Have you noticed that no matter what you do, your legs are always out of proportion to the rest of your body. It doesn’t matter how much you exercise or diet, they just never seem to change shape. When you mention it to health professionals, do you just get told you need to diet or exercise more?
This is an issue that faces many women. Often they are told they have a slow metabolism or they need to exercise more and be stricter with their diet. What may actually be causing this is not lifestyle choices or lack of effort but a condition called lipoedema.
What is lipoedema?
Lipoedema is an incurable condition that results in an increased number of fatty tissue cells (adipocytes) being deposited in affected areas of the body. This leads to out of proportion enlargement of fat deposits which are commonly found around the hips, thighs, calves or arms depending on the type of lipoedema.
Lipoedema occurs almost exclusively in women and recent research has been able to identify a genetic link for the condition (Ishaq et al. 2021). It is also affected by our hormones with women noticing onset around times of hormonal fluctuation, eg. puberty, pregnancy and menopause. Lipoedema is predicted to affect 11% of women in Australia however it is still under diagnosed by health professionals meaning in reality that percentage could be much higher.
What are the symptoms of lipoedema?
- Symmetrical excessive fatty deposits usually around thighs, buttocks &/or lower legs. Arms can also be affected however hands and feet are usually spared.
- The fatty tissue feels lumpy like there are small peas or grains of rice in it and can have a wavy appearance similar to cellulite.
- Diet and exercise do not make significant improvement to fatty deposits.
- There is a significant difference in clothing size between top and bottom half of the body.
- Legs and/or arms feel heavy, particularly towards the end of the day or when it’s hot.
- Affected areas can be extremely painful, especially to touch.
- Skin is cold to touch over lipoedema deposits.
- Skin bruises easily.
- Very flexible joints and stretch marks on the skin (signs of loose connective tissue).
Can anything be done for lipoedema?
There are many therapies that can improve the health and well being of women with lipoedema. Individual therapy needs will vary and a specialist allied health team can assist to create a management plan that suits your lifestyle and needs. Beneficial management strategies for lipoedema include:
- Healthy diet: Research has shown that following a healthy, balanced diet that limits inflammation can be effective in reducing overall weight and in reducing the size of the fatty tissue deposits. Examples include: the modified Mediterranean diet, the RAD (rare adipose disorder) diet and Keto diet. For further information, see a dietitian with experience in anti inflammatory diets to discuss sustainable and achievable diet options for you.
- Exercise: Low impact cardio training and strength training are beneficial for women with lipoedema. Aerobic exercise assists to burn non lipoedema fat deposits while resistance training improves muscle strength and bulk to better support joints and to boost resting metabolism. A physiotherapist or exercise physiologist can educate and guide you if you are unsure or new to exercise.
- Psychological support: The cycles of crash dieting and body shaming that some women with lipoedema have experienced to can lead to unhealthy relationships with food and exercise as well as significant psychological impact. Psychologists can assist to work through this trauma to improve your relationship with yourself.
- Compression: Compression has been proven to be effective at reducing tissue inflammation, swelling and pain in the affected body parts. A lymphoedema practitioner can assess your needs and prescribe the best style and level of compression for you. Lymphoedema practitioners can also assist with access to state government compression garment programs to reduce ongoing garment costs.
- Manual lymphatic drainage (MLD) massage: This is a specialised massage performed by lymphoedema practitioners to drain the bodies lymphatic vessels. Although lipoedema does not always cause lymphatic swelling, MLD is believed to release water that is bound to the fatty cells to return it to the circulation which reduces the heaviness in the limbs. MLD can also reduce tissue hypersensitivity and promote relaxation.
- Pneumatic compression pumps: A compression pump is a device that allows you to independently complete manual lymphatic drainage in your own home. There are many types of compression pumps on the market but do your research as not all of them have suitable settings for lymphatic drainage. A lymphoedema practitioner can assist with trialing and prescribing compression pumps to make sure it is right for you.
- Dry brushing: This involves the use of a soft bristled brush to stimulate the lymphatic tissues and to free bound water from the fatty tissues. This reduces fluid that may be in the legs and arms as well as helps to exfoliate the skin to keep it healthy.
- Vibration plates: Research has shown that whole body vibration therapy used at high amplitude and high frequency can stimulate circulation as well as can increase muscle fiber recruitment and reduce body fat. These are most beneficial when combined with exercise and the strategies mentioned above.
- Liposuction: Lymph sparing liposuction may be considered in more severe cases of lipoedema to assist in improving pain, heaviness and function.
What should I do if I think I have lipoedema?
Lipoedema is only just gaining recognition as a disease in Australia so there are low levels of awareness around it even among health professionals. If you think you may have lipoedema, see your GP but if they are unsure about lipoedema ask for a referral to a dermatologist, vascular specialists or accredited lymphoedema practitioner. These clinicians can diagnose your condition and also provide education about management options to help you move forward.
If you would like to see a lymphoedema practitioner, you can book online at Calm & Connection Physiotherapy [here] or find an accredited lymphoedema practitioner in your area via find an ALA Accredited Practitioner (lymphoedema.org.au).
Want to know more about lipoedema?
Below are links to some excellent resources that provide further details about lipoedema.
Lipoedema (lipoedemaaustralia.com.au) – Australian Lipoedema organisation.
Lipoedema UK | Lipoedema Advice & Support – UK Lipoedema organisation.
Fat Disorders Resource Society – USA site for all fatty disorders including lipoedema.
Remember, lipoedema is an incurable condition however there are lots of options on offer to help people with lipoedema live their best lives. Don’t hesitate to reach out to us at hello@calmphysiotherapy.com.au if you would like further information.
Until next time, be kind to yourself,
Jenny Romanczukiewicz
Physiotherapist
ALA accredited lymphoedema practitioner
