Does Lymphatic Drainage Add to Lymphoedema Care?What a Randomised Trial Found
In 194 people with chronic breast cancer-related lymphoedema, arm swelling went down by a similar amount whether they had fluoroscopy-guided, traditional or placebo lymphatic drainage on top of standard care.
- Written by
- MyoFitness Research Team
- Published
- Reading time
- 3 min read
- Year
- 2022
- Journal
- Journal of Physiotherapy
- Study design
- Multicentre three-arm randomised controlled trial
- Lead author
- De Vrieze T et al.
What the study looked at
Breast cancer-related lymphoedema is ongoing swelling of the arm, hand or trunk after cancer treatment affects the lymph nodes. Standard care is decongestive lymphatic therapy: education, skin care, compression and exercise, often with manual lymphatic drainage (MLD) as well.
The EFforT-BCRL trial asked whether MLD adds anything once the other parts of treatment are in place. It also tested a newer version of MLD guided by imaging of each person's lymph flow.
What each treatment involved
The trial ran across five Belgian hospitals
The trial ran across five Belgian hospitals. 194 people with chronic lymphoedema on one side were randomly split into three groups of about 65. Everyone received the same decongestive lymphatic therapy: an intensive phase of 14 sessions over three weeks, then a six-month maintenance phase. Only the type of MLD differed.
Fluoroscopy-guided MLD
A scan called lymphofluoroscopy mapped how lymph was moving in each person's arm and trunk, and the therapist's hand techniques followed those routes.
Traditional MLD
The standard drainage technique, without individual mapping.
Placebo MLD
A deep massage with relaxing movements, not designed to move lymph. Participants and assessors didn't know which group people were in.
What the results showed
Swelling improved in every group, and the differences between groups were close to zero.
- 01
Arm swelling went down in all groups
After the intensive phase, the relative reduction in excess arm and hand volume was about 23% with fluoroscopy-guided MLD, 21% with traditional MLD and 25% with placebo MLD.
- 02
No meaningful difference between groups
The authors describe the effect of fluoroscopy-guided MLD as very similar to both traditional and placebo MLD.
- 03
Other outcomes followed suit
Fluid at the shoulder and trunk, everyday function, quality of life, skin infections (erysipelas) and satisfaction showed no clinically important differences.
- 04
A question of added benefit
The trial tested whether MLD adds to a full care package, not whether MLD works on its own.
Key finding in plain terms
When people with chronic lymphoedema already had compression, exercise, skin care and education, adding manual lymphatic drainage didn't make a clinically important difference to their swelling.
What this means for practice
For chronic breast cancer-related lymphoedema, the everyday parts of care, especially compression and exercise, appear to do most of the work. MLD still features in many plans and some clients value it, but this trial suggests it shouldn't replace those core elements.
Clients should talk with their lymphoedema team before changing their care. Anyone whose swollen limb becomes red, hot or painful, or who feels feverish, should see their GP or treating team promptly, and call 000 for chest pain or sudden breathlessness.
Clinical relevance by discipline
Manual lymphatic drainage
Present MLD as one part of a package, and make sure compression advice, exercise and skin care are central to every plan.
Myotherapy
When clients ask about lymphoedema, refer to a trained lymphoedema practitioner and avoid deep work in an affected limb.
Physiotherapy
Supports prioritising exercise, compression and education in decongestive therapy programmes.
Remedial massage
A useful reminder to check lymphoedema history at intake and to refer on rather than treat swelling directly.
Limitations to be aware of
The trial only included chronic breast cancer-related lymphoedema, so results may not apply to early or mild cases or to other types of lymphoedema. All participants were treated by expert therapists in Belgian hospitals, which may not match every setting.
It answers whether MLD adds to standard care, not whether MLD helps compared with no treatment.
Summary
In 194 people with chronic breast cancer-related lymphoedema, adding fluoroscopy-guided or traditional MLD to decongestive therapy reduced swelling no more than a placebo massage. Function, quality of life and infection rates were also similar.
For lymphoedema therapists, myotherapists and remedial massage therapists, this reinforces that compression, exercise, skin care and education carry most of the weight, with MLD as an optional addition rather than the centrepiece.
Full research paper
This page is a plain-language summary. The original paper holds the full methods, statistics and discussion.
De Vrieze T et al. (2022). Does Lymphatic Drainage Add to Lymphoedema Care?. Journal of Physiotherapy, 68(2), 110–122.
DOIDOI: 10.1016/j.jphys.2022.03.010
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