When I Should Not Have MLD
Manual Lymphatic Drainage is one of the gentlest therapies there is, and it suits most people in most situations. But like any hands-on treatment, there are some circumstances where it’s not appropriate — and others where we simply need a quick conversation before we begin.
If you’re ever unsure whether any of this applies to you, just get in touch. I’d always rather you ask than miss out on something that could genuinely help.
When MLD isn’t suitable right now
In the following situations, MLD isn’t appropriate until the underlying issue is being treated or has resolved. These are sometimes called “absolute contraindications” — though that phrase makes them sound scarier than they usually are in practice.
- Active infection with a high temperature — including cellulitis, sepsis, or any situation where you feel unwell and feverish. MLD moves fluid around the body, which isn’t helpful when infection is present.
- Acute deep vein thrombosis (DVT) — if a DVT is suspected or confirmed but hasn’t yet been treated. Once your medical team has given the go-ahead, MLD can often be helpful.
- Acute heart failure or cardiac oedema — if swelling is coming from the heart not pumping effectively, MLD isn’t the right approach without medical clearance first.
- Untreated kidney failure — the kidneys need to be working well enough to process the fluid being redirected.
- Active, untreated malignancy — if cancer has not yet been diagnosed or a treatment plan is not in place. Please read the note below — many people with cancer can and do benefit from MLD.
When we just need to talk first
In the following situations, MLD may well be entirely suitable — but I’ll want to know about it before we begin, and we may need to adapt the treatment or get a note from your GP or consultant.
- Pregnancy (first 12 weeks) — I don’t treat in the first trimester. After that, MLD can be wonderfully helpful for swelling and that heavy, achy feeling. I’ll adapt positions throughout to keep you comfortable.
- Active flare of an autoimmune condition — if lupus, rheumatoid arthritis, IBD or similar is in acute flare, we may need to wait. Between flares, many people with autoimmune conditions find MLD really beneficial.
- Overactive thyroid (hyperthyroidism) — MLD on the neck can stimulate the thyroid area, so we need to be thoughtful about how and where we work.
- Asthma or respiratory conditions — work on the chest and neck can sometimes affect breathing, so I’ll take things gently and adapt as we go.
- Low blood pressure (hypotension) — MLD can lower blood pressure a little, so I’ll always make sure you feel steady before you head off.
- Broken or significantly damaged skin in the treatment area — open wounds, active eczema, psoriasis flare-ups, or recent skin procedures. I’ll work around these, not over them.
- During chemotherapy or radiotherapy — timing matters here. Let me know where you are in your treatment cycle and I’ll advise based on that.
- Recent surgery — how recent and what type are the key questions. This is one of the most common queries I get, and the answer is usually “yes — but let’s talk about where you are in your recovery first.”
A note on cancer and MLD
This often surprises people: MLD is actually widely used as part of cancer care and recovery. It’s particularly valued for managing lymphoedema, post-surgical swelling, and fatigue following chemotherapy or radiotherapy.
The main caution is around active, untreated malignancy — where a diagnosis or treatment plan isn’t yet in place. If you’re currently in treatment, post-treatment, or managing a long-term condition related to cancer, please do get in touch. I’ll work with you and your clinical team to make sure MLD is approached safely and with care.
Not sure if any of this applies to you?
Just ask. The situations listed above might look quite weighty written down, but in most cases a quick conversation is all it takes to work out whether MLD is right for you right now. There are very few circumstances where we can’t find a way to help.
