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Lipoedema

Joanne BrennanChartered Physiotherapist

Cancer Exercise & Rehabilitation SpecialistLymphoedema Therapist

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About me…

• Chartered Physiotherapist• Member of ISCP

• Cancer Exercise & Rehabilitation Specialist• Worked in oncology since 1999

• Lymphoedema Therapist• Qualified in Leduc Medical Lymphatic Drainage

LIPOEDEMA

• The disease they call fat

• The misunderstood fat

• Painful fat syndrome

• You’re just FAT!

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Lipoedema:

Lipoedema is a disorder of the adipose tissue (fat) in the body. It results in an abnormal symmetrical, bilateral distribution of fat in the legs, and sometimes occurs in the arms. A disproportionate waist to hip ratio is characteristic of lipoedema.

Fat Lady: Roel van den Burg

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Lipoedema is:

• Poorly recognised• Rarely diagnosed• In a 2014 UK study only 7%

received a diagnosis• Often labelled as obesity• Sufferers often told ‘go and lose

weight!’

Numbers:

• 11% of post-puberty female population• 17 million women in US• 370 million women worldwide• 3.5 million in UK• 210,000 (approx) in Ireland

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The Fat Lady: Arianna Usai

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2014 UK Study:

• 240 women surveyed:• 78% - started to notice at

puberty• Only 5% (of the 7% who got a

diagnosis, diagnosed by a doctor)

• Average age of diagnosis is 44• 51% said it impacted on their

ability to work• 55% felt mobility was

restricted• 50% said social life affected• 60% said sex life affected• 85% said it affected their

mental health (low self esteem, lack of confidence, depression, self-harm, suicidal thoughts)

Lipoedema UK

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“For years I was told I was obese and told to go and lose weight. My GP said I

drank too much tea & coffee.”

My Doc: “You’re just FAT. Stop wasting my time and

yours – go on a diet, go and join a gym!”

“For nearly 30 years I felt so ashamed of my body. It

wasn’t like I was stuffing my face all day every day. But I would get so depressed that

I would then turn to food and feel really guilty for

eating”

“My legs hurt so much all the time. From the moment I woke up I was constantly aware of the

ache in my legs and it was always getting worse, never

better!”

“I’ve never been able to wear short skirts.

Skinny jeans strangle me and as for knee high boots.....NO CHANCE!”

“I was ashamed that I couldn’t control the fat in my legs – surely it must have been my

fault – or that is how I was made to feel”

“I hate my body, it is disgusting!”

5 distinguishing featues:

1. It can be inherited2. It is almost exclusive to women3. It can occur in women of all sizes, from

seriously underweight to morbidly obese4. The excess fat deposits usually occur between

the waist and the ankles (feet not affected)5. It is not generally lost through diet and

exercise, like ‘normal’ fat

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symptoms

• Weight gain in lipoedemic areas, weight loss in other areas

• Column like legs (cankles)• Inverted champagne bottle legs• Orange peel effect on skin, rubbery feel

to skin• Disproportionate looking body(difficulty

clothes shopping)• If left unmanaged – lymphatic system

comes under more stress and can lead to lipo-lymphoedema (cellulitis, fibrosis, reduced mobility)

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symptoms

• Painful, achy, uncomfortable legs• Bruise easily• Tender to light pressure• Painful hips, knees, feet, spine• Fallen foot arches• ‘heavy’ legs• ‘Run down’ – catch colds/bugs easily

and struggle to shake them off

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symptoms

• Lack of self esteem • Low self confidence• Body image problems• Depression and anxiety• Stigma of obesity• Withdrawal from activities (exercise,

swimming

Causes:

• ?????????????????????????????????????• Often triggered at times of hormonal

disturbance – puberty, pregnancy, menopause, gynae surgery, high stress (assoc with increased cortisol hormone)

• **most sufferers have a hormonal imbalance

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Making a diagnosis

Does the client: Have a pear shaped appearance Have normal,even ‘skinny’ looking feet Reports consistent attempts to lose weight (generally success only lasts 1 month) Have a higher weight than expected Have cottage cheese/orange peel skin in affected areas Have evidence of weakend immune system (frequent colds, run down) Have unexplained joint pains (no evidence of RA/gout etc) Have symetrical looking legs Get sore when pressure applied to area Report sensitivity to the sun, insect bites, Have a family history of thyroid or hormonal disorders Have flat feet Family history of ‘big legs’

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The 3 stages of Lipoedema

1 32

Management – what doesn’t help

•Go on a diet•Go exercise•Here take these water tablets•Here take these diet pills•Go elevate your legs

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Management – what does help

If left untreated it will progressively get worse with knock on effects.....early recognition and treatment are vitalManual Lymphatic DrainageCompressionExercise (esp aquatic exercise)Skin careLiposuction/liposculpture – ONLY in specialised centres

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Manual Lymphatic Drainage (MLD)

• A specialised type of massage to stimulate the lymphatic system. Used to treat lymphoedema and swelling

• Hands on very gentle technique • Stimulates the parasympathetic nervous

system (switches off stressors)• Enhances immune system• Decongests and detoxifies• Deeply relaxingwww.homephysio.ie

www.homephysio.ie

• Lymph is a colourless fluid• Normally drains back into circulation

through lymphatic vessels & nodes• Nodes play an important role in

defence• If drainage routes are blocked or

damaged, lymph can accumulate in the tissues

The Lymphatic System

Exercise

Regular exercise helps to:• Improve circulation• Keep joints flexible• Keeps muscles strong• Maintains CV fitness• Reduce fatigue• Improve mood & well being

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• Walking – can be painful with lipoedema

• Swimming/water based exercise:• Bouyancy of water protects

joints/reduces pain• Support from water to move• Gradient pressure = Compression

from water• Water provides micromassage effect• Low impact• Intensive• Offers resistance

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Types of Exercise

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High Compression

Low Compression

Exercise Guidelines

• 30 mins of moderate intensity exercise on most days of the week

• Start gently and build up slowly• Wear compression garments if you have them• Keep hydrated• Enjoy yourself & have fun!

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Compression Therapy

• Compression Bandaging

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Compression Garments

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“I can actually get out of bed without thinking.....that awful constant soreness and ache

is gone.”

“My legs are still big, but I now know why and that

means I can be easier on myself cos I know its a

condition I was born with”

“Having someone listen and say that they understand

means so much – it makes you feel valued again”

“I love water aerobics, at first I was terrified of baring all in a

pool, but to hell with it – it makes me feel good and I’m doing my bit to make sure I

don’t get any worse.”

“ It is what it is.....I wish I didn’t have lipoedema

but I do and now I know how to manage it, I feel

better about it”

“I’m not quite ready for short skirts, but I’ve

started to wear skinny jeans and leggings – Being confident is so

much sexier than being thin!”

“My legs don’t define me anymore!”

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It’s NOT my fault!

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Resources

• The Lipedema project• The Disease they call FAT (film)

Lipedemaproject.org• Lipoedema ladies (UK)

Lipoedemaladies.com• Lipoedema UK

Lipoedema.co.uk• NHS UK• RCGP online training module

http://elearning.rcgp.org.uk/course/info.php?id=146

Thank You! Questions?

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