FG-MLD....challenging and changing what we know about lymphoedema!

I've just spent the weekend in Cork doing some training with Jane Wigg of The Lymphoedema Training Academy, learning all about the new Fluoroscopy Guided Manual Lymphatic Drainage (FG-MLD) technique. I first did my MLD training with Jane in 2009 and ever since have been using it to great effect with clients who present with lymphoedema and chronic swelling. There is no doubt in my mind that MLD works – we know that, we see limbs shrink in volume, we feel fibrosis soften and we hear what difference that is making to patients. There are different schools of MLD, all using slightly different techniques but with broadly similar treatment aims – to re-educate the lymphatic system to take fluid away from where it is collecting to an area where it can be drained effectively. A problem that we have though in the field of MLD is that up until very recently, we didn't know for sure exactly how it works and the 'it just does' view has little value in the inquisitive and evidence based medical world. There is very little published research evidence available to prove that MLD works. We can set our hypotheses but actually testing them at the most vigorous level is difficult. So my mind has been well and truly blown over the last few days when I have learnt about some of the most recent work being done in lymphology to strengthen the evidence base and to finally answer with conviction the 'how it works' question. Professor Jean Paul Belgrado's work using an infrared camera to view the lymphatic system in living people is further building on Professor Leduc's anatomical work on cadavers from the 1970's. The evidence is compelling. Now we can see lymphatic flow in action in real life, we can see the impact that a compromised lymphatic system is having on that flow and we can see exactly how our hand placements, stroke movements and pressures applied can be adapted to maximise the effectiveness of the MLD technique, and that is what Jane Wigg, Professor Belgrado and his team have done with the creation of FG-MLD. I actually think that this new knowledge will have a massive impact on how we manage lymphoedema now and in the future and in my mind it is a significant medical breakthrough that will have life-changing consequences. Think about how Watson and Crick impacted on our knowledge of genetics or Fleming contributed to fighting infection – I think FG-MLD is the double helix or the penicillin of today!

So, what does this mean to MLD Therapists who are currently effectively treating people with lymphoedema using MLD techniques that have been tried and tested over decades, what does FG-MLD offer us? Well, it means we can have a fuller more informed understanding of what we are doing and why, and have the conviction to be able to say 'This works and we have the evidence to prove it'. It means that we can achieve more, we can have even better outcomes we can be even more effective at moving fluid and softening fibrosis. For patients with lymphoedema it means we can provide you with a researched and evidenced based technique which will reduce your swelling and it will improve your quality of life.

As a therapist I find this incredibly exciting and as I said 'mind-blowing', although at the same time I find myself really challenged. Challenged to change what I am doing, challenged to think differently, challenged to accept a fundamental change in the approach and underlying assumptions to that which we heretofore held about lymphoedema and MLD, challenged to trust this paradigm shift. How comfortable am I with such a high level of challenge? To answer that I have to bring my focus back to why I do what I do. I am a clinician, I want to achieve the best for my clients, I want to make them better, yes the techniques that I am currently using are doing that, but if I can use something that promises to be even better........I can't erase the images in my mind of the fluorescent lymphatic fluid being pushed out of a limb that are there since I saw the video evidence over the weekend. For me its a no-brainer! It's FG-MLD all the way from now on!

So, I actually can't wait to bring this knowledge to my clients. I can't wait to tell them all the new stuff I've learnt (and tell them to forget some of the stuff that I would have told them previously) and I CAN NOT wait to try out the new technique and see the results for myself . The world is revolving and evolving at a fast pace and similarly we have to evolve in our clinical practice. I for one am delighted to be part of this exciting new world of lymphoedema management!