Efficacy of Manual Lymphatic Drainage: An Estimation of the Truth Culled From the Literature

Evidence-based studies have implied that manual lymphatic drainage (MLD) is not an essential component to complete decongestive therapy (CDT) due to a lack of evidence that MLD affects volume and that it is a time-consuming intervention. This perspective aims to refute this narrative and provide a logical interpretation of manual lymphatic drainage, including historical and contemporary evidence garnered from the literature to provide an estimation of the truth about its efficacy and emphasize the intended physiological impact that MLD has on the lymphatic system and the role it plays in CDT. Research has recognized the physiological effects of MLD with regard to the interstitial environment, microcirculation, lymphatic system, venous stimulation, enhancing the immune system, and affecting biomarkers, hormones, and the autonomic nervous system. After applying clinical reasoning from their deep understanding of lymphatic anatomy and physiology, lymphedema pathophysiology, patient goals and preferences, and a balance of research evidence, certified lymphedema therapists (CLTs) should apply MLD as a treatment for lymphedema. Most importantly, if the CLT is providing MLD, then they should also encourage and support an enhanced home program for the patient that includes MLD on a regular basis throughout the CDT maintenance phase along the continuum of care. The intelligible evidence that MLD stimulates lymphangiomotoricity is sufficient for its application on dysfunctional lymphatic systems whether that be due to lymphatic malformations or due to impairment of lymphatic structures.