What is MLD?

What is MLD?

Medical or Manual Lymphatic Drainage (MLD) is ‘a very gently skin stretching technique or message designed to move the skin in specific directions based on the underlying structure and physiology of the lymphatic system’ (BLS 2001).

The stretching and massage techniques are designed to stimulate the lymphatic vessels which carry substances vital to the body’s defences and remove waste products. The aim of MLD is to move fluid to an area where it can flow more freely.


MLD Technique

The lymphatic drainage used within this course will be Fluoroscopy Guided MLD (FG-MLD/’Fill and Flush’ technique).

This pioneering technique has been developed by Prof J P Belgrado (University of Brussels) following the imaging of over 1500 lymphatic systems. This had allowed identifying for the first time the usual lymphatic pathways used following a pathology.  Fluoroscopy also provides real-time images of the lymphatics allowing for us to see how to use our hands to move fluid better and ensure that we are carrying out an effective technique.

It is from the feedback of fluoroscopy that Prof. Belgrado has developed the new and researched based technique known as ‘Fill and Flush’.

The technique builds on existing knowledge but is devised with the most recent finding of anatomy, pathology and physiology.

Since October 2014 LTA has trained over 700 therapists in FG-MLD, the feedback has been amazing with therapists seeing faster outcomes and shorter treatment times.

Who can train?

The MLD technique is taught to all healthcare professionals with degree level training or Registered General Nurses. Training is suitable for medics, nurses, physiotherapists, radiographers, occupational therapists, osteopaths and chiropractors. LTA also trains complementary therapists/Sports Therapist/Bodyworkers with degree level training and those holding a valid certificate in a recognised form of MLD (please supply a copy of this certificate on application).

In addition, if you are working as healthcare support worker alongside an LTA trained therapist, you can undertake training and carry out prescribed care from your supervisor.

If you wish to be considered for the course please read our T&C’s and contact the office if you need any further information.


What is Fluoroscopy Guided MLD?
Though the use of Near Infrared imaging, the superficial lymphatics can be visualised in real time. This allows observing for the mapping of functional lymphatic collectors, the observation of dermal rerouting areas, dermal backflow areas and functional substitution pathways. This allows for the mapping and the identification of the lymphatic system and ensures that the therapist knows the best drainage pathways to be used for the patient. Never before have we been able to identify functional lymphatic’s in real time. This development means that the therapist can ensure that they carry out an MLD technique to which they know the lymphatics are responsive.
Prof JP Belgrado has been working with NIR fluoroscopy for the last 5 years and has presented globally regarding its technique, applications and outcomes for clinical practice in lymphoedema and other related conditions. Some of the research carried out by Prof. JP Belgrado has examined over 1500 pathological lymphatic patients. This has allowed for the identification of common lymphatic pathways of differing pathologies, leading to a better understanding of lymphatic pathways and subsequent drainage. It has also demonstrated what hand contacts, movement and pressure is necessary for effective drainage of the lymphatic system. Jane Wigg also carries out lymphofluroscopy, continually building on the evidence for this technique, identifying new pathways and increasing our knowledge of lymphatics, flow and drainage pathways.
Do I need a NIR camera?
No, you do not need to have access to a NIR camera but should your patient choose to be mapped with lymphofluroscopy, the mapping picture and video you receive will provide individual drainage pathway for them.
Can you carry out FG-MLD without mapping?

Yes, you can carry out FG-MLD without a camera. We will show you on the course how to map patients without fluoroscopy and how to apply this to each individual patient according to their pathology and its application to our understanding of these new pathological and existing anatomical pathways. FG-MLD is  also the term that best describes a technique that Fluoroscopy has identified as working better through unique hand movements. The hand movement used is also referred to as ‘Fill’ and ‘Flush’.

What does the course entail?
The FG-MLD course consists of 5 days training (45hrs classroom, 45hrs self-learning + prior learning).

If attending the FG-MLD only training, you will have pre-existing knowledge of the lymphatic system and already hold a certification in lymphoedema management or MLD (prior learning requirements). Therefore, the training will concentrate on recent research findings related to lymphatics and lymphoedema, newfound and common drainage pathways used, the ‘fill’ and ‘flush’ technique and relevant surgical advancements. Research and video evidence will be presented to demonstrate hand movements and manoeuvres which effectively drain the collecting vessels and reduce oedema. Live lymphofluroscopy is usually carried so the student can practice their technique for efficiency. The clinical application will show the delegate how to ‘map’ the patient and apply FG-MLD for different pathological conditions. You will practice the technique to achieve competency of FG-MLD for upper and lower limbs and trunkal oedema and practice FG-MLD for the Head and Neck.

The Complete Package course- 10 days training (90hrs + 45hrs self-learning).

This course is for Healthcare professionals and therapists who are new to lymphoedema or want to learn a better way to practice taking in the latest methods and technology from the LTA. You can also attend if you hold an appropriate bodyworker or alternative therapy degree (prerequisites apply). In addition to the above sessions will include;

  • Anatomy, physiology and pathophysiology of the lymphatic system,
  • Clinical definitions, assessment and diagnosis of lymphatic conditions using clinical and technological assessment,
  • Essential care including skincare, compression, multi-layer bandaging, exercise, weight management and psychosocial care,
  • Innovative and Emerging therapies, including Laser and LED therapy, pneumatic compression, Kinesiotaping and other electrotherapy treatments,
  • Management of oedema in advancing disease,
  • Management of Midline oedema and head and neck oedema

The examination will take place through a theory exam and clinical case studies.

Can this course lead to accreditation?
Yes, this course can be accredited at BSc level though Wolverhampton University by writing of a challenging assignment. It is also available through Royal Marsden Hospital and supported by Katie’s Lymphoedema Fund. It is recognised by the National Lymphoedema Network (NLN-USA) and forms part of UBL physiotherapy training.