the need for further experimental studies on the effectiveness of MLD in lymphedema.Implications for Cancer SurvivorsThere is some evidence that MLD in early stages following breast cancer surgery may help prevent progression to clinical lymphedema. MLD may also provide additional benefits in volume reduction for mild lymphedema. However, in moderate to severe lymphedema, MLD may not provide additional benefit when combined with complex decongestive therapy.

BackgroundWe investigated the comparability of Complete Decongestive Therapy (CDT) including manual lymphatic drainage (MLD) vs. without MLD in the management of arm lymphoedema in patients with breast cancer.MethodsPatients randomised into either treatment including MLD (T+MLD) or treatment without MLD (T−MLD) received treatment 2×weekly for 4 weeks. The primary outcome was the volume reduction (%) of arm lymphoedema at 7-month follow-up. The secondary outcomes were volume reduction after the end of treatment, circumference of the arm, patient experience of heaviness and tension, and health status.ResultsDespite difficulties enrolling the planned number of patients (160), 77 were randomised and 73 (38 in T+MLD, 35 in T−MLD) completed the trial. In both groups, the volume of lymphoedema decreased significantly, with no difference between groups (1.0% [95% CI, −4.3;2.3%]): the precision in the 95% confidence interval indicates that the efficacy was comparable; the mean (SE) changes at month 7 were −6.8%(1.2) and −5.7% (1.2) in the T+MLD and T−MLD, respectively. There were no statistically significant differences with respect to any of the secondary outcomes. The results were robust and the conclusion was not sensitive even to various alternative assumptions or analytic approaches to data analysis.ConclusionManual lymphatic drainage adds no further volume reduction in breast cancer patients.