Complete decongestive therapy is a multicomponent treatment protocol that is the recognised standard of care for lymphoedema in the United Kingdom, Europe, and North America. It is described in the NICE clinical knowledge summary for lymphoedema and the British Lymphology Society guidelines as the treatment against which other interventions should be compared. Understanding what it consists of and why each component matters helps patients become more effective participants in their own care.
The Two Phases
CDT is delivered in two phases. The intensive phase, typically lasting two to four weeks with daily treatment sessions, aims to reduce limb volume as much as possible. The maintenance phase, which is lifelong, aims to preserve the gains made during the intensive phase through self-management. Both phases involve the same four core components, but their application and intensity differ.
Manual Lymphatic Drainage
MLD is a specialised massage technique that uses extremely light, rhythmic skin-stretching strokes to stimulate lymphatic capillary activity and re-route fluid around obstructed or damaged lymphatic territories toward functioning nodes. It was developed by Danish physiotherapist Emil Vodder and later systematised by Michael Foeldi. The pressure used is far lighter than conventional massage, around 30 to 45 mmHg, because the target is the superficial lymphatic capillaries in the dermis, not the deeper musculature. Studies measuring limb volume after intensive CDT consistently show MLD-plus-compression produces greater volume reduction than compression alone in moderate-to-severe lymphoedema.
Multi-Layer Compression Bandaging
During the intensive phase, multi-layer short-stretch compression bandaging is applied after each MLD session and worn continuously until the next session. Short-stretch bandages have a high working pressure and low resting pressure: they resist the expansion of the limb during muscular contraction, which drives lymphatic return, while not applying damaging pressure at rest. The multi-layer construction creates a graduated compression from the most distal point proximally. This phase creates the most significant volume reduction in lymphoedema treatment.
Exercise
Prescribed therapeutic exercise, performed while wearing compression, activates the muscle and joint pumps that are the primary mechanical drivers of lymphatic return. Movement compresses lymphatic vessels between muscles, propelling lymph proximally. Deep diaphragmatic breathing creates negative intrathoracic pressure that draws lymph from the thoracic duct into the venous system. Simple exercises performed in compression garments during the maintenance phase are as important as the formal MLD sessions during the intensive phase.
Skin Care
Skin integrity is critical in lymphoedema. Cellulitis, a bacterial skin infection, is a serious complication that accelerates lymphatic damage and can be life-threatening. Maintaining intact, well-moisturised skin reduces entry points for bacteria. Low-pH, fragrance-free emollients applied daily reduce the risk. Patients are taught to inspect the affected limb daily for breaks in skin integrity, redness, or warmth that might indicate early cellulitis, and to seek prompt medical attention at the first sign of infection. Fingernail care, sun protection, and avoiding skin trauma are all part of the skin care component.