**Author details**

thrombosis and coincidently these two participants did not comply with the use of compres-

MLD should be applied as a low pressure, manual skin-stretching form of massage applied from distal to proximal throughout the lower limb, with the two hands of the physical therapist placed side by side and respecting the anatomy and flow of venous vessels, in order to

MLD treatment for CVD should be applied during 2–5 weeks; patients should complete 10–14 sessions (45 min duration for both legs) of MLD. The sequence of MLD maneuvers should be applied proximal to distal, followed by a sequence in reverse direction (i.e., from distal to proximal) such as recommended for lymphedema [124, 128]. Because inflammation may be present in these patients, direct manual skin-stretching should be avoided over the edema, as for local inflammation in lymphedema. Although there is no evidence of the efficacy of MLD

Despite no evidence that MLD prevent secondary complications associated to venous stasis, like venous thrombosis, the use of MLD may be an option to increase superficial and deep venous flow [23, 104]. In particular, MLD is recommended before venous surgery and should

It is recommended to use MLD to relief edema, symptoms, severity of disease, and ameliorate HRQL. These effects are more consistent when MLD is used as a coadjutant treatment of compression stocking [17, 18, 21]. When adherence to compression treatment is difficult, MLD can

Compromised muscle pump function, low muscle strength, and limited ankle range of motion

CVD is a very common disease across the world. Despite the cosmetic issues, there are very important dysfunctions associated with this pathology, like muscle pump dysfunction, symptoms like pain, limitation of range of motions and muscle strength, gait alterations, Lymph(edema), higher risk of deep venous thrombosis, among other. Physical therapists may have an important role in assessing (using a uniformed procedure with other health professionals) and treating these dysfunctions using a wide number of strategies, like exercise, Kinesio taping, and others. MLD may be an alternative coadjutant conservative treatment of patients with CVD, previous or not to surgery. Although there is already information about the importance of MLD as a treatment choice for CVD, further research is warrant to deter-

be an option to relief symptoms and improve HRQL in patients with CVD [21].

can be addressed with other conservative approaches, like physical exercise.

mine the best way to combine this approach with the existing CVD treating tools.

), it can be applied in these patients as long as no contraindications

increase venous return from the lower limb in subjects with or without CVD (C1\_5).

sion stoking [21].

166 Clinical Physical Therapy

in treating venous ulcer (C6

are present [21].

**9. Conclusion**

**8.4. Recommendations for treating CVD with MLD**

be complemented with compression stockings [17, 18].

Rute S.S. Crisóstomo1 \* and Paulo A.S. Armada-da-Silva2

