Depending on the training of the therapist the techniques may vary. In the Dr. Vodder Schools, the application of manual lymph drainage consists of four different types of stroke techniques. The techniques are used on the skin in a combination of round or oval, small or large circular motions. These motions are performed on the skin without sliding on the skin and without applying pressure to the tissues below the skin. However, the intensity of the pressure may vary depending on the condition of the tissue. For example: If the tissue has started to harden and become fibrotic, then the pressure used in the treatment will be firmer. If the tissue is soft then the techniques will be lighter as is the case, generally, when treating lymphedemas.