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Tese de Doutoramento em Motricidade Humana especialidade em Reabilitação, Universidade de Lisboa, Faculdade de Motricidade Humana, 2014

Objective: To assess the efficacy of manual lymphatic drainage (MLD) in the treatment of patients with chronic venous disease (CVD). Design: Three cross-sectional studies and one single-blind randomized controlled trial, were performed. Methods: A total of 108 participants with CVD and 62 healthy participants were assessed in four studies. The first study assessed calf muscle pump function (CMPF) and architecture of gastrocnemius muscles by ultrasound in CVD and healthy participants; the second and third studies were performed with duplex ultrasound to assess venous hemodynamics during MLD; the fourth study, a randomized controlled study, assessed for efficacy of the MLD in CVD management. Results: Ultrasound measures demonstrate changes in CMPF efficacy along a series of contractions as well as between CVD and healthy participants, although the method suffers from bias. MLD maneuvers increase superficial and deep venous flow, mostly when applied along the anatomical course of the major lower limb veins, but without differences between different MLD maneuvers. MLD decreases the symptoms and clinical severity (related to venous edema) of CVD, and improve dimension of pain of health-related quality of life in this condition, after four weeks of treatment and the effect is maintained after 4 weeks of follow up. Conclusions: MLD applied with skin-stretching along the course of venous vessels increases venous return, and may be used as a conservative coadjutant option to treat patients with CVD.