People with a history of cancer (Breast, Testicular, Cervical, Pancreatic, Colorectal, Liver, Prostrate, or Uterine), chemotherapy treatments, surgery, and are overweight are likely to develop Lymphedema. It is associated with peripheral swelling of arms and legs due to lymphatic blockage. This is caused due to damage, removal or blockage of lymph nodes during surgery incision or while giving chemotherapy treatment.

The blockage restricts lymph fluid from circulating through that area and the buildup causes swelling of an arm or leg, rarely both arms or legs.  Depending on the extent of swelling, it can be mild or severe.  A mild lymphedema is hardly noticeable, but in severe cases, a person feels heavy limb or arm that loses flexibility and becomes immovable. Currently, there is no cure for lymphedema, but don’t fret, its manageable with manual lymphatic drainage.

What’s Manual Lymphatic Drainage? How does it work?

Manual Lymphatic Drainage or MLD is a gentle focused and rhythmic massage technique that uses mainly four different key motions, rotary, stationary circle, scoop and pump to move the blocked lymphatic fluid into normal functioning lymphatic system areas and stimulate the lymphatic vessels and nodes to promote lymph flow. Out of these 4 motions, some are designed for body extremities- hands and legs while others for stimulating subcutaneous tissue lymph vessels.

Stationary circle technique uses oval shaped hand motions to stretch the skin. It is generally applied to the lymph node groups but can be applied to the entire body surface.

Scoops are spiral hand motions applied with one or two hands on the lower parts of extremities. While applying this technique, palmar surface of the hand transitionally moves on the skin combining supination and pronation.

The rotatory technique involves moving up the large body surface areas such as back with gentle strokes. In an elliptical fashion, the hand and fingers continuously move up the surface in small increments. This technique can be alternated with other techniques when bi-manually applied.

Pump technique applies circle shaped pressure on the skin using palmar surface and proximal phalanges with various wrist motions. It can be applied with single hand or bi-manually to manipulate lymph vessels.

How Is Manual Lymphatic Drainage different from traditional Massage?

Traditional massages focus on relaxing muscle groups whereas MLD does not work that deep. It works on draining lymph fluid from the lymphatic structures in the subcutaneous tissues. MLD is a low-intensity technique or applies less force than massages and its goal is to stretch subcutaneous tissue containing lymph vessels.

MLD motions have a brushing effect rather than kneading or rubbing like typical massages. An MLD session takes around 20 to 30 minutes, massages, on the other hand, depending on the type can vary from 45 minutes to 2 hours. MLD treatments are usually covered by medical insurance because they are done at medical practitioner’s office.

MLD for Lymphodema caused by Breast Cancer Surgery

Nowadays, there has been a significant spike in breast cancer cases among women above the age 30 in Singapore. The breast cancer treatment-involving mastectomy that performs axillary clearance or gynecological surgery with pelvic lymph node dissection affects lymphatic system and drainage. Also, chemotherapy treatment is given after surgery adversely affects the system. This causes pain, lack of energy, and onsets lymphodema. MLD is one of the best and natural treatments to ease these problems and facilitate a smoother post breast surgery rehabilitation.

MLD is also beneficial for people who have gone through orthopedic surgeries such as total knee replacement, ankle surgeries, and post-upper limb surgeries. It can help people who have cosmetic surgery related lymphodema because of getting facelifts, tummy tucks, hip replacement, liposuction, and others. Other than helping to manage lymphedema, MLD relieves constipation, migraine, pregnancy fluid retention, boosts immunity, body relaxation, and supports breastfeeding.

If you are noticing signs of Lymphodema, do not delay to seek medical treatment.

Book an appointment with physiotherapist at, get it diagnosed at the earliest and receive necessary treatment. Also, in case you need MLD massages for relaxation and other health benefits, you are welcome to visit our clinic.


The article is contributed by Rapid Physiocare , a  client-centric physiotherapy practice in Singapore. The centre provides the highest standard of care to every patient, every day and use evidence based practice and does not compromise quality care at any cost.