MLD for post-COVID symptoms and the ?forgotten? intercostal pathways

Intensive drainage of the intercostal pathways are used during MLD for upper torso and arm lymphoedema, and along with the bronchitis techni

Last November I posted on the role of MLD in the treatment of potential post-COVID symptoms, you can read my preliminary thoughts on the matter here.

Textbook of Dr Vodder's MLD: Basic Course Vol 1. Wittlinger
Textbook of Dr Vodder's MLD: Basic Course Vol 1. Wittlinger

Back then I didn't know of any therapists treating people with these long term effects, and I also notice that I didn't mention the respiratory specific MLD techniques that we teach in Level 2. More recently during a presentation on alternative pathways for breast drainage, a therapists in the audience suggested that we had forgotten about the intercostal pathways, which I hope is not true for Vodder trained therapists!


Intensive drainage of the intercostal pathways are used during MLD for upper torso and arm lymphoedema, and along with the bronchitis technique, are a very effective treatment for chronic respiratory conditions. So I wasn't surprised when Veronica Watson posted to our therapist Facebook group on an MLD client who is the only one in their post-COVID group to have had a resolution of symptoms.

Veronica has been using intensive intercostals on a couple of clients with long-term COVID symptoms and reports that both had presented before treatment with...

Inhalation phase of the bronchitis technique. Dr Vodder's MLD. A Practical Guide. Wittlinger.
Inhalation phase of the bronchitis technique. Dr Vodder's MLD. A Practical Guide. Wittlinger.


"...pain in the chest around the Xiphoid Process referring around the ribs to the back. Breathlessness on exertion, gasping for breath when speaking, fatigue, intermittent dry coughing.

After the first MLD treatment working intercostals both front and back, the chest pain was gone and other symptoms reduced about 70%, including the cough.

After a couple of treatments the cough became productive with a small amount of mucus expelled, and breathing became easier. Fatigue and chest pain disappeared and stress levels became more manageable."

The intercostal lymph vessels drain the pleural cavity and the cortical portion of the lungs, emptying anteriorly into the parasternal lymph nodes and posteriorly into the paraspinal nodes. This pathway in the chest wall is very rarely interrupted in any breast cancer therapy, which is why it is such a useful and important alternative pathway for arm, breast or chest wall lymphoedema.

In respiratory conditions intensive intercostal MLD removes excess fluid and inflammatory mediators in the pleura and lung tissue which can accumulate and exacerbate symptoms. I have had many good results with people affected by COPD, traumatic chest and lung injury, emphysema etc. But I am also curious about the effect of this intensive but gentle therapy on the dermatomes and sympathetic pathways that also follow the intercostal spaces. The profound sympatholytic effect of MLD applied intensively to these neural pathways may account for the rapid resolution of residual pain experienced by Veronica's clients, and the improvement in stress levels.

I hope Veronica's clients are spreading the word to others their COVID long-haulers groups about the benefits of Dr Vodder's MLD.

Read more about what is taught in the Certificate in Applied MLDhere.

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Jan Douglass
Jan Douglass

Jan has been practicing and educating in manual body therapies since 1986. Specialising in MLD and Lymph Taping, she became an Accredited Practical Instructor with the Dr Vodder School in 2002 and a certified Lymph Taping Instructor in 2017. Her diverse background includes eight years as the senior lymphoedema therapist at Flinders Medical Centre Breast Oncology Clinic, and trial coordinator at Flinders University. With a PhD in lymphatic dysfunction, Jan has consulted internationally for the Liverpool School of Tropical Medicine and co-founded the LKN Foundation Ltd in 2021 to support global lymphoedema management.

Read more articles by Jan

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