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The Casley-Smith method is a non-invasive means of treating lymphoedema.

Who was it developed by?


Dr John and Dr Judith Casley-Smith

Dr John and Dr Judith Casley-Smith (left). Dr John Casley-Smith (right) working on the electron microscope.

Dr John and Dr Judith Casley-Smith developed the Casley-Smith method.

You can read about the Casley-Smith method here. 

What does complex physical therapy mean?

Complex physical therapy was designed with patients that had a compromised lymphatic system in mind. “Decongesting” or “undamming” the tissues is the aim. It can be used on patients that have an intact lymphatic system as well as those that have a compromised system (e.g. when lymph nodes are removed or missing.)

We use simply “complex physical therapy” (or CPT) to designate this method. We use “physical therapy” rather than “physiotherapy,” because this has wider implications internationally and therapeutically.

CPT involves four aspects: 1) skin care and the treatment of any infection; 2) a special form of massage; 3) compression bandaging (a garment is prescribed at the end of the course); and 4) special exercises that complement the massage. It has two phases: 1) a treatment course of up to 4 weeks or more gaining the reduction and 2) maintaining and continuing the reduction by continuing with compression, exercises, and skin care.

How is the lymphatic massage performed?

The massage is based on the concept of emptying the truncal regions first to give the lymph from the periphery somewhere to go; i.e., an empty reservoir is created. Only then is the limb massaged. The proximal region of the limb is always cleared first, then the massage is extended distally. Starting at the distal end and attempting to push the lymph into the unemptied, proximal regions is contraindicated. Other deeper abdominal work may be performed by a well trained therapist that will aid in the clearance of this region and create a larger reservoir for drainage from the thoracic quadrant.1

Modern lymphatic massage approaches, such as understanding the influence of indocyanine green lymphography on lymph drainage in the video below, inform the delivery of Casley-Smith lymphatic drainage.

How do I know I will be recognised?

Lymphoedema courses need to be taken by a qualified Casley-Smith instructor. You can verify qualified instructors of the Casley-Smith International website. Andrea Mangion is on the Board of Casley-Smith International.

Complete 135 hour courses are recognised that include both online and face to face training through a qualified Casley-Smith instructor.

How does this impact me as a health professional?

If you wish to practice as a Lymphoedema practitioner you will often be asked by your peers, “What method of lymphatic therapy you are trained in?”

The Casley-Smith method is the original Australian method for the treatment of lymphoedema. It highlights empowering patients to care for themselves and encourages health care practitioners to use their clinical reasoning skills in order to provide the best quality care. You can read more about the extensive work of Dr Judith and John Casley-Smith here. 

Some bonuses of training with the Casley-Smith method:

  • an expiration date is not written into your certificate which means that you earn a qualification for life. It is then up to you to undertake further continuing professional development to maintain your health professional registration (such as the standard requirements through AHPRA).
  • the Casley-Smith method is updated on an ongoing basis by an international community (Casley-Smith International). This is advantageous over a single University/educational school providing education as the information that is delivered represents consensus from an international community of health professionals.
  • all aspects of training are considered including manual lymphatic drainage (lymphatic massage) as well as education, exercise, bandaging and garment prescription.
  • you can be proud to be taught with a technique that is thoroughly evidence-based.
  • you are not required to sign a disclaimer form stating that you cannot learn or use other methods. We encourage health practitioners to grow their clinical skills and discourage statement such as “I am an XYZ (brand) lymph therapist” and instead encourage “I am a qualified lymphoedema practitioner.” As a lymphoedema community we will continue to grow and help others in need if we all work together to provide excellence.
  • The information that is taught is communicated in an easy to understand and modern manner.

What are famous methods for the treatment of lymphoedema?

Famous methods for the treatment of lymphoedema are:

  • Casley-Smith method
  • Leduc method
  • Földi method
  • Vodder method

All of these methods have been based on the health practitioners that have dedicated their lives to the area of lymphology.

Winiwater was the first to introduce physical therapy for lymphedema. Techniques of lymphatic massage (drainage) were improved in the 1930s by Vodder.1 These were modified and extended in practice by Asdonk and Leduc, Földi and later by the Casley-Smith’s.

Can I see an example of the Casley-Smith method?

You can watch a video from the UK team in the video below. It shows you indocyanine green lymphography and real lymph movement in real time.