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In 2021 I became a certified Fluoroscopy Guided Manual Lymphatic Drainage therapist FG-MLD® after completing my Lymphoedema Management training for Manual Therapists at the Lymphoedema Training Academy with Jane Wigg MSc RGN. This training will enable me to practice the most researched and evidenced based method of MLD via FG-MLD®/’Fill &Flush to clients with upper and lower limb lymphoedema.

MLD can be very relaxing helping to calm the nervous system and can also help reduce pain, thought to be related to the calming and cleansing actions and effects on the body. In addition it can significantly reduce trauma based and post orthopedic or cosmetic operative oedema.


Initially I will need to see new lymphoedema clients each weekday for 5 days or a minimum of 3 days during the first week to enable us to really start to get things moving in a meaningful way. Thereafter we will assess each week what the best plan would be for you as an individual. I will also give guidance on self manual lymphatic drainage for you to do at home and can signpost clients to specialist lymhoedema services who can advise further on multi component bandaging, wraps, compression garments, wound and skin care.  

What is lymphoedema? [1]:

Lymphoedema is the swelling of a part of the body due to a build-up of fluid in the skin. It usually affects the legs or arms, but can affect any part of the body. A recent study suggested 100,000 people in the UK may be affected by this condition. It is considered to be extremely uncomfortable, can affect mobility and movement and some people also experience pain with this condition.

What causes lymphoedema? [1]:

Lymphoedema occurs when there is a problem with the lymphatic system. The lymphatics form part of your immune system and are responsible for cleansing your tissues and maintaining a balance of fluids in your body. If the lymphatic system is not working correctly, the fluid in the tissues builds.

Types of lymphoedema [1]:

Lymphoedema can be described as primary or secondary.

Primary lymphoedema is usually present from birth and arises due to the under-development or failure of the lymphatic system. It may develop without any obvious cause at different stages in life, however, particularly in adolescence and during menopause.

Secondary lymphoedema is the result of some problem outside of the lymphatic system that prevents it working properly. This can be due to surgery, radiotherapy, injury or infection, reduced mobility/paralysis, problems with veins and cancer.

What is MLD? [2]

Medical or Manual Lymphatic Drainage (MLD) is ‘a very gentle skin stretching technique or massage designed to move the skin in specific directions based on the underlying structure and physiology of the lymphatic system’ (BLS 2001). The stretching and massage techniques are designed to stimulate the lymphatic vessels which carry substances vital to the body’s defences and remove waste products. The aim of MLD is to move fluid to an area where it can flow more freely.

What is Fluoroscopy Guided MLD? [2] 

Though the use of Near Infrared imaging, the superficial lymphatics can be visualised in real time. This allows observing for the mapping of functional lymphatic collectors, the observation of dermal rerouting areas, dermal backflow areas and functional substitution pathways. This allows for the mapping and the identification of the lymphatic system and ensures that the therapist knows the best drainage pathways to be used for the patient. Never before have we been able to identify functional lymphatic’s in real time. This development means that the therapist can ensure that they carry out an MLD technique to which they know the lymphatics are responsive.

MLD Technique [2]

Fluoroscopy Guided MLD (FG-MLD/’Fill and Flush’ technique) has been developed by Prof J P Belgrado (University of Brussels) following the imaging of over 1500 lymphatic systems. This had allowed identifying for the first time the usual lymphatic pathways used following a pathology.  Fluoroscopy also provides real-time images of the lymphatics allowing for us to see how to use our hands to move fluid better and ensure that we are carrying out an effective technique. It is from the feedback of fluoroscopy that Prof. Belgrado has developed the new and researched based technique known as ‘Fill and Flush’. The technique builds on existing knowledge but is devised with the most recent finding of anatomy, pathology and physiology.

Lymph Vision [3]


LymphVision are able to provide ICG Lymphatic Imaging to map, via Fluoroscopy, an individuals lymphatics in real time providing valuable insight and a bespoke lymphatic mapping plan, to assist with lymphatic drainage, with the aim of achieving improved outcomes and effective self-managment. Please see for further information.





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