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MLD & the mechanics of skin-health

Updated: Sep 17, 2023

Skin, not just our largest organ-

The external layer that can be seen by others, our protective layer keeping out invaders that can't be seen, and a highly sensitive signal system for any that we come into contact with.


Affluent populations spend big on keeping their skin healthy and improving it's appearance.

At the other end of the spectrum, a big chunk of the healthcare budget is spent on venous insufficiency, dependent oedemas and non-healing wounds.

Non-healing wounds can lead to serious infection and even amputation.

Lymphoedema is a skin disease

Untreated high protein oedema induces connective tissue changes, leading to significant skin pathology such as papillomatosis and dermatosclerosis. Hyperkeratosis and loss of tissue elasticity are early markers of pathological change in the dermis and epidermal layers and can be measured using ultrasonography (1) .

Using this method, a single application of MLD was shown to reverse skin stiffness at the posterior calf in lymphedema of the leg, with the authors concluding that

"MLD did not simply soften the skin, but rather normalized it in terms of strain."

Most of the people in the study had early/middle-stage lymphedema, where skin changes are accumulating but may not be visible as a skin disease yet. In this stage, the elastic changes will be more easily restored immediately following treatment as the fibres won't be too badly damaged yet. The skin will recover faster than the underlying tissue where the fibrotic changes will be more advanced than in the skin.

By the time significant skin thickening has occurred, repeated MLD applications will be required to restore tissue elasticity, and compression therapy will likely be necessary, but positive change always be made with regular treatment.


Synergy between MLD and skin-health

Elasticity is just one piece of the complex mechanical interplay between the loose connective tissue, the lymphatic system and MLD and skin-health.
by Diane Lacey

Over the last century our understanding of the loose connective tissue, inflammation, and the lymphatic system has grown exponentially. We can now link the very precise stretch and shear forces created by the original Dr Vodder method to the formation of new lymph vessels and the pathway of the pre-lymphatic channels, tissue healing on a molecular level and restoring the properties of the connective tissue fibres.

The Vodders and Gunther Wittlinger

It is easy to link these new discoveries to the movements created by the Vodder's over half a century before we knew any of this, and I am constantly in awe of how they managed to so closely mimic the skin's positive mechanical properties.

And who knew those same mechanical properties would be essential to lymph angiogenesis and tissue healing?!?!

I feel pretty confident that as we continue to learn more about the loose connective tissue, inflammation and the lymph system, the more support we will find for the healing touch of something as simple as stationary circles .....


1; Tissue Strains Following Manual Lymph Drainage in Legs with Lymphedema. Kotaro Suehiro, et,al

Objectives: To study the immediate impact of manual lymph drainage (MLD) on skin and subcutaneous tissue strains in legs with lymphedema using free-hand real-time tissue elastography (RTE). Methods: Skin and subcutaneous tissue strain measurements were taken at the middle of the inner thigh and calf by RTE in 20 legs with lymphedema of 18 patients (stage II: 11, late stage II: 7, stage III: 2) and in 70 legs of 35 normal subjects. In patients with lymphedema, the same measurements were repeated immediately following MLD. Results: Significant negative correlations were found between pre-MLD strains and the MLD-induced changes in thigh and calf skin strains (thigh skin: p <0.01, calf skin: p = 0.05), but not in subcutaneous tissue strains. Pre-MLD intercepts of these regression lines were closer to normal values as compared to mean pre-MLD values (normal thigh skin: 0.54% ± 0.30%, calf skin: 0.25% ± 0.18%, Pre-MLD thigh skin: 0.39% ± 0.20%, calf skin: 0.17% ± 0.12%, Pre-MLD intercept of thigh skin: 0.48%, Pre-MLD intercept of calf skin: 0.31%). Conclusions: It appears that MLD did not simply soften the skin, but rather normalized it in terms of strain. However, this was not confirmed in the subcutaneous tissue.

Keywords: ultrasonography, elastography, lymphedema,


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Sep 13, 2023
Rated 5 out of 5 stars.

Thanks Jan, how valuable and powerful tool is MLD


Sep 12, 2023
Rated 5 out of 5 stars.

Which mld method did the studies use?

Jan Douglass
Jan Douglass
Sep 26, 2023
Replying to

Described in the methods as;

The MLD maneuvers including drainage techniques such as stationary circles, pumping, scooping, and rotary techniques as well as tissue softening techniques such as

kneading and the skin fold technique as described by Földi.


Sep 12, 2023
Rated 5 out of 5 stars.

Thanks for passing on this very useful information.

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