Manual Lymphatic Drainage

Manual Lymph Drainage (MLD) is a gentle manual treatment technique.  MLD should not be confused with massage. MLD is very specific, gentle and rhythmical. It is preformed in a precise sequence by a highly trained Lymphedema Therapist.

The main goal in treatment of lymphedema is to reroute the lymph flow around blocked areas to healthy lymph vessels.

Other indications for MLD treatment are:

Surgical: Post Mastectomy Edema, Post Hysterectomy Edema, Post Surgical Swelling, Pre Surgery Preparation, Pre/Post Cosmetic Surgery, Lymphedema

Musculoskeletal: sprains/strains, tendonitis, neck pain/whiplash, chronic pain

Ear/Nose/Throat: allergies, sinusitis, tinnitus

Neurological: tension headaches, migraines, stress

Other: constipation, arthritis, acne, rosacea, to complement Naturopathic treatment, Bronchitis

Combined Decongestive Treatment

Combined Decongestive Therapy (CDT) is a combination of MLD, bandaging of the affected area (with Coban Bandages or short stretch bandaging), remedial exercises and skin care.  CDT is divided into a two-phase program.  An "intensive treatment phase" which is then followed by a "maintenance program" continued by the patient at home.  Even in advanced lymphedema, CDT achieves excellent results with no side effects.  CDT is labour intensive, time consuming and requires patient adherence to their treatment plan, therefore patients must be completely committed to the program.  Goals may also include prevention and decreasing the risk of infection and the reduction of fibrotic tissue.

Assistive Devices Program

for Compression Garments

The Assistive Devices Program of Ontario will cover 75% of the cost of Compression Garments for those who qualify. You must have a diagnosis of Primary or Secondary Lymphedema. If this is your first time applying, the diagnosis may NOT come from your family doctor, there is a list of specialists or surgeons who can sign the form for you.  I'll attach the current link to the online fillable form. If it does not connect you - please google "Assistive Devices Program Ontario Pressure Modification Devices"

Aqua Lymphatic Therapy

At this time there are no Aqua Lymphatic Therapy (ALT) classes scheduled.

What I have been doing is verbally explaining the techniques during an appointment, as there is a risk of making yourself worse if you don't understand the principles behind it.

ALT uses the properties of water (buoyancy force, hydrostatic pressure, drag, viscosity) to apply a gentle pressure or compression to the lymphatic system.  They hydrostatic pressure of the water is greater (and more comfortable) than a compression garment if used correctly.  Following a special exercise sequence done in a slow rhythm in the pool and combining it with self massage, you can use the properties of water to reduce swelling. Measurements are taken of the affected limb before and after the ALT class.  Once calculations are made, you will know your fluid loss in mL's showing your progress which helps decide how to best continue with your individual goals.

Goals include: improve or maintain lymphedema, improve range of motion, improve function and quality of life, improve muscle strength and endurance, group support and you are learning a treatment that you can do on your own (great as an "emergency" self treatment especially when you are travelling).

 

Lipedema

wHICH may be renamed

Lipalgia Syndrome

or

Lipedema-Lipalgia Syndrome

The information included under this heading was taken from a webinar I attended on May 23, 2026 and hosted by Dr. Anna Towers, the Director of the Lymphedema Program at Montreal McGill University Hospital.

Lipedema is a syndrome. It has signs and symptoms, the same way Chronic Fatigue Syndrome, Fibromyalgia  and Irritable Bowel Syndrome have symptoms. This creates difficulties in diagnosis.

Lipedema is generally unknown to medical providers and is usually confused with obesity.  Lipedema involves abnormal fat deposition that results in pain, immobility and lymphatic disturbances. With obesity reaching epidemic proportions and anti-fat bias prevalent in healthcare, it becomes critical that patients are correctly diagnosed and that resources are invested in understanding this disease and how it can be treated.

In 2024, the USA and Europe got together to agree on a definition of Lipedema.

They "frequently agreed" upon the following characteristics of Lipedema.

1. It occurs almost exclusively in women.  

2. there is a disproportionate distribution  of adipose tissue to the lower body and upper arms

3. Onset or exacerbation was during periods of hormonal flux (puberty, pregnancy, perimenopause)

4. easy buising

5. Increased sensitivity and pain to touch ** (this is necessary for diagnosis) 

6. Limited or no response to calorie restricted dieting and exercise programs

7. Distinct alterations in characteristics of subcutaneous tissue/skin by inspection and palpation.

They "disputed" the following characteristics of Lipedema

1. there is a family history and potential genetic implication

2. non-pitting edema and negative stemmers sign

3. onset with gynaecological or other surgeries

4. using definitions of "stages" and evidence of disease progression (meaning there is no evidence that previous staging information or photos are accurate)

5. circulating biomarkers in plasma or serum

Here is a link to some recent published research on lipedema



Lipedema treatment

  • Combined Decongestive Therapy (CDT) which consists of Manual Lymphatic Drainage (MLD), bandaging, skin care and exercises.
  • Compression garments (most need to wear compression 24hrs /day to hold on to the benefits of CDT/MLD). The garments will not reduce the fat but they will help move lymph through the lymphatic system and help reeducate the fat by sculpting it over time.
  • Diet.  There are a few popular diets - anti-inflammatory, RAD diet and the keto diet which shows a lot of promise.  Intermittent fasting combined with Keto is also worth investigating (check out You-tube videos with Dr. Jason Fung, a Toronto Nephrologist who runs the Intensive Dietary Management program, although his focus is diabetes, he explains fasting in such detail and it works!).Even though Lipedema fat is more resistant to weight loss, diet is still very important because patients who are obese AND have lipedema will have significantly more problems with pain and mobility.
  • Exercises including deep breathing, water walking, Aqua Lymphatic Therapy, walking outdoors while wearing compression, rebounding, vibration plate.
  • Pneumatic compression pumps ... these are so expensive I hate to even mention them...
  • Supplements (please see a qualified practitioner familiar with fat disorders).  There are many supplements mentioned in you-tube symposiums by Dr. Karen Herbst and Linda Kahn, it's worth watching.

this fact sheet is very old.some information is now outdated but I am including it as it is still interesting

 

Lipedema Information from the Lymphatic Summit 2024


The following screenshots were taken from the Lymphatic Education & Research Network's Virtual Lymphatic Summit. Dr Andrzej Szuba, MD, PhD, from the Wroclaw Medical University spoke on the topic of "Dietary Approaches in Lipedema".