Is compression beneficial for lipoedema?
There is so much confusion around this one topic.
I see posts on the socials where people are being told that there’s no oedema in lipoedema and therefore you don’t need compression, manual lymphatic drainage (MLD) or pumps.
Then there are other schools of thought which say that even though there isn’t lymphoedema associated with lipoedema (in the early stages) there is oedema and compression, MLD and pumps may help manage that fluid.
So, which is it?
At the recent Lipoedema Australia Conference 2024 Karen Herbst, one of the keynote speakers, talked at length about whether compression was beneficial for lipoedema.
In one of her talks she brought up a slide on the debate between the “no edema” claim of the International Lipedema Association (ILA) and the “edema” claim of the World Lipedema Alliance (WLA).
I was in the room when Tobias Bertsch, (MD, Dr. med. Dipl. Soz-päd.; Senior Consultant for Internal Medicine at the Foeldi Clinic in Germany, European Centre of Lymphology), presented the consensus paper: Lipoedema: a paradigm shift and consensus to the plenary at the 2022 ALA Conference in Hobart.
I was gobsmacked at what he was saying. Affronted even. I wrote about it on my socials here. I won’t go into what he said in detail because you can read the whole document yourself. Other than the consensus states compression isn’t necessary for lipoedema and if a patient wanted to wear it that would be ok as it may address the pain but nothing else as there’s no oedema. I’m paraphrasing, obviously.
Imagine my JOY, when Karen Herbst (Ph.D., M.D., Board-Certified Endocrinologist, Internationally Recognized Lipedema Expert, Head of Research, Director of Diagnostic and Preventative Medicine at The Roxbury Institute, Vice President of the Lipedema World Alliance) started her talk challenging the claims of no oedema in lipoedema from the Bertsch consensus paper. She instantly won my approval (she already had it, but this cemented it in perpetuity).
Her research has shown that while there may not be free fluid in lipoedema tissue, there is bound fluid – known as glycosaminoglycans (GAGs) – which does not show up on fluid scans. Again, I’m paraphrasing. You can read the Standard of care for lipedema in the United States, which she co-authored, for more information.
She talked at length about the different ways compression could help manage lipoedema symptoms:
- Smooth out the shape of the legs/arms to allow ease of movement
- Support lobules
- Move fluid out of the interstitial space into lymphatic vessels
- Reduce inflammation
- Reduce pain including myofascial pain
- Move fluid away from nerves reducing neuropathy and therefore pain
- Reduce the risk of cellulitis/fibrosis
- Support distended veins and accelerate venous blood back to the heart
- Put pressure on fat which sends message to fat cells that there is less need to grow
- Improve posture
- Provide a feeling of comfort
While the use of compression will not reduce lipoedema tissue (the only thing that will do that is surgery), it can reduce multiple symptoms associated with lipoedema.
Does that mean that every person with lipoedema needs heavy-duty compression?
No.
Remember, this is an incredibly individual disease.
Compression can be hugely beneficial, even if it is just some cheap sports compression.
The same with manual lymphatic drainage, pumps or vibration.
Many of the treatment techniques used to treat lymphoedema are also appropriate for lipoedema, even if the type of fluid involved is different.
Research is constantly changing and challenging how we treat lipoedema.
If you have been told there is no oedema in lipoedema but you KNOW your legs go up and down depending on the time of the day then I encourage you to find a therapist who will support you with what is appropriate for YOUR body.
You can download my Self-treatment for lipoedema free guide here.
PS – you will note I have used two different spellings in this post. In Australia we use “lipoedema” and in the US and other parts of the world it is spelt “lipedema”. When using names of organisations or publications I have used the spelling for where it is based.
And here’s a cheeky photo of me, Jen (Chair of Lipoedema Australia) and Lucy (fellow Advisory Board and Board member) fan girling on Karen at our last dinner after the conference … we were not subtle at all!
