Manual lymph drainage (MLD) is a light, painfree therapy which is able to utilise the power of the lymphatic system to treat a wide variety of conditions, using very precise manual movements which encourage tissue fluid to enter the initial lymph vessels and stimulate lymphatic contraction, greatly increasing the movement of lymph through the system. MLD is literally skin deep, working primarily with the superficial lymphatics and also, for people, with direct stimulation of groups of lymph nodes, and some deeper abdominal work. Anatomical differences mean that this deeper work is largely not possible with horses, and more indirect application is used. However the lack of fat and muscle in the horse’s lower leg means that in this region, both the superficial and the deep systems can be treated together, increasing the effect of MLD.
Whereas blood is pumped through vessels, lymph transport has a suction effect and treatment always starts as close as possible to the junction of the lymphatic ducts and the veins into which they finally discharge, before working on the area to be treated. Sometimes it isn’t possible to work directly on an area (perhaps it is too painful), so MLD utilises the synchronous contractile nature of the system, enabling it to drain such areas by working elsewhere on the body. It’s also possible, using the network of valveless initial vessels, to move fluid in different directions, from one area to another. This is an essential part of lymphoedema treatment, in which fluid is moved from one territory where drainage is faulty, into another where the lymphatic system is functioning adequately.
MLD influences blood circulation by increasing blood flow without increasing pressure, so that where tissues are congested oxygen and nutrient supply is increased, but less fluid enters.
The slow, rhythmical movements also effect the nervous system, so that the ‘fight or flight’ sympathetic system is calmed and the parasympathetic, responsible for ‘rest and renewal’ predominates. MLD movements also provide moderate pain relief, blocking nerve signals along the same principle as ‘TENS’ machines.
Having an MLD treatment is usually a very pleasant relaxing experience, and clients, both human and animal, often fall asleep during one.
Combined Decongestive Therapy (CDT)
If the lymphatic system is unable to function properly, a lymphoedema develops, as fluid and protein build up in the tissue. CDT is a two-phase treatment. The initial intensive phase consists of daily MLD, followed by compression bandaging, skin care and exercise to reduce the oedema and fibrosis. The compression bandage used for CDT should not be confused with compression bandages applied by vets for other purposes. It takes skill and experience to apply correctly and isn’t, as I have known happen, something a vet should suggest an owner attempt! It uses thick padding, and multi layered low-elastic short stretch bandages to create a pressure gradient which supports lymphatic and blood flow. Applied correctly, the bandage provides firm support to the limb when the horse moves, but cannot become over tight. Please note, it isn’t simply using short stretch bandaes which achieves the results, it is the whole treatment and the skill with which the bandages are applied, so please don’t contact me asking where to get them from because you fancy having a go! During treatment, an assistant is needed to hold the horse during bandaging and to exercise it for 30 minutes afterwards if no alternative is available. Exercising before and after bandaging encourages the movement of lymph and drainage of the oedema.
Care of the skin is important because it is damaged by lymphoedema, encouraging the entry of infections.
Measurements to calculate the reduction in volume may be made before treatment starts, and when reduction ceases. At this point, the second, maintenance phase starts. Because lymphoedema is progressive, and something which has to be dealt with on an ongoing basis, the second phase of treatment becomes, for practical reasons, the primary responsibility of the horse’s carer, with input when required from an MLD practitioner.
For people with lymphoedema this means being fitted with a compression garment (sleeve, stocking) or learning to self bandage if the oedema is resistant to treatment, and the continuance of skin care and exercise, and further MLD treatments as required. Until recently for horses this has meant wearing a simple long knitted stocking which provides suitable compression to prevent fluid refill but has been found not to prevent fibrosis, and therefore regular ‘follow up’ MLD treatments are recommended. Alternatively I am happy to train owners to bandage their own horses after treatment.
Support stocking/garments are intended to be used when oedema reduction is optimal following CDT. The simple stocking described above is effective for horses whose legs fill when confined to stables. Products like ‘Tubigrip’ do not have sufficient compression value to support compromised equine lymphatics.
I have found Deep Oscillation Therapy® effective for reducing fibrosis, and Equitape useful to support volume reduction should bandaging not be possible, for example when a wound, abscess or skin condition is present.
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