Casley Smith Method

The Casely Smith Method for the management of lymphoedema is similar to other treatment protocols developed for this condition. It also employs lymphatic drainage, compression, skin care, exercises and self care. The main difference is in manual lymphatic drainage. This is what this page focuses on, the other components of the treatment are described on the MLD page.

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Lymphatic Drainage

Manual Lymph Drainage (MLD)was developed in the 1930s by the Danish therapist Emil Vodder. He introduced his method of MLD in Paris in 1936 after studying the lymphatic system for four years. He his curiosity was aroused by patients with chronic sinusitis and their swollen lymph glands. All current methods of lymph drainage are based on his work.

Judith Casely Smith focussed on patients with lymphoedema. For the lymphatic drainage she drew on the general principles of the Vodder method, but she also incorporated new knowledge of the lymphatic system. She took account of lymphatic drainage regions (lymphotomes) and the watersheds between them (studied by Stefan Kubik), as well as her (and her husband John's) own research on microcirculation of the lymphatic system.

The Casley-Smith lymph drainage uses light and slow strokes to move fluid, proteins, and waste products away from regions where they are accumulating and stagnating because of a problem in the lymphatic system. The strokes take this fluid across the 'lymphatic watersheds' over to regions of the body with functioning lymph vessels and lymph nodes.

How is the Casley Smith Method similar to the Vodder method?

The strokes are slow, gentle, and rhythmic
The strokes create changes in the total tissue pressure
The strokes start proximal to the problem areas first and the direction of the strokes is towards areas with functional lymph nodes.

And how is the Casley Smith Method different?

Many of the strokes move across the skin instead of using stationary skin-stretching techniques
In the swollen areas, the emphasis is on moving fluid through the tissue channels rather than on trying to increase the pumping of lymph vessels in that area
There are specific strokes done at the watershed region
The lymphotomes on the limbs (lymph drainage areas) are addressed more specifically
The emphasis is on concentrating on what the therapist feels under their hands rather than on the precision of the strokes.

I have trained in the Casely Smith Method for the treatment of lymphoedema. On the first day of my training we obviously started learning about the lymphatic system, but we were also presented with a (hypothetical) patient with lymphoedema of the leg. Over the next few days we learned what to do in this case. In a similar vain we learnt about oedema of the arm, breast, face, etc. Later we saw “real” patients with these conditions.

I am required to update my skills every other year. I qualified in 2005, so I have been on a number of updates. For one of them I went for 5 days to the Főldi Klinik in the Black Forest in Germany. This is a hospital specializing in the treatment of lymphoedema. Here they practice the Főldi method of Manual Lymphatic Drainage. I have been back to the Főldi Klinik for further updates. I have also been to Casely Smith updates in Holland, England and Wales, my most recent one. I noticed that "these days" there is much more emphasis on active client participation in the treatment.

It has been found that all recognised methods of MLD "work". If you have lymphoedema, the Casely Smith method of lymphatic drainage, together with compression, skin care, exercise and self care, is likely to help your condition. I usually combine MLD with Deep Oscillation for even better results.

If you would like to experience benefits of manual lymph drainage without having lymphoedema I would recommend Aromatherapy Lymphatic Massage. This treatment combines rhythmic lymphatic massage with the use of pure essential oils. A recent study found that massage is as effective for helping a functioning lymphatic system as MLD.

Use of Coumarin

When the Casley-Smiths developed their treatment of Lymoedema, an important adjunct was the oral or topical (local) use of Coumarin, [Lodema]. This is a benzo-pyrone which helped soften fibrotic tissue and made reduction of lymphoedema faster and easier. However Coumarin never received FDA approval in the US. In many countries where it had been in use it was taken off the market because the oral version led to hepatotoxicity (liver damage) in a small number of cases.

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