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Trigger Point Therapy - Manual Lymphatic Drainage (MLD)

Posted by Jane Ziegler on

Lymphatic System Overview - Maureen Abson


Many experts believe that MLD techniques may be effective for releasing trigger points

Manual lymph drainage (MLD) is a gentle manual treatment technique initially developed in the 1930’s by Danish Drs. Emil Vodder and Estrid Vodder.

It is a type of gentle massage which is intended to encourage the natural drainage of the lymph, which carries waste products away from the tissues back toward the heart.

The Vodders began to study the lymph system in the early 1930's, developing light, rhythmic hand movements to promote lymph movement.

They first introduced the technique 1936, in Paris, France, and after the second world war, they returned to Copenhagen to teach other practitioners to use this therapy.

Whilst scientific research has shown mixed results, MLD is practiced quite widely. 

A 2009 meta-analysis of studies in the area of sports medicine and rehabilitation showed the best evidence of effectiveness for Manual lymphatic drainage treatment to "enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema (swelling) around broken bones". 

MLD is based on a "more subtle" approach

Manual Lymphatic Drainage (MLD) requires a more subtle approach and also a good knowledge of the morphology of the lymphatic system.

Very light pressure is used to encourage lymph flow, as opposed to forcing blood through the system.

MLD is considered by many therapists to be useful at releasing trigger points in the scalenes, anterior cervical musculature, and clavipectoral fascia (ex. in the acute phase of whiplash injury).



The Lymphatic System


Trigger Points and Lymphatic Flow

Trigger point activity has been demonstrated to attenuate lymphatic flow in the following ways (Simons et al.1998):

  • Scalene trigger points (especially anterior) cause tension that interferes with drainage into the thoracic duct. This is compounded by restrictions in the 1st rib mechanics (often secondary to trigger points in the middle and posterior scalenes). 
  • The peristaltic movement of lymph is disrupted by trigger points in the scalenes.
  • Lymph flow in the arms and breast may be disrupted by trigger points in the subscapularis, teres major, and latissimus dorsi.
  • Lymph flow to the breast may be further disrupted by trigger points in the anterior axillary fold (especially in the pectoralis minor). This commonly results from a protracted, chronically round-shouldered posture (Zinc 1981).

MLD Technique

MLD procedure is best described (Harris & Piller, 2004) as follows:

  1. Administer light, rhythmic, alternating pressure with each stroke.

  2. Perform skin stretching and torque both longitudinally and diagonally.

  3. Apply pressure and stretch in the direction of the desired fluid flow (not always in the direction of lymph flow).

  4. Use light pressure over spongy, edematous areas and slightly firmer pressure over fibrotic tissue.

  5. Do not exceed a pressure of 32 mmHg.

It is suggested that MLD should be employed either before deeper work or after it, in order to help remove excessive toxins and/or waste products from the tissues (Chaitow & DeLany 2000).



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Useful Links 

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Trigger Point Workbooks 

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Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.

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Niel Asher Education is a leading provider of distance learning and continued education courses.

Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.

Our courses are accredited by over 90 professional associations and national accreditation institutions including the National Academy of Sports Medicine (NASM) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Full details of all international course accreditations can be found on our website.  

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We are honored to have received the "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.

Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.

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Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.

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If you are a qualified/licensed manual therapist or exercise/fitness professional you can expand your credentials with NAT certification.

In addition to national accreditation for continued education, each course that we offer includes "NAT Learning Credits". By taking and completing courses you can accumulate NAT credits to qualify for NAT certification.

There are currently 3 levels of NAT certification. Certifying NAT is a valuable way to show your clients that you take continued education seriously, and to promote your skills and qualifications.

Most of our courses are accredited for CE/CPD/CPE. A full list of CE accreditations can be found by clicking on the link below. 

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Niel Asher Technique

Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.

The Niel Asher Technique for treating frozen shoulder was first introduced and published in 1997 and has been widely adopted by therapists and exercise professionals working within elite sports and athletics.

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When you purchase a "Printed" edition, you will also receive free access to the download edition.

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We offer a range of over 50 courses, presented by some of the worlds leading manual therapists. All courses are reviewed annually, and new courses are regularly added.

Our courses are modular, and designed to build on what you already know. For more information, please visit our "Where to Start?" page.

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 



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