MANUAL LYMPH DRAINAGE BY HEATHER POWELL

Manual lymph drainage (MLD) is a light, non-invasive, painless and effective therapy developed in the last century by Dr Emil Vodder, who also pioneered the medical speciality lymphology. It is used in the treatment of many different pathologies, and is the treatment of choice for the condition lymphoedema. For many years the lymphatic system has been the body’s ‘Cinderella’, and it is only recently – as technology and molecular biology have become sufficiently sophisticated to reveal its secrets – that the international medical profession has discovered that it is much more active, influential and complex than was ever realised. The study of equine lymphology, and the adaptation by researchers and vets of manual lymph drainage to the horse (EMLD), has its centre at Hannover University Medical School, through which I trained to become the first qualified practitioner outside the German language countries.
It is now established that the horse is a ‘lymphoedema model’ being particularly disposed to this disease, although in the UK this is still not adequately recognised. Equine lymphoedema is often classified as ‘filled legs’ and ‘chronic’ lymphangitis, with the lymphoedema being untreated. Fortunately, the horses’ anatomy makes it particularly responsive to MLD, and to date it’s effectiveness has been established with a number of conditions, including acute tendon injuries, ‘tying up’ and oedema after surgery. Two of these conditions, which farriers may often encounter are chronic progressive lymphoedema and laminitis.
Chronic progressive lymphoedema (CPL) is a disease diagnosed in the last decade at the University of California Davis Veterinary Medical School Center for Equine Health. It has been found so far in Shires, Clydesdales Belgian Drafts, and most recently 'Gypsy' Cobs. It was originally thought to be a therapy-resistant form of pastern dermatitis caused by mite, fungal and bacterial infections in these heavily feathered breeds, but research established that these are secondary infections to which affected horses are particularly vulnerable because the underlying condition compromises their immunity. Initially CPL was thought to be quite a rare condition, but is now considered to be common amongst the affected breeds. If left untreated, fibrotic skin folds and nodules develop, severe infection is frequent and the limbs become disfigured, which is frequently hidden under heavy feather. Disability develops and in severe cases, horse have to be euthanased at an early age.
Incurable condition
Lymph oedema is not a curable condition, but it can be controlled using ‘combined decongestive therapy’, which involves an intensive course of MLD, specialised compression bandaging, exercise and skin care, followed by the use of compression garments (specially designed stockings for horses are available). Earlier this year, we undertook a pilot study into the use of CDT with horses with chronic progressive lymphoedema at UCDavis. The results were very positive, not least with the oldest horses in the study whose movement had previously been limited by the condition and was now improved, and will be described in detail in a paper to be published.
It is likely that CPL is hereditary and there are, understandably, some breeders of affected horses who would prefer to deny that the condition exists, blaming the swelling and fibrosis it causes on 'scar tissue' from mite infection or similar, and it is likely that many vets are unaware of the condition and are misdiagnosing it, but hopefully when the paper is published this will increase awareness within the veterinary profession. However, in the meantime, farriers may come across owners of affected horses who would welcome knowing about the condition and that there is a means to control it. Detailed information about CPL is available at www.vetmed.ucdavis.edu/elephantitis/about/htmll.
There is growing anecdotal evidence that acute and sub-acute laminitis responds well to MLD. This treatment effectively reduces oedema and inflammation, helping to decrease pain and pressure within the hoof capsule, eliminating blood and tissue toxins, and slowing necrosis. However it cannot affect established pedal bone rotation, so it should be used as soon as possible after laminitis is suspected or symptoms are spotted. EMLD must be used with veterinary permission, but I have never encountered a problem with this, once the treatment is proposed. My own experience of using EMLD with a mare which developed laminitis after aborting a foal was very positive, her farrier said he was stunned by the mare’s recovery; she has been sound ever since. I have also used it to provide considerable relief to a horse with equine metabolic syndrome who had been on box rest with laminitis for several months, and with whom it also appeared to have a ‘normalising’ effect.
Proposed study
Currently it is extremely difficult to observe the very fine lymphatic vessels within the laminae, and, despite the practical evidence of EMLD’s efficacy with laminitis, there has been no formal study into this. I am therefore hoping to undertake a small study into the use of EMLD with acute and sub-acute laminitis, and would welcome hearing from any readers interested in this.
For more information about the equine lymphatic system, the conditions affecting it, and the use of EMLD, visit the website www.equinemld.com or contact Heather Powell through [email protected] or on 0121 447 7873.

Captions from left to right -

Clipped leg of 10-year-old Clydesdale mare with chronic progressive lymphoedema before treatment; infected folds in pastern, firm oedema around and above joint

Mare in pics 2 & 3 after nine days CDT treatment

Clipped hind legs of 17-year-old Shire mare with chronic progressive lymphoedema. Large fibrotic folds and lesions, movement affected

Early chronic progressive lymphoedema in a 4-year-old cob mare (feather clipped) showing characteristic fibrotic folds and lesions

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