Don’t Throw Manual Lymphatic Drainage Out With the Volume

Certified lymphedema therapists (CLTs) have been debating that recent evidence-based studies do not recommend manual lymphatic drainage (MLD) as an essential component to complete decongestive therapy (CDT). The overarching conclusion to abandon MLD in clinical practice primarily focuses on the lack of evidence that MLD reduces volume. This commentary aims to address the non-MLD narrative and offer a different perspective in support of MLD as an essential component of CDT. The narrative that MLD does not reduce volume is a moot point because that never was the implication to disprove from the beginning. MLD increases lymph production, increases lymphangiomotoricity, increases venous return, stimulates the autonomic nervous system, and facilitates the immune system. CDT consists of a combination of several treatments, including MLD, which are all equally important when administered properly. Discernment is recommended when applying the non-MLD narrative to clinical practice.