The following study appeared in the Spring, 1998 edition of The Journal of Soft Tissue Manipulation, Volume 5, Number 3. Please follow this link to view a PDF of the original article along with the treatment contract, treatment protocol and pain and function index.
A Study on the Effects of Manual Lymph Drainage on Fibromyalgia
By Eveylyne Tucker, RMT, Sylvia Krueger, RMT and Eunice Mooney, RMT
This study was initiated by three Vodder¬-certified Manual Lymph Drainage (MLD)® therapists in Saskatchewan to investigate the effect of MLD treatments on people who have been diagnosed with fibromyalgia (FM).
MLD, originated by Dr. Emil Vodder in 1936, is widely practised in Europe. To date, there are approximately 350 certified MLD Therapists in North America who have com¬pleted the extensive Vodder training.
Fibromyalgia, a chronic musculoskeletal condition causing fatigue and widespread pain throughout much of the body, affects a signifi¬cant percentage of the population each year.1 A person with FM will often say, "I hurt all over!" and be frustrated by the feeling that there is no cure and they'll "just have to live with it."1
MLD is a gentle, soothing, rhythmic hands-on technique. MLD not only provides relief, but also encourages healing to take place in the connective tissue. This works on several levels: by normalizing the fluid balance, thereby removing toxins; by calming the sym¬pathetic nervous system; and by reducing pain. Because of these effects, and by increasing lymph flow, MLD may stimulate the body's defense system and help fight off infections.2
Because fibromyalgia alters the bodily functions on these same levels, MLD might decrease the discomfort caused by FM and increase the patient's quality of life.
The theory proposed by the three Vodder therapists was that if fibromyalgia was, at least in part, due to the stagnation of proteins in the tissues, then MLD might help return the interstitial fluid to a more normal balance. The analgesic effect of MLD might decrease the patient's level of pain, and allow more normal sleep patterns, organ functions and healing potential.
Each of the therapists selected three candidates from her local Fibromyalgia Support Group. All participants were female, ranging in age from 38 to 57. It is not surprising that all the participants in the study were women, since women are predominantly affected by FM.1 The duration of the condition, after a formal medical diagnosis, ranged from six months to six years, although most had been suffering from symptoms for some years prior. Symptoms affected the whole body.
A Pain and Function Index was created using a blend of the Vernon-Mior and the Revised Oswestry3 which would approximate the problems of people suffering from FM. Instead of a "lifting" category, "exercise" was chosen as more specific to the tasks of the study population.
The index is scored in the following way: In each section, scores of zero (statement one) to five (statement six) are possible. The score for each section is added up and then multiplied by two to give a percentage.
The researchers then rated the participants in the following way: A score of 0-10% = healthy, 10-20% = mild, 20-30% = moderate, 30-40% = fairly severe, 40-50% = severe, 50¬60% = extremely severe. Participants varied from mild (1 participant), moderate (3 participants), fairly severe (4 participants), to severe (1 participant).
The treatment protocol was developed with the MLD knowledge base in mind. Because FM is a systemic condition, it was important to systematically clear the whole body initially, then concentrate on areas of remaining pain.
The therapists began treatment in the neck and upper body because the lymphatic pathways transport the waste products toward the venous arch where the jugular and subcla¬vian veins join in the neck. Dr. Vodder called this the "terminus" because it is the point where the lymph flows into the venous system from the lymph vessel system.2
It is important to ensure that there is optimal drainage and no blockage close to the terminus before moving distally. This is similar to removing any dams in a river before allowing more water to flow through it. MLD actually produces a sucking effect on the lymphatics distal to the area of treatment.4
The therapists began the treatment series with daily treatments because when clearing a sluggish lymphatic system, it is more beneficial to do repeated treatments close together and prevent the body's tendency to revert to the original state. As the system's functions im-prove, the treatments are then spaced further apart.5 The Vodder School teaches very specific sequences and repetitions for treating various body parts.6 All therapists used the same sequences on the same days.
The therapists were all certified in the Vodder advanced training program in the summer of 1993 and re-certified in 1995 and 1997. This ensured that all the study subjects received essentially the same treatment, regardless of therapist.
Each candidate received 14 MLD treatments of 45 minutes over a four-week period with specific guidelines regarding diet, rest and exercise (see Treatment Contract on page 10). Exercises consisted of gentle mobilization movements for the joints and spine.
To provide an optimum comparison, a Treatment Protocol was developed. Therapists administered the same technique sequences. Appointments were scheduled daily for the first week (Monday-Friday), four times the second week, three times in the third week, and twice in the fourth and final week. Participants had to maintain a daily diary, noting sleep quality and quantity, comfort levels, diet and exercise.
The majority of participants felt MLD treatments had been beneficial. All participants completed questionnaires indexing their pre- and post-treatment pain and function levels. Improvement in client function as indicated by the questionnaire varied from zero to 27 per cent. The greatest improvements were found in the areas of pain reduction and sleep quality, which in turn contributed positively to the quality of life. Participants felt a new sense of control over their lives. They became optimistic about their future, realizing that something could be done to change the effects of fibromyalgia.
A summary question asked each participant to rate the benefit of MLD therapy on a scale of zero-10, with 10 being extremely beneficial. The average rating for the group was seven, with two participants indicating 10 and one participant indicating one. It is interesting that the candidate's perception of benefit did not necessarily coincide with the percentage change in the rating scale. One candidate rated zero per-cent improvement and rated the benefit as six.
Another showed five per-cent improvement and rated the benefit as 10.
Therapists noted improvements in tissue health. Areas in muscles that had previously felt fibrous started to soften, spongy tissue became firmer, and complexions became clearer.
The MLD therapists who initiated this project realize that to be recognized as a valid clinical study, a much larger participant base would be required. However, the positive results achieved indicate that MLD may indeed be a beneficial treatment for individuals dealing with fibromyalgia.
Participating Vodder MLD therapists:
1. Eveylyne Tucker, RMT, 103-2318 Arlington Avenue, Saskatoon, SK S7J 3L3,
1. Kelly,], Devonshire R: Taking Charge of Fibromyalgia-3rd ed. Abbott Northwestern Hospital, Arthritis Care Program, 800 E. 28th St., Minneapolis, Minn. 55407-3799;1995.
2. Kurz I (Harris R: transl.): Textbook of Dr. Vodder's Manual Lymph Drainage, Vol. 2, 2nd ed. Karl. Heidelberg: F. Haug Publish¬ers;1989.
3. Chapman-Smith, D: Measuring results with patient questionnaires. The Journal of Soft Tissue Manipulation 1996;3(4):13-15, 24-26.
4. Weissleder H, Schuchhardt C: Lymphe-dema: Diagnosis and Therapy, 2nd. ed. Bonn: Kagerer Kommunikation;1997.
5. Kurz I (Harris R transl.): Textbook of Dr. Vodder's manual lymph drainage, Vol. 3 Treatment manual. 2nd ed. Karl. Heidelberg: F. Haug Publishers:1990.
6. Wittlinger G, Wittlinger H (Harris R transl.): Textbook of Dr. Vodder's manual lymph drainage, Vol. 1, 3rd ed. Karl. Heidelberg: F. Haug Publishers;1990.