Complete Decongestive Therapy

The gold standard for treating both lymphedema and lipedema is a combination of modalities called Complete Decongestive Therapy (CDT). CDT is endorsed by the International Society for Lymphology, the National Lymphedema Network, the International Lymphedema Framework, and by the committee that advises Medicare and Medicaid on evidenced-based treatment of specific diseases.

Complete Decongestive Therapy (CDT) is comprised of four parts delivered in two phases. The four parts are:

— Manual lymph drainage (MLD)
— Compression, which includes bandaging and/or compression garments, plus aquatics therapy
— Meticulous skin and nail care
— Decongestive and breathing exercises

All four parts are present in both phases of treatment. The first phase, the intensive phase, is treatment provided in the clinic by a therapist certified in lymphedema care. The second phase is the life-long, self-management or optimization phase completed at home by the patient or caregivers. Instruction in self-care for lymphedema is provided by the therapist in the transition from the intensive to the optimization phase.

Treatment for lipedema is much like that of lymphedema — it is multifaceted and consists of several therapies, the basis of which is complete decongestive therapy. For more information, see the article Goals for Lipedema Care.

Complete decongestive therapy. (n.d.) Physiopedia.

Manual Lymphatic Drainage

There are different approaches in training and performing manual lymphatic drainage.

Vodder — Several hand motions are used on the skin surface, depending on the part of the body being treated. Vodder also includes edema movements at fibrotic areas. The different motions include “pump,” “scoop,” “stationery circle,” “rotary” and “thumb circle.”

Foldi — This method is based on the Vodder technique but places emphasis on a “thrust” and “relaxation” phase. “Encircling strokes” are included in this approach.

Casley-Smith — This method involves the use of gentle and slow effleurage movements with the side of the hand. The effleurage movements are performed over the “watershed” areas between lymphotomes.

Leduc — This method involves use of “calling up” (or enticing) and “reabsorption” movements which reflect how lymph is absorbed first in the initial lymphatics and then into larger lymphatics.

Földi and Vodder refer to two methods of manual lymphatic drainage (MLD), a specialized massage technique used to stimulate the lymphatic system and reduce swelling. Vodder is the original method, while Földi is an extension of it, incorporating a thrust and relaxation phase with circular hand motions.
Here’s a more detailed explanation:
Manual Lymphatic Drainage (MLD):
MLD is a gentle massage technique that aims to stimulate the lymphatic system, which is responsible for filtering waste and fluids from the body.
Vodder Method:
This method uses various sweeping motions around the area being treated to encourage lymph fluid flow. It involves different hand motions, including “pump,” “scoop,” “stationary circle,” “rotary,” and “thumb circle”.
Földi Method:
The Földi technique is an extension of the Vodder method, emphasizing a “thrust” and “relaxation” phase with circular hand motions. It also incorporates “encircling” strokes to help reduce edema.
Other MLD Methods:
Besides Vodder and Földi, other MLD methods include Casley-Smith and Leduc. Casley-Smith uses gentle, slow effleurage movements with the sides of the hands, while Leduc involves collecting lymph fluid and redirecting it into the larger lymphatic system.
Benefits of MLD:
MLD can effectively reduce swelling (lymphoedema) caused by fluid buildup, and can provide symptomatic relief of migraine headaches, fibromyalgia, rheumatoid arthritis, scleroderma, reflex sympathetic dystrophy (RSD), stress, fatigue, and more.
Importance of Trained Therapists:
It’s crucial to seek MLD from a therapist specially trained in one of these methods, as the techniques are specific and require expertise.