Lipedema or “large-bone syndrome” is a chronic progressive disorder of adipose tissue with a lymphatic component. It occurs mainly in women – 10 to 18 percent of women between the ages of 25-65 suffer from it and significantly affects their quality of life. Lipedema is characterized by an abnormal, bilateral and symmetrical distribution of subcutaneous adipose tissue of the lower extremities or, very rarely, of the upper extremities, associated with moderate edema. It causes spontaneous pain when pressed or pinched, a feeling of tension on the skin and frequent bruising. It is often confused with obesity, lipodystrophy or lymphedema and unfortunately remains relatively unknown to both the medical community and the general public. However, it has a major impact on patients’ body image and quality of life. Lipedema primarily affects the legs (97% of cases). The increase in fat volume is accompanied by a vulnerability of the blood capillaries that release fluid to the surrounding tissues and are more susceptible to strokes, resulting in bruising or hematomas.

Lipedema origin and causes

Lipedema is a condition that probably has a hereditary origin and is related to periods of hormonal changes such as puberty, pregnancy or menopause. It usually begins gradually from adolescence and then evolves more or less rapidly, sometimes becoming very disabling. Lipedema is in no way related to nutrition, with which it is wrongly associated. This fluid released into the tissues is usually drained by the lymphatic system. In the long term, however, this permanent stimulation reduces the transport capacity of the lymphatic vessels, which promotes the formation of edema, inflammation and then collagen deposits, which are responsible for the irreversible fibrotization of the adipose tissue and skin.

Causes:

• Hormonal imbalance: This can be caused by fluctuations in hormones such as estrogen, progesterone and testosterone.
• Genetic predisposition: Certain genes may be associated with an increased risk of developing lipedema.
• Obesity: Being overweight or having a higher than average body mass index (BMI) can increase the risk of developing lipedema.
• Stress: Persistent high stress can lead to an increased risk of lipedema.
• History of trauma: Previous injuries or trauma to the legs and hips can contribute to the development of lipedema.
• Occupations: Occupations that require sitting and/or standing for long periods of time may increase the risk of developing lipedema.
• Medical conditions: conditions such as diabetes, hypothyroidism, kidney disease and lymphedema may increase the risk of developing lipedema.
• Medications: Certain medications, such as those for cancer, can cause lipedema

Symptoms with diagnosis of lipedema:
The diagnosis is mainly clinical, but additional examination may be required in case of doubt: CT scan, high-resolution ultrasound, MRI and lymphoscintigraphy.

• Swelling and heavy feeling of the legs/arms (also known as “stovepipe” or “pole legs”)
• Abnormal fat distribution of fat from the hips to the ankles and foot, creating a pear-shaped silhouette
• Vulnerability of the superficial microcirculation leading to small bruises at the slightest impact
• Superficial venous insufficiency with frequent varicose veins and stretch marks near the joints
• Limited range of motion of the knee, ankle or elbow joints.
• Pain or sensitive skin (legs, arms, buttocks) when pressure is applied

Stages of lipedema:
Based on anatomical and pressure findings, lip edema can be divided into three stages. The severity of symptoms or the volume of edema do not play a role.

• Stage 1: smooth skin surface, thickened subcutaneous fat, fine nodular fat structure.
• Stage 2: uneven skin surface, rough, lumpy fat structure.
• Stage 3: rougher and harder skin surface and subcutaneous tissue, large deformed fat lobes.

What treatments are available

Many people suffering from lymphedema wonder if it is curable. Although pathological swellings cannot always be completely cured, proper treatment can at least significantly reduce them. The available treatments are more or less effective depending on the evolutionary stage of the lipedema and the patient’s expectations. They must therefore be studied on a case-by-case basis, since the treatment of the condition is not codified.
Physiotherapy

• Manual lymphatic drainage
• Decongestive physical therapy with short extension bands of less than 100%
• Muscle exercises under multi-component bandages to release some of the trapped water

Pressotherapy

• Pressotherapy, pneumatic massage from distal to proximal, as an adjunct to physical therapy. It is performed by sliding-wave massage and promotes blood circulation and lymph flow. Especially with medically certified devices such as our devices, significant effects can be observed. They can reduce swelling, relieve pain and remove stagnant fluid from the tissue.This technology can be used in the physical therapist’s office, as well as at home with a personal device.

Surgery  

• Liposuction to reduce volume, reshape the trochanteric region and inner thighs, with continuous elastic compression for the first 7 days, then only during the day for 4 to 6 weeks. The procedures can be repeated up to 6 times, depending on the areas to be treated, with an interval of at least one month between liposuctions.
• Skin resection of bulky masses on the inner thighs or calves, with decongestive physical therapy (low elasticity bandages) preoperatively to reduce the fluid component to facilitate wide resection, and postoperatively to stabilize the volume.

Additional approaches  

• Wear custom-made Class 2 or 3 elastic compression stockings to maintain long-term volume and act on venous insufficiency
• Elevation of the limbs to reduce pain
• Physical activity to maintain muscle tone and stabilize weight, especially in an aquatic environment to reduce spontaneous superficial pain (aquagym, aquabike)
• Skin care: hydration
• Psychological care

Using a Pressotherapy system

Nymph’s system consists of a pump and 1 or more cuffs, these are easy to use, safe and effective for edema. It is important that you follow the instructions given to you by your nurse, therapist or doctor for edema therapy.

Before using the system, remove compression bandages or stockings. Making sure you are in a comfortable position, place a cylindrical cotton bandage or