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Any wound or injury to the body, including infections, creates tissue damage. The nature and quality of the extracellular environment during the healing process determines the level of scarring that remains and the degree of functional recovery in the affected tissue.
Whether dealing with acute injuries or chronic wounds, optimising the healing process is a primary aim of healthcare interventions, and crucial to achieving the best possible outcomes.
The Dr. Vodder method of Manual Lymph Drainage (MLD) can be used to improve outcomes in all aspects of healing to support immune activity, stimulate functional tissue repair, and promote lymph-angiogenesis.
This post explores how the unique and specific movements of MLD support the fundamental processes of tissue repair, promoting lymph flow and contributing to functional rehabilitation and re-organisation of the healing skin and connective tissue.
Fundamentals of Wound Healing
The body’s healing mechanisms are highly effective and small skin breaches are often repaired without scarring. At the other end of the spectrum, chronic non-healing wounds are a growing burden on our public health systems.
How Tissues Repair
Tissue damage by injury, infection, or surgery, initiates non-specific immune processes involving inflammation and vascular repair, and which lead to tissue rehabilitation and scar formation.
Key Requirements for Tissue Recovery
There are three essential factors:
1: Adequate blood supply The warm, red signs we associate with acute inflammation indicate an increased blood flow to deliver oxygen and nutrients necessary for repair. Capillary repair and immediate restoration of blood flow are crucial in an acute injury, while in chronic wounds reduced tissue perfusion is a major barrier to healing.
2: Immune cell and cytokine infiltration and re-circulation. Small cytokines (immune molecules) can pass across the capillary wall into the blood stream to attract more immune elements to the damaged area. However, while cells and larger molecules can enter the tissue spaces from the capillary, they can only leave via the initial lymph plexus.
3: Effective waste removal
Damaged tissue, immune cells, and other repair-related by-products must be removed efficiently. Any trapped immune cells and degrading cellular debris initiate chronic inflammatory process within the tissue which delay and prevent proper wound healing.
Oedema in the extracellular spaces swamps the pre-lymphatic channels, and eventually disorganises the normal tissue architecture. Untreated, this type of high protein oedema leads to poor wound closure, tissue fibrosis and an increased risk of infection.
The Role of the Lymph Flow in Healing
The lymphatic system plays a pivotal role in wound healing by maintaining a healthy connective tissue environment during the repair and rehabilitation phases.
Lymph vessels achieve this primarily by 'suctioning' out cellular debris or anything harmful that got in, and removing spent immune elements and pathogens from the damaged area.
1: Immune signalling and co-ordination
As well as providing the highway for immune cells to travel from the injury site to the lymph nodes, lymphatic endothelial cells are involved in complex immune signalling.
Lymphatic endothelial cells at the connective tissue-initial lymph vessel inface are sampling the contents of the lymph to co-ordinate lymphatic pumping, and and interacting with tissue mast cells to report on the status of the injury site to the lymph nodes.
2: Garbage disposal and final clean up
Much more than just a passive drain, the constant pumping of a healthy lymphatic system creates a suction effect in the superficial compartment under the skin, drawing in the soft tissue and allowing tendons and veins to stand out.
Although this low level of pumping is the 'tortoise' of all body systems, background lymph-motoricity is enough to maintain sub atmospheric interstitial pressures under this skin. This allows the atmosphere to compress our soft tissues, giving us our natural body contours.
3: Impact of a damaged lymph system
When lymph vessels are damaged such as during surgery or due to burns or tissue abrasion, the growth of new lymph vessels through the healing tissue is only possible during to first 3 - 6 months.
Inefficient lymph drainage can lead to chronic inflammation and delayed healing. When lymph vessels are unable to function optimally, wastes accumulate, inflammation persists, healing slows, and chronic wounds may develop, creating a cycle of poor outcomes.
In chronically inflamed tissue, poor lymph outflow is a contributor to the cycle of ever increasing inflammatory recruitment.
Benefits of MLD in Wound Healing
As a manual therapy which manipulates the soft tissues of the body, MLD is often referred to as a 'massage' technique. But...
... nothing could be more opposite in application than MLD and pressure massage.
Even lymphatic effleurage (stroking) which is performed in the correct direction and pressure will only temporarily enhance lymph flow, and does not deliver the physiological effects on the vessels and tissues that are created by the circular movements of the Vodder method.
1. Enhancing Blood Flow Without Increasing Pressure
MLD has been shown to increase the velocity of blood flow through capillaries by 12% without raising capillary pressure, unlike traditional massage which increases tissue prefusion by compressing capillaries and forcing fluid into the surrounding interstitium.
