Flouroscopy Guided MLD (FG-MLD)
Flouroscopy Guided MLD (FG-MLD)

MLD forms part of lymphoedema treatment and is a specialist skill, requiring specialist training. The movement is specific, gentle and rhythmic designed to move interstitial fluid into the superficial lymphatics. (Leduc and Leduc, 2000)
The Lymphatic system helps to regulate fluid homeostasis in the interstitium. The filtered fluid returns to the circulation mostly through lymphatics. If the lymphatic system is not working properly, it causes lymph stasis, leading to progressive swelling in areas in the body.
There are several types of hand manoeuvres used in lymphatic drainage to encourage movement of lymph (Leduc and Leduc 2000, Casley- smith 2001, Wittlinger and Wittlinger 2003).
The most recent research is Flouroscopy Guided Manual Lymphatic Draning (FG-MLD). Through observation using Flouroscopy, Professor Jean Paul Belgrado observed and recorded lymph flow in the upper limbs of healthy volunteers, using infrared fluroescence lymphatic imaging in real time. He found that the lymph flow is not continuous. If a segment of the lymph collector does not contain enough lymph to trigger the contraction (resulting in lymph flow), it remains inactive. Contraction only starts when a lymphangion (a segment of the lymph collector) contains enough lymph to stretch its endothelium (lining) . The physical treatment of lymphoedema intends to move the fluid out of the stasis area by applying forces on the oedema. Pressure variations are provided by manual lymph drainage, compression therapy devices and/or multicomponent banadages and sleeves.
By observing occlusion pressure of the lymph collectors based on scientific research, Professor Belgrado came up with the most efficient hand movements for draining the fluid – The Fill and Flush manoeuvre. I have used this technique on a few of my clients suffering lymphoedema and lipeoedema as well as post surgical odema and have observed faster outcome. It addressed the anatomical changes . With fluoroscopy, we are able to work in the areas where it is needed.
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