Human and equine manual lymphatic drainage

What is EMLD?

EMLD is a specialised, hands-on technique which allows the therapist to encourage more fluid to be taken up by the small, initial lymphatic vessels which lie in the deeper layers of the skin. The initial lymphatics are anchored by filaments that are able to be stretched very gently in two directions, encouraging them to empty completely. Then a “zero” phase of almost no pressure on the anchoring filaments gives time for the initial lymphatics to refill.

The technique, although it can look simple to the observer, needs to be very precise and takes time to learn. Therapists must have a complete understanding of lymphatic drainage routes around the body, lymphatic watersheds, and the biomechanics and biochemistry of the system as a whole. The manual technique must be applied extremely precisely, at the right speed, rhythm, and with the correct amount of stretch, otherwise the technique will not yield good results. Therapists must also have experience of dealing with and getting the feel of different types of oedema, so that they can tailor the therapeutic procedure to suit what they are feeling under their hands. The therapy is administered and then adapted according to what is happening under the hands and anatomically in that individual patient, as scar tissue, fibrosis and fascial tension can inhibit drainage routes. There can also be a great deal of variance between individual patients, so a therapist has to be aware that if expected results do not occur, they have to make and informed decision as to which alternative drainage routes will be safe and effective to utilise.

EMLD is well tolerated by horses, as it is very gentle. The therapist starts proximally and works distally towards the affected limb. The therapist then repeats the procedure back to the neck region, working in specific lines down the body and paying attention to the quality of the skin stretch, the direction of lymph flow and the firmness of any oedema. EMLD brings the parasympathetic nervous response to the fore, encouraging the body’s natural “relax and restore” mode. It also helps lessen pain by triggering an inhibitory nerve response via the synapses.

EMLD forms part of what is known as Decongestive Lymphatic Therapy, when combined with compression bandaging in the treatment of lymphoedema.