In contrast, the gentle, rhythmic movements of MLD relaxes the precapillary sphincters via sympathetic reflexes. The increased volume of blood passing through the capillaries brings essential repair materials to the injury site, without contributing to oedema.
This key difference between massage and MLD explains why MLD is indicated in acute (uninfected) oedema and massage is not.
2. Immune cell activity and cytokine coordination
Lymph vessels are the only way out for immune cells and elements to leave the tissues and return to the lymph nodes.
The circular movements of MLD have been shown to directly stimulate lymphatic pumping via activation of sympathetic reflexes, increasing the rate and force of lymphatic smooth muscle contraction.
3. Reducing inflammatory mediators
Enhanced lymphatic activity ensures complete removal of spent immune elements, preventing their accumulation and degradation within the tissue.
When lymphatic function is subpar, noxious materials build up in the tissue spaces, recruiting new immune cells, which then become trapped along with the others, leading to further inflammation and a chronic inflammatory cycle begins.
4. Supporting lymph-angiogenesis in damaged vessels
When lymphatic vessels are injured, MLD plays a key role in stimulating lymph-angiogenesis.
The unique and specific movements of MLD in the connective tissue help to reform the pre-lymphatic channels which may have been obliterated by the injury, or flooded by oedema.
Lymphatic endothelial cells migrate from health lymph vessels against the movement of the escaping fluid to restore connecting vessels across the healing wound. This process is only possible in the first three months of healing, after which the budding lymph vessel will not be able to penetrate the forming scar, underscoring the importance of early MLD application whenever possible.
Applications of MLD in Wound Management
In acute (non-infected) injuries, the earlier MLD is started the more chance of establishing new vessel growth in the injured area. But it's never too late to make improvements, and MLD can be used to reverse the downward spiral of poor wound healing and oedema in non-healing wounds too.
Prevention is better than cure
For anyone at risk of non-healing wounds, such as those with poor skin integrity and dependant oedema, regular MLD is indicated. Just like all other muscle tissue, lymphatic smooth muscle responds to use, and MLD can be considered an effective form of lymphatic 'exercise' for the system, stimulating optimal function and capacity.
1: Pre-Surgical MLD
MLD should be used for 2 or 3 days before the procedure to maximise tissue health and improve post-surgical outcomes, enhancing vessel regrowth, reducing post-operative swelling and minimising long-term scarring.
2: Post-Surgical and Acute Injury MLD
In acute injuries or surgical recovery, MLD safely increases lymph flow, even when the affected site cannot be directly treated (e.g., burns). This supports healing without exacerbating inflammation or swelling.
Vodder trained Aestheticians have been called on to perform proximal MLD in the post-op recovery room after a facial surgery to help prevent complications in high risk cosmetic cases.
By reducing inflammation and promoting tissue repair, MLD prevents the progression of acute wounds into chronic conditions.
3.: Chronic Wound Management
Chronic wounds, such as venous ulcers, benefit significantly from incorporating MLD into existing treatment protocols, and has led to complete healing of venous ulcers, even in long-standing cases.
The Cost of Chronic Wounds
Chronic wounds, such as venous ulcers, affect 1-2% of the population in developed countries. Treating these wounds is costly, with annual healthcare expenditures reaching approximately $25 billion globally.
How MLD Reduces Costs
By promoting faster healing and preventing complications, MLD can significantly reduce the financial burden of chronic wound care.
Early intervention with MLD can shorten recovery times, decrease hospital stays, and eliminate the need for expensive interventions like amputations.
Conclusion
MLD offers significant benefits at every stage of wound healing. It promotes lymph-angiogenesis, reduces scarring, and accelerates recovery by supporting the lymphatic system’s essential role in tissue repair. From acute injuries to chronic wounds, MLD ensures a health environment for repair activities, reduces inflammation, and helps to prevents long-term complications.
Allied Health Professionals across every sector can incorporate MLD into their clinical practice to some degree. Private practitioners seeking effective ways to improve client satisfaction, public wound clinics needing to resolve a greater proportion of chronic wounds, and policy makers tasked with reducing the burden of non-healing ulcers on the healthcare system, should all consider MLD as a primary intervention for acute and chronic wound healing.
MLD is a powerful and underutilised tool to save costs while improving lives. Early application in all wound-care settings is not just beneficial; it's essential.
Koller, T. Mechanosensitive Aspects of Cell Biology in Manual Scar Therapy for Deep Dermal Defects. Int. J. Mol. Sci. 2020, 21, 2055. https://doi.org/10.3390/ijms21062055
Koller, Mechanosensitive Aspects of Cell Biology in Manual Scar Therapy for Deep Dermal Defects.
A good write up of uses of MLD and Bandaging in wound healing 👍