Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra?…

Randomized trialArchives of physical medicine and rehabilitation· Sep 2026

Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra? A Single-Blind, Randomized Non-Inferiority Trial.

Elif Duygu-Yildiz, Samet Genez, Mustafa Fatih Yaşar, Nuriye Özengin

Musculoskeletal RehabilitationRandomized trialTreatmentQ1IF 3.2

Compression bandaging alone is non-inferior to adding manual lymphatic drainage for leg lymphedema.

Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra? A Single-Blind, Randomized Non-Inferiority Trial.

Elif Duygu-Yildiz … Nuriye Özengin

Archives of physical medicine and rehabilitation · Sep 2026 · Q1 in Rehabilitation

Purpose

To determine whether compression bandaging (compression bandaging) alone is non-inferior to compression bandaging combined with manual lymphatic drainage (manual lymphatic drainage) in terms of reducing limb volume, tissue stiffness, and skin/subcutaneous thickness during the intensive phase of Stage 2-3 lower extremity lymphedema (lower extremity lymphedema) treatment.

Methods

A total of 32 extremities with Stage 2-3 lower extremity lymphedema were randomly assigned to either the compression bandaging group (n = 16) or the compression bandaging+manual lymphatic drainage group (n = 16).

n = 16

Results

similar leg volume reduction with bandaging alone vs bandaging plus drainage

19.67%

CB

22.23%

CB+MLD

More results

Both groups achieved significant reductions in limb volume (p<0.001, Cohen's d: 1.35 for compression bandaging, 1.49 for compression bandaging+manual lymphatic drainage).

The 95% confidence interval for the mean difference in percentage volume reduction was [-4.57,9.68], which remained within the field non-inferiority margin.

More results

Both groups also demonstrated significant improvements in distal tissue stiffness (p<0.001, d: 1.27 for compression bandaging, 1.32 for compression bandaging+manual lymphatic drainage) and subcutaneous thickness (p<0.001, d: 1.06-1.24), with no significant inter-group differences (p>0.05).

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Conclusion · 1 of 2

Compression bandaging alone is non-inferior to compression bandaging+manual lymphatic drainage for reducing edema and tissue stiffness in Stage 2-3 lower extremity lymphedema.

Conclusion · 2 of 2

Consequently, prioritizing appropriate compression may allow for more cost-effective and less time-consuming treatment strategies without compromising therapeutic efficacy.

Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra? A Single-Blind, Randomized Non-Inferiority Trial.

Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra? A Single-Blind, Randomized Non-Inferiority Trial.

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