Manual lymphatic drainage and medically-correct compression, monitoring and useful tools as adjuncts to primary treatment.
What is CDT?
Combined Decongestive Therapy is a highly skilled and essential tool for lymphoedema care. CDT comprises of both Manual Lymphatic Drainge (MLD) and medically-correct compression (multi-layer lymphoedema bandaging or MLLB) with an additional focus on carefully monitoring the results, along with multiple “add on” skills such as kinesiotaping.
Unfortunately over the years it has become apparent that MLD is not particularly rewarding for sufferers of CPL. The trouble being the severity of effect on the lymphatic retraction of the legs. In many cases, as soon as the MLD sessions are complete, the legs simply refill. In advanced cases even compression can’t help unless the horse lives in it, in which case their quality of life is seriously compromised. That said, MLD may offer temporary relief from the unpleasant sensations caused by lymphoedema. More on that here.
Equine CDT (and indeed MLD in it’s own right) requires practitioners to have qualified first in human lymphoedema care. Technically, it is not possible to teach someone MLD via video or similar on a short (“intensive”) course – it needs to be done in the flesh, so to speak. This is because qualified MLD practitioners undergo assessment to ensure they are applying the proper levels of pressure, something that is not possible to do without physical instruction. It is much more than just massaging the legs (something that is strictly contraindicated) and requires the knowledge to monitor the quality of the skin and tissue and level of oedema.
The Press and Stretch Test for Diagnosing and Monitoring CPL.
CPL is surprisingly easy to diagnose once you know what to look for. For veterinary and therapeutic professionals with an interest in equine lymphatics, this is very useful. Always monitor your clients the proper way, checking tissue quality as well as limb circumference as described below…
Affolter and Powell study into CDT for CPL treatment.
Verena K. Affolter who has researched and written extensively on the subject of CPL in draft horses teamed up with Heather Powell (formerly Equine MLD in Worcestershire, UK) to look into the use of CDT when treating CPL horses. Please see the summary below, followed by the PDF link to the whole study. As you will see, the use of CDT is often complicated by the horse’s level of pain tolerance and additional problems like secondary infections.
“This pilot study documents evidence that CDT assists management of CPL. Current CPL management is limited to palliative treatments of secondary infections. Whilst not a permanent treatment, CDT offers a promising tool to manage horses with CPL, improving their quality of life and potential usefulness. More extensive and prolonged studies with a larger number of horses are warranted to evaluate the full potential of CDT.”
V. K. Affolter, H. Powell; Combined decongestive therapy including equine manual lymph drainage to assist management of chronic progressive lymphoedema in draught horses.
Chronic Progressive Lymphoedema 