Gathering place for osteopaths
Lipedema/Lipoedema
Dear Osteos,
I was wondering if anyone had an osteopathic perspective on lipedema/lipoedema.
I am currently treating two middle-aged ladies for LBP and knee pain who have for want of a better description are pear shaped with chunky legs that are very tender to palpate. The legs look like they are oedematous but there is no swelling/fat depostion/oedema the ankles and they are quite slim above the waist. Systemically they are both well. Most puzzling.
I am wondering if long term venous/lymphatic congestion leads to fat deposition/storage or if there are other mechanisms at work.
Ironically they both have an almost identical c-shaped curve in the lower LSP that seems to end to the right of the right ASIS and seems to bypass the natal cleft.
Any thoughts, osteopathic, naturopathic,dietary ???
Shivaun
Information from the LSN website
This information has been reproduced from the LSN fact sheet ‘Lipoedema’ which was produced and verified by accepted experts in their field and reflects current practice. The information has been designed to assist you in managing your condition and is not intended to replace advice you may receive from your health care practitioner. If you, or your health care practitioner would like further information, to ask any questions about this information or to find out what research underpins it, please contact the Lymphoedema Support Network on 020 7351 4480.
What is lipoedema?
Lipoedema is a bi-lateral (and symmetrical) limb swelling mainly affecting the legs and thighs (but sometimes arms too) and is thought to occur as a result of an abnormal accumulation of fat cells in the tissues under the skin.
Patients generally present with very large lower limbs that are similar in shape and size on both sides.There is often a very distinctive pad of fat below the knees and many patients have a similar area on the thighs that can resemble a ‘saddle bag’ in appearance. The thighs, hips and buttocks often tend to be disproportionate (much larger) than the rest of the upper body and the feet (and hands) are hardly ever affected.
The tissues of the limbs appear to be very loose and ‘floppy’ and are often very tender or painful to touch. Bruising occurs easily and spontaneously (without any apparent cause).
Other common features are painful knees which adds greatly to patient discomfort and disability.
Due to the increased amount of fat under the skin, the skin can appear pale and feel cold compared to the unaffected parts of the body. Bulging fat can often lead to a mattress effect on the skin, often described as Cellulite.
At present, we do not understand why lipoedema occurs but a family history suggests a genetic basis. It seems to affect females exclusively and it is usually first noticed when there is a hormonal change such as at puberty or pregnancy or even menopause.
Lipoedema is a condition that is often inaccurately or even misdiagnosed by the medical profession and it is often mistaken for other conditions, in particular lymphoedema. This happens most frequently in the later stages of the disease when the fat obstructs the lymphatic drainage leading to a mixture of lipo-lipoedema and lymphoedema. In this instance, patients may be offered treatment for lymphoedema, but the underlying lipoedema can often be missed.
To try and explain the differences, it is helpful to compare the two conditions:
Main differences between Lipoedema and Lymphoedema
Lipoedema
- Swelling of the lower limbs (and sometimes arms) which is symmetrical (the same on both sides)
- The swelling is usually soft and often comprises of loose, floppy, connective tissue and fat.
- There is often a pad of fat just under the knees and hips
- Feet (or hands) are usually not affected (giving the appearance of a “bracelet effect” at the ankles/wrists). However, as the disease progresses over time, the hands and feet can become swollen
- Pitting (firm pressure on the skin leaving obvious indentations) of the skin is not present
- Pain in the joints, especially the knees is often reported.
- Tenderness of the tissues can also be a feature
- Limbs will often bruise easily
- Risk of infection in affected areas is no greater than normal
- The affected skin condition is usually soft and supple and not thickened.
- Affects females only
- Does not seem to respond to losing weight
- There is often a family history of the condition
Lymphoedema
- Swelling may be unequal on each side of body – one limb is often much larger than the other
- Feet are frequently affected
- Pitting of the skin will be present – especially in the early stages of the condition
- No pain is felt if pressure is applied to the skin, but there is often a feeling of tightness in the tissues
- Limbs do not tend to bruise easily
- Increased risk of infection (Cellulitis) in affected, swollen areas
- Can affect females and males of any age
- The affected skin is often thickened and may have other features such as warty change or papillomatosis (cobble stone effect on the skin).
- Losing weight usually has a beneficial effect on the swelling
- In 20% there is a family history of the condition
Produced March 2011
Next planned review March 2013
Replies to This Discussion
-
Permalink Reply by clotilde chereau on -
Hello Shivaun,
I am currently treating (for the past 3 months more or less) a 40 year old woman with lipoedema. She seems to respond very well to body lymph drainage and bilateral legs drainage. I personally picture it as a defect in the vessel of the lymph, resulting in poor drainage in the LEX a little bit the same way leg varicos veins are defective vessels in the CVS.
Her leg are still bigger than what we would expect from someone of her size, but they are now a bit less, and she definitely feels better (reduction of swelling sensation and a lot less feeling of leg heaviness ).
Diaphragm seems to be definitely an issue in her case too. Therefore I do insist on that part of the drainage. I assume it is failing to do well its pumping mechanism work. Her legs get worse as she get stressed and her diaphragm gets tighter as a results.
I hope this help a little
Clotilde
-
Permalink Reply by Timbones on -
Hello Shivaun,
Interesting case. When dealing with this type of condition I find it important to think of the whole lymphatic system its relation to venous function and ultimately the relationship of the heart and circulatory system... the lymph relis on the suction forces as you were created by the venous system which in turn is regulated by the efficency of the heart as a pump.. so ideally as well as improving drainage using local lymphatic drainage techniques, we still have to ensure the lymph has somewhere to go.. so treat to provide freedom of lymph drainage in relation to freeing up abdominal circulation , hence venous drainage then open up the saphenous drainage in relation to the inguinal region and ensure that the diaphragm and its asoociated lymphatic structures are also free to function well.In the classical model we talk abour lymphatic centre innovation assisting the lower extremeties in relation to the D-L region and the trunk and arms in relation to the c-d regions of the spine .. we treated the circulation here too via the cervical and upper dorsal smpathetic innovation to blood vessels and particularly in relation to heart force..the heart rate and ryhtmn influencing circulation (vasomotion) and venous activity which in turn assists lymphatic circulation ( google for a nice diagram of the cvs system and lymph to illustrate this relationship), there are also lots of lymphatic demonstrations by Mervin Waldman on this subject on the DvDs available from The Instutute of Classical Osteopathy.... Hope this helps... perhaps the ICO could organise a Lymphatics workshop to demonstrate and discuss this subject (based on Littlejohns Technique Notes etc ) ...Happy Treating (Tim Sparrow)
-
Permalink Reply by Timbones on
-
ps sorry about the typos ..getting used to my ipad touchscreen keyboard :-)
-
Permalink Reply by Shivaun Riley on -
Hi Timbones, A very belated thank your for your post. All juicy pointers to fluid health in the body. Treating was all the happier for your input. Good luck with the new technology.
Shivaun
Timbones said:Hello Shivaun,
Interesting case. When dealing with this type of condition I find it important to think of the whole lymphatic system its relation to venous function and ultimately the relationship of the heart and circulatory system... the lymph relis on the suction forces as you were created by the venous system which in turn is regulated by the efficency of the heart as a pump.. so ideally as well as improving drainage using local lymphatic drainage techniques, we still have to ensure the lymph has somewhere to go.. so treat to provide freedom of lymph drainage in relation to freeing up abdominal circulation , hence venous drainage then open up the saphenous drainage in relation to the inguinal region and ensure that the diaphragm and its asoociated lymphatic structures are also free to function well.In the classical model we talk abour lymphatic centre innovation assisting the lower extremeties in relation to the D-L region and the trunk and arms in relation to the c-d regions of the spine .. we treated the circulation here too via the cervical and upper dorsal smpathetic innovation to blood vessels and particularly in relation to heart force..the heart rate and ryhtmn influencing circulation (vasomotion) and venous activity which in turn assists lymphatic circulation ( google for a nice diagram of the cvs system and lymph to illustrate this relationship), there are also lots of lymphatic demonstrations by Mervin Waldman on this subject on the DvDs available from The Instutute of Classical Osteopathy.... Hope this helps... perhaps the ICO could organise a Lymphatics workshop to demonstrate and discuss this subject (based on Littlejohns Technique Notes etc ) ...Happy Treating (Tim Sparrow)
© 2012 Created by Ronan O'Brien.
