The Vodder and Leduc Treatments for Lymphedema
Different approaches both combat effects of lymphedema
By Brian Ferrie
Lymphedema is a symptom of lymphatic transportation malfunction in which lymphatic fluid accumulates, especially in the extremities, and causes edema.
There are two basic categorizations of lymphedema. Primary lymphedema, defined as impaired lymphatic flow because of congenital malformation of the lymphatic vessels, accounts for only about 10 percent of all lymphedema cases. Secondary lymphedema is acquired and represents the most common type of lymphedema. Precipitating factors include surgical removal of the lymph nodes, traumatic injury to the lymphatic system, and fibrosis secondary to radiation (Goodman, C., Boissonnault, W. Pathology: Implications for the Physical Therapist, Philadelphia: W.B. Saunders Co., 1998).
Of the variety of possible treatments for patients with lymphedema, two of the most prominent are the Vodder method and the Leduc method. Fundamentally similar in that each treatment makes use of manual lymphatic drainage, the two are also notably different.
The purpose of this article is to present background information concerning the two schools. The possible benefits or downfalls of each are not addressed.
Origins of Vodder School
According to Renato Kasseroller, MD, medical director of the Dr. Vodder School, Walchsee, Austria, Emil Vodder, PhD, first developed the technique of manual lymphatic drainage (MLD® registered trademark of North American Vodder Association for Lymphatic Therapy), involving direct pressure on the skin to stimulate proper lymphatic flow, during the 1930s for the treatment of patients with swollen lymph nodes (Dr. Vodder received his PhD in philosophy from the University of Brussels in Belgium in the early 1920s). In the 1960s, this method was adapted to lymphedema treatment by Dr. Vodder and Austrian physical therapist Guenther Wittlinger, both of whom established the Dr. Vodder School for lymphedema therapy in 1971.
Origins of Leduc School
Albert Leduc, PhD, full professor at the University of Brussels, director of laboratories of lymphology, attended a manual lymphatic drainage course taught by Dr. Vodder in Brussels, Belgium, in 1969. At the time, Dr. Leduc had already earned a doctorate in physical education as well as a license in physical therapy and rehabilitation from the University of Brussels. Dr. Leduc and his team subsequently conducted scientific lymphology research during the 1970s at University of Brussels research laboratories under Dr. Leduc's direction. Refining some of the principles taught by Dr. Vodder, Dr. Leduc and the members of his team developed the distinctive Leduc method of lymphedema management, which they began teaching in 1978.
Robert Harris, PT, HND-Applied Biology, director of the Dr. Vodder School-North American, Victoria, British Columbia, explained that the Vodder method involves a distinctive technique of MLD using a variation of pressure. Among the other aspects of the method are bandaging and garment compression, as well as education regarding exercises, skin care and lifestyle guidelines.
The Leduc method also involves a distinctive technique of manual lymphatic drainage, in addition to the use of a compression device, according to Anne-Marie Vaillant-Newman, PT, director of the North American training program for the Leduc method of lymphedema management. Other aspects of the method include specific nonelastic bandaging and compression garments. Patients are provided with advice concerning proper skin care, low-grade exercise and lifestyle guidelines.
Vodder Training Course
The four-week North American Vodder training course is comprised of four levels and 160 hours of instruction. The school is based in Victoria, British Columbia, and classes are held across the United States and Canada. Doctors, nurses, physical therapists and occupational therapists are eligible to attend, along with massage therapists who are deemed qualified by the Vodder staff. The course covers the complete program of manual lymphatic drainage, bandaging, garment review, exercise, diet/nutrition, and skin care, as well as orthopedic and venous-related edemas. A certificate is provided at the end of each level of training, but full certification requires completion of the entire course.
Vodder therapists must recertify every two years in order to remain currently certified with the school. The process involves a three-and-a-half day review class, technique supervision, assimilation of new treatment approaches, and skill-level review.
Currently, there are 350 certified Vodder therapists in North America, more than 300 of whom practice in the United States.
Leduc Training Course
The six-day training course for the Leduc method includes 48 hours of instruction. In the United States, the Leduc school is based in Woodbury, CT. Leduc training is open only to doctors, physical therapists and occupational therapists. The complete program of treatment is covered including manual lymphatic drainage, bandaging, garment review, exercise, diet/nutrition, and skin care, as well as a review of the use of compression devices. A certification is granted upon satisfaction of the course requirements. Pretests and post- tests address the initial and final competence levels of the students. Currently, there are 182 certified Leduc therapists in the United States.
An advanced course is open to physical therapists, occupational therapists and medical doctors who are certified in the basic course. This two-day program reviews MLD and bandaging techniques in addition to addressing psychological problems relating to lymphedema. The same mode of assessment is used for this training program as for the first-level course.
Future Development of Vodder Method
Because lymphedema is a permanent condition, the development of lymphedema treatment is a topic of great interest. Harris stated that approaches and procedures are always evolving.
Dr. Kasseroller commented, "Manual lymphatic drainage is already a highly refined technique, but it is only part of the treatment. In reference to the bandaging, there are always progressive developments. For example, the fabric can be improved. There are certainly better bandages available now than there were 10 years ago."
"I don't think there will be many more changes in the manual treatment," stated Hildegard Wittlinger, senior director and instructor at the Austria-based Vodder School. "But I think there will be much more progress in the investigation, which is the medical part. For example, I hope there is further development with lymphoscintigraphy, in which the affected lymph nodes can be traced and then targeted in less radical operations. That's what they do now already in regard to partial mastectomies. In some other cases, however, patients are terribly radiated. Generally, I think that a better approach to cancer must come from the doctors."
Future Development of Leduc Method
"A medical method must be permanently in evolution," Dr. Leduc stated. "Considering the scientific evolution, what we are teaching today is sometimes different than what we were teaching yesterday. For any candidate interested in learning the method, it is understood that he must stay up to date with the evolution of treatment techniques."
Vaillant-Newman added, "I hope that answers to some scientific questions regarding the physiology of the lymphatic system will be found. I wish that medical doctors will have the opportunity to be exposed to this possibility of treatment and will prescribe it to their patients on a timely basis. Finally, I hope that a lot more research will be done in the field of physical treatment of lymphedema in order to reach a strong consensus at the international level. Several proposals of consensus have been published by the International Society of Lymphology. The impact of the studies done, however, is still too limited."
Therapists should study carefully the offerings of both schools, beyond what is written here, to determine which approach is best for their patients.
* For more information, contact, the Dr. Vodder School-North America, at (250) 598-9862; the Lymphedema Management Leduc Method at (203) 266-9133 phone/fax.
Brian Ferrie is on staff at ADVANCE.