Manual lymph drainage for equine lymphoedema-treatment strategy and therapist training

Idiopathic primary lymphoedema (‘swollen legs’) and secondary lymphoedema following trauma or infection (e.g. wound oedema or phlegmon/cellulitis) are frequently encountered problems in equine veterinary practice. At present, therapy of these diseases is often based on symptomatic and empirical treatment, using NSAIDs, antibiotics and compression bandages (Fig 1). Less consideration is given to the underlying disturbance of the lymphatic system. In order to understand the susceptibility of horses to lymphoedema better, it must be remembered that the horse is a flight animal, normally in constant movement. Modern methods of keeping horses in box housing, with limited free exercise and concentrated training sessions compromise the lymph system in apparently healthy horses, particularly in the feet (Laue, 1987). Under these conditions, even minor trauma (e.g. skin wounds) can lead to serious oedema. Manual lymph drainage (MLD) is a treatment option applied directly to the lymphatic system. Furthermore, this method does not contravene anti-doping regulations and has no side effects. Although established for decades in human medicine (Földi et al. 2006), it is only slowly gaining a foothold in veterinary medicine.