Complete Decongestive Therapy (CDT) involves manual lymph drainage (MLD) & compression bandaging (as well as skin care & exercise). In some instances, CDT should not be performed. These occasions include:
1. Active Infection caused by pathogens. During localized infection, lymphatic vessels constrict to prevent pathogens & other harmful matter from escaping the area & entering the rest of the circulation. When MLD is performed, the spasm may be counteracted. This would allow normal flow to resume & potentially spread the toxin(s). In general, a person needs to be on an antibiotic for 2-3 days with signs of improvement (no fever; swelling, redness, pain have subsided) before MLD may resume. Some professionals wait up to 7-10 days before resumption as the inflammatory response can last that long. The multi-layer compression bandaging may hinder the body’s inflammatory response.
2. Deep Vein Thrombosis / Thrombophlebitis. MLD stretches the skin & may potentially dislodge a blood clot. Mild compression can be beneficial as it encourages clot adhesion to the vascular wall. It is recommended to have physician approval prior to application.
3. Cardiac Edema. All lymph fluid returns to the circulatory system at the venous angles. In acute congestive heart failure, the heart is already overwhelmed by the volume of fluid being managed. MLD only increased the load the heart must manage. The same is true for bandaging. Additionally, in acute cases of heart failure, the cause of swelling is the failing of the heart, so CDT will not help.
4. Peripheral Artery Disease. While MLD is not a concern, bandaging can compromise an already reduced arterial blood flow. Arterial pressure in the foot below 70 mmHg (as measured by Doppler Ultrasound) is a contraindication for compression.
5. Active Cancer. Malignant tumors with a tendency to metastasize are an absolute contraindication for MLD as MLD only speeds up lymphatic flow & cancer travels via the lymphatic system or the cardiovascular system. However, if a person is responding to chemo & the physician approves MLD, the massage may be performed (avoiding the immediate area of the tumor). In other types of cancers, MLD may be permissible with physician approval. Compression can be useful in helping to manage swelling.
There may be other occasions when aspects of CDT is not appropriate.
References
Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 416, 438, 527ff, 602. Germany: Urban & Fisher.
Kumar, V., Abbas, A., Aster, J. (2013). Robbins Basic Pathology (9th ed.), location 1829, 1890. Pennsylvania: Elsevier Saunders.
Kasseroller, R. (1998). Compendium of Dr. Vodder’s Manual Lymph Drainage, p. 85, 174ff. Germany: Huthig GmbH.
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