By Thomas Wright MD FACPh FACP
Lipedema is characterized by painful and swollen fat which accumulates disproportionately in the subcutaneous tissue. New studies have shown that all stages of lipedema show increased swelling in the lower extremities as measured by Bioimpedence. In a study published this year in the Journal of Lymphatic Research and Biology, Crescenzi, Donahue, and Herbst showed that compared to controls all stages of lipedema have increased extracellular water or swelling. (R. Crescenzi, 2019) Further, the study showed that the edema or extracellular water increased with each stage of lipedema. We know that extremity edema or lymphedema is associated with multiple inflammatory processes that are responsible for pain, tenderness, and progressive fibrosis of the affected areas. All the Standard of Care [Dutch (Damstra, 2017), German, and British (Coppel, 2017)] Guidelines for the management of lipedema recommend the use of compression for patients with lipedema [Stage 2,3]. All of the care guidelines recommend a multidisciplinary approach to treatment involving lymphedema therapists teaching patients manual lymphatic drainage, proper fitting compression garments, and instruction on the proper application of the compression garments. Therefore, we conclude that compression is usually needed in stage 1 lipedema and always needed in stage 2 and 3 lipedema.
What is the Goal of Compression Therapy in Lipedema?
The goal of compression therapy in lipedema is:
1) Reduce discomfort, aching, and limb heaviness as well as supporting the health of the tissue.
2) Help to streamline uneven or distorted limb shape and improve movement.
3) Help to reduce edema by reducing the interstitial fluid formation and encourage venous and lymphatic return in lipedema. (Hardy, 2016)
All three goals are critical for the management of lipedema. Compression is the cornerstone on which all other treatments for lipedema are built upon as it is the only treatment that has been shown to benefit every patient with lipedema. Studies have shown medical-grade graduated compression is the most universally applied effective treatment for reliving limb heaviness, tenderness, and leg cramping and it should be the first line of treatment for lipedema as it is an extremely low risk and relatively low cost and readily available treatment. Compression with or without other lymphatic stimulating treatment is an effective first line of therapy for managing lobules, wrist, and ankle cuffs that occur with lipedema.
Read more here.