Contraindications for Manual Lymph Drainage (MLD)

Manual Lymph Drainage (MLD) is a gentle therapy that supports the lymphatic system, but it is not suitable for all clients or conditions. Some health concerns require caution or physician approval before treatment.

Absolute Contraindications (Do Not Perform MLD)

MLD should never be performed in the following situations:

  • Acute infections: Bacterial, viral, or fungal infections, including cellulitis, erysipelas, fever, or flu-like symptoms.

  • Active cancer: Especially metastatic or systemic malignancies; risk depends on cancer type and stage—physician clearance required.

  • Deep vein thrombosis (DVT) or acute clotting disorders: Risk of dislodging a clot.

  • Severe heart failure: May worsen cardiovascular strain.

  • Acute kidney or liver failure: Fluid shifts can overload impaired organs.

  • Extreme dermatitis or skin lesions: Severe eczema or active skin infections.

  • Pain with edema: Indicates underlying pathology needing medical evaluation.

  • Recent injectables: Botox, fillers, or other facial injectables—wait at least 2–3 weeks before MLD.

Relative Contraindications (Use with Caution and Physician Approval)

MLD may be considered with medical supervision in the following situations:

  • Uncontrolled or unstable hypertension

  • Chronic inflammatory or autoimmune conditions (e.g., asthma flare-ups)

  • Edema from cardiac decompensation

  • Thyroid dysfunction

  • Edema following cancer treatment or malignancy in remission

  • Pregnancy: Requires careful evaluation. MLD is generally avoided or modified in cases of:

    • First trimester or morning sickness

    • High-risk pregnancy conditions: Gestational diabetes, preeclampsia, or eclampsia

    • Dental or other active infections

    • Other complications requiring physician oversight

  • Cancer in remission or under treatment: Depends on stage and history (oncologist approval required)

Important Considerations

  • Always inform your therapist of any new, changing, or ongoing medical conditions before each session.

  • The therapist and physician will evaluate risks versus benefits for each individual.

  • While research suggests MLD does not contribute to cancer spread, it remains a cautious contraindication in many professional guidelines.

Absolute Contraindications Expanded

Absolute contraindications represent severe medical conditions for which MLD is inappropriate and may cause life-threatening complications. They include: 

  • Acute infections: MLD can spread bacterial, viral, or fungal infections throughout the body, potentially leading to sepsis or worsening the condition. Wait until the acute phase is over and fever is broken.

  • Active malignant tumors (cancer): MLD may promote the spread of cancer cells (metastasis) through the lymphatic system. Treatment on a patient with active cancer requires specific approval from an oncologist.

  • Deep vein thrombosis (DVT): Increased circulation from MLD could dislodge a blood clot, causing a pulmonary embolism, which can be fatal. A history of blood clots within the last six months also requires medical clearance.

  • Congestive heart failure (CHF): For patients with a compromised heart, MLD can increase the fluid load on the cardiovascular system, potentially worsening their condition.

  • Renal (kidney) failure: Severe kidney dysfunction can be exacerbated by the increased fluid processing caused by MLD, leading to fluid overload. 

Relative Contraindications Expanded

These conditions require a modified approach, medical consultation, and close monitoring to ensure the patient's safety.

  • Chronic inflammation or autoimmune disease flare-ups: MLD should be avoided during the "waxing" or flare-up stage of autoimmune conditions. It can be beneficial during the waning phase to aid healing.

  • Thyroid dysfunction: When working near the neck, MLD could stimulate the thyroid gland and potentially alter hormone levels, especially in cases of hyper- or hypothyroidism.

  • Bronchial asthma: In some cases, MLD can stimulate the vagus nerve, which could potentially trigger an asthma attack.

  • Hypotension (low blood pressure): The vagotonic effect of MLD can cause further decreases in blood pressure in some individuals.

  • Pregnancy: While generally considered safe after the first trimester for healthy pregnancies, MLD is relatively contraindicated in the first trimester or for high-risk pregnancies.

  • Diabetes: MLD may affect how the immune system acts in some diabetic patients and should be approached with caution.

  • After carcinoma treatment: MLD may be used in these cases, but with specific precautions and medical oversight.

  • Open wounds or skin conditions: Dermatological issues like eczema or open wounds in the treatment area pose a risk of irritation or infection, and MLD should be avoided until skin integrity is restored.