Can Lymphatic Drainage Prevent Arm Lymphoedema?What a Randomised Trial Found
After breast cancer surgery with lymph node removal, adding manual lymph drainage to prevention advice and exercise didn't lower the number of people who developed arm lymphoedema in the first year.
- Written by
- MyoFitness Research Team
- Published
- Reading time
- 3 min read
- Year
- 2011
- Journal
- BMJ
- Study design
- Single-blind randomised controlled trial (160 people after breast cancer surgery)
- Lead author
- Devoogdt N et al.
What the study looked at
When breast cancer surgery includes an axillary lymph node dissection, which removes lymph nodes from the armpit, there's a risk of lymphoedema developing in that arm. Manual lymph drainage (MLD) is sometimes offered after surgery in the hope of preventing it.
This trial, run at University Hospitals Leuven in Belgium, asked whether adding MLD to prevention advice and exercise therapy reduces the chance of arm lymphoedema.
What each treatment involved
The MLD group
79 people received six months of lymphoedema-prevention guidelines, exercise therapy and manual lymph drainage.
The comparison group
81 people received the same guidelines and exercise therapy for six months, without MLD.
What counted as lymphoedema
An increase in arm volume of 200 mL or more compared with the same arm before surgery.
What the results showed
Arm lymphoedema was no less common in the group that also had MLD.
- 01
No reduction in lymphoedema
At 12 months, 24% of the MLD group and 19% of the comparison group had developed arm lymphoedema. The difference wasn't statistically significant.
- 02
No delay in onset
There was no significant difference in how soon lymphoedema developed during the first year.
- 03
A large effect ruled out
The authors concluded MLD is unlikely to have a medium to large effect in preventing arm lymphoedema in the short term.
- 04
Both groups had active care
Everyone received guidelines and exercise, so the question was only whether MLD added anything extra.
Key finding in plain terms
Adding manual lymph drainage to prevention advice and exercise didn't reduce the number of people who developed arm lymphoedema in the first year after lymph node surgery.
What this means for practice
This trial doesn't support offering MLD as a routine way to prevent lymphoedema after surgery. Exercise, arm care and watching for early signs, such as heaviness, tightness or rings and sleeves feeling tighter on one side, remain the practical focus. MLD keeps its place in treating established lymphoedema alongside compression, exercise and skin care.
Clients whose arm becomes red, hot, swollen or painful, or who feel feverish, should see their GP or treating team promptly. Chest pain or sudden breathlessness needs a call to 000.
Clinical relevance by discipline
Manual lymphatic drainage
Be clear with post-surgical clients that MLD hasn't been shown to prevent lymphoedema, and teach early warning signs.
Myotherapy
Encourage the exercise and arm care advice from the surgical team, and refer early if swelling appears.
Physiotherapy
Supports exercise therapy and prevention guidelines as the foundation of post-operative care.
Remedial massage
Ask about lymph node surgery at intake and adapt or avoid work on an at-risk arm, referring on where needed.
Limitations to be aware of
The main results covered the first 12 months, and lymphoedema can develop later. The trial was based at one university hospital in Belgium, and surgery and cancer care have changed since 2011.
It compared MLD added to guidelines and exercise, not MLD versus no care. A small benefit can't be fully ruled out, but a medium to large one is unlikely.
Summary
In 160 people after breast cancer surgery with lymph node removal, adding MLD to prevention guidelines and exercise didn't lower the rate of arm lymphoedema at 12 months or delay when it started.
For lymphoedema therapists and other manual therapists, the everyday steps of exercise, arm care and early monitoring carry the weight in prevention, while MLD is better reserved for treating swelling when it occurs.
Full research paper
This page is a plain-language summary. The original paper holds the full methods, statistics and discussion.
Devoogdt N et al. (2011). Can Lymphatic Drainage Prevent Arm Lymphoedema?. BMJ, 343, d5326.
DOI10.1136/bmj.d5326
Read the full paperEvidence-based treatment is available near you.
Find a qualified myotherapist or remedial massage therapist who works from the research, or write to us with a question about this study.
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