Medical information
This page discusses lymphoedema management. The information here is for educational purposes and does not replace medical advice. If you have lymphoedema or suspect you may have it, consult a specialist lymphoedema practitioner before starting any treatment.
What is manual lymphatic drainage?
Manual lymphatic drainage (MLD) is a specialised massage technique performed by a trained therapist. Using very light, rhythmic hand movements, the therapist stimulates the lymphatic system to move fluid from swollen areas toward functioning lymph nodes. It was developed in the 1930s by Dr Emil Vodder and remains a cornerstone of lymphoedema treatment worldwide.
MLD is different from normal massage. The pressure is extremely light - about 30-40 mmHg, roughly the weight of a hand resting on skin. The technique follows specific anatomical pathways, working from the unaffected areas first (to "clear the way") before addressing swollen regions. A session typically lasts 45-60 minutes.
Pressotherapy uses the same underlying principle - sequential compression from extremities toward the heart - but delivers it mechanically through inflatable chambers. The pressure range (20-80 mmHg in home devices) overlaps with MLD. The key difference is that a machine applies pressure in a fixed pattern, while a therapist can adapt their technique in real-time based on what they feel.
Side-by-side comparison
| Factor | Pressotherapy | Manual Lymphatic Drainage |
|---|---|---|
| Delivery | Mechanical (air compression device) | Manual (trained therapist's hands) |
| Limb drainage | Very effective - consistent, repeatable pressure | Very effective - adaptive technique |
| Trunk/torso | Limited (some full-body suits cover waist) | Excellent - can treat any body area |
| Adaptability | Fixed patterns (adjustable pressure/modes) | Fully adaptive - responds to tissue in real-time |
| Consistency | Identical every session - no variation | Varies by therapist skill and session |
| Frequency | Daily use at home - no appointments | Typically 1-3x per week (appointment required) |
| Cost per session | Pennies (electricity only) | £60-£100 per session |
| Total annual cost | £200-£500 one-off (device lasts years) | £3,000-£5,000+ (weekly sessions) |
| Independence | Self-administered - no reliance on appointments | Requires a trained therapist |
| Complex cases | Limited for trunk, head, neck, genital oedema | Can address any area, any complexity |
| NHS availability | Not typically provided (patient buys own device) | Available for lymphoedema (long waiting lists) |
| Evidence base | Strong for limb volume reduction | Strong for lymphoedema management |
What the research says
Are they equally effective?
For limb lymphoedema specifically, multiple studies have compared pneumatic compression with MLD and found comparable outcomes for limb volume reduction. A 2004 Cochrane review and subsequent studies have shown that intermittent pneumatic compression is effective for lymphoedema when used as part of a combined programme.
The International Society of Lymphology recommends both modalities as part of Complete Decongestive Therapy (CDT). In practice, pressotherapy is often used as an adjunct to MLD rather than a replacement - not because it's less effective for limbs, but because MLD can address areas that machines can't.
Where MLD still wins
A skilled MLD therapist can treat areas that pressotherapy devices don't cover: the trunk, abdomen, neck, face, and genital region. They can also work around scar tissue, assess tissue quality in real-time, and modify their technique based on how your body responds during the session. For complex or multi-region lymphoedema, this adaptability is invaluable.
Where pressotherapy wins
Pressotherapy wins on frequency and consistency. The biggest challenge with MLD is that it needs to be done regularly - ideally daily for optimal results - but clinic sessions are expensive and time-consuming. A home pressotherapy device allows daily treatment, every day, for years, at a fraction of the cost. Consistency is arguably the most important factor in lymphoedema management, and home devices make it achievable.
When to choose each
Choose pressotherapy if you...
- Need daily home treatment for limb lymphoedema maintenance
- Can't afford or access regular MLD appointments
- Want consistent, repeatable treatment without therapist variation
- Are using it for general wellness, beauty, or sports recovery
- Live in an area with limited specialist lymphoedema services
- Want independence from clinic appointments
Choose MLD if you...
- Have complex lymphoedema involving trunk or multiple body areas
- Are newly diagnosed and need initial assessment and treatment planning
- Need treatment for head, neck, face, or genital oedema
- Have significant scar tissue or fibrosis that needs manual work
- Prefer the therapeutic relationship and personalised care
- Can access NHS-funded MLD through specialist services
The best of both: the combined approach
Recommended for lymphoedema patients
Most lymphoedema specialists now recommend a combined approach:
Phase 1 - Intensive (weeks 1-4): MLD sessions with a specialist 2-3 times per week. This establishes your treatment protocol, addresses complex areas, and achieves initial volume reduction. Your therapist can also advise on which home device is right for you.
Phase 2 - Maintenance (ongoing): Home pressotherapy daily or several times per week, supplemented with compression garments. MLD sessions reduced to monthly or as-needed for reassessment and areas the machine can't reach.
This approach gives you the expert assessment and adaptability of a trained therapist during the critical early phase, plus the consistency and affordability of home treatment for the long term. It's also what the NHS lymphoedema pathway often looks like in practice.
Our recommendation
For lymphoedema patients: Start with MLD to establish your treatment, then invest in a home pressotherapy device (£200-500) for daily maintenance. This combination is more effective than either alone and dramatically more affordable than ongoing MLD sessions.
For wellness, beauty, or sports recovery: Skip the MLD sessions entirely and go straight to a home pressotherapy device. You'll get equivalent lymphatic drainage benefits at a fraction of the cost. MLD for wellness purposes is a luxury, not a necessity.
If you're already paying for regular MLD: A mid-range pressotherapy device pays for itself in 3-8 sessions and lets you reduce your clinic visits to monthly check-ins rather than weekly treatments.
Frequently asked questions
For limb lymphoedema maintenance, largely yes. For complex cases involving trunk, head, or neck, a trained therapist is still needed. The most effective approach is MLD for initial treatment and complex areas, then pressotherapy for daily home maintenance.
Yes, for diagnosed lymphoedema. Access is through specialist lymphoedema services, usually via GP or consultant referral. Availability varies significantly by area and waiting lists can be long. Many patients buy home pressotherapy devices to supplement NHS treatment and maintain progress between appointments.
Private MLD sessions typically cost £60-100 per hour in the UK. London and the South East are at the higher end. A standard initial course might involve 8-12 sessions (2-3 per week), costing £480-1,200. Ongoing weekly maintenance would add £3,000-5,000+ per year. A home pressotherapy device (£200-500) offers a significant cost saving for long-term management.
No. Home pressotherapy devices are consumer products available without a prescription. However, if you have lymphoedema or any medical condition listed in the contraindications, consult your specialist before purchasing. They can advise on the appropriate device specifications (pressure range, number of chambers) for your condition.
For lymphoedema, look for devices with 6+ chambers per limb, adjustable pressure up to at least 60 mmHg, and sequential compression mode. The CarePump Expert8 is a popular choice in the medical category. See our pressotherapy for lymphoedema guide for detailed recommendations.