1. Manual lymph drainage It is the treatment that encourages the lymph flow to decrease the plasma proteins contents in the interstitial spaces and therefore decrease edema in the part.

2. It consists of: Elevation. Compression
It consists of: Elevation. Compression. Medical massage of the sound part. Medical massage of the affected part. Muscle contractions.

3. Indications:
Lymph edema
Chronic edema resulted from sport injuries.
As a result of bites.
Contra indications
Edema as a result from renal failure.
Edema as a result from heart failure.
Edema as a result from burns.
Edema as a result from vascular thrombosis.

4. Elevation
Let the edematous part to be elevated with a support, to allow the force of gravity to assist in venous and lymphatic return.
Compression
The use of compression bandage will prevent further increase of intracellular fluid, and maintain the size of the part after the session.

5. Elevation & compression

6. Wraps must be overlapped to increase the pressure gradient on the tissue.
Medical massage of the sound `part
The purpose of it is to produce vasodilatation of the sound part to allow the excess fluid in the intracellular space of the affected part to enter the lymphatic system of the sound part.

7. Medical massage for the affected part.
The purpose of it to assist the drainage of edema into healthy lymphatic capillaries.
Effleurage
Hand over hand effleurage
Longitudinal effleurage.
Transverse effleurage may be used.

8. The following considerations must be followed:
Patient should be placed in a comfortable position.
The edematous part must be elevated as possible to get use the force of gravity to assist in lymphatic drainage.
The direction of force must be in the same direction of the muscle fibers.

9. Pressure should be regulated by the type and amount of tissue.
Rhythm must be steady and even.
Duration (15 – 30 min) depends on:
The size of area is being treated.
Speed of motion.
Age of the patient.
Condition of the patient.

10. Sufficient lubricant can be used so that the hands will move smoothly.
Petrissage to increase venous and lymphatic return after superficial strokes of effleurage.

11. The technique of Petrissage
Pick the muscle between fingers and thumb in U shape hand, pull up and release.
Use both hands in step A, then squeeze (the muscles are gently squeezed, lifted and relaxed).
Roll the muscles under the fingers or hands.

12. Petrissage Kneading

13. If adherent tissue resists the absorption of edema, use Cyriax technique.
Cyriax technique is a deep friction massage to break down the adhesions, it is painful.
Return to kneading strokes again.

14. Deep Friction Massage

15. Kneading Massage

16. Petrissage Kneading