Aqua Lymphatic Therapy (ALT)
The Tidhar Method ®

Aqua Lymphatic Therapy – The Tidhar Method©

Aqua Lymphatic Therapy is based on the principles of the Casley–Smith exercise program for lymphedema and is applied in an aquatic environment. The method enhances the lymphedema therapy by combining principles of lymphatic anatomy and physiology with the effect of water immersion. 

The water temperature ranges from 31°C to 33°C (87.8-91.4°F). At this temperature slow limb movement can be performed without increasing swelling. The buoyancy of the water holds the limb afloat. enabling exercises and self massage with minimal effort while swelling reduction is facilitated by the hydrostatic pressure of the water which increases lymph and venous return (similar to the effect of a compression garment).

ALT is a self treatment in a group setting. The participants are encouraged to choose the exercises which benefit them the most. They are provided a chart with their limb measurement results every month to help them decide how best to continue their individual treatment plan. The participants are thus provided with the tools they need to carry out self treatment at their convenience and the physiotherapist serves as a resource, but does not direct the individual plans of care. This method provides active opportunities for self directed care that may enhance self advocacy, independence and self-esteem.


Dorit Tidhar, MScPT

Dorit was trained in lymphedema treatment by Prof. Judith Casley-Smith in 1999 and was certified by her as a teacher in Self Management and Exercise for Lymphedema in 2003. The program of Aqua Lymphatic Therapy was designed by Dorit to help people with lymphedema maintain and improve results of conventional treatment and it has been tested in a randomized controlled trial. 
Dorit is an active member of the steering committee of the Israel Lymphatic Therapy Interest Group of Physiotherapists. She has published 5 articles in scientific journals. Presently she works at the McGill University Health Centre’s Lymphedema Clinic in Montreal as a clinician and an instructor. She is coordinator of the educational program for lymphedema therapists, physiotherapists and nurses in various subjects related to lymphedema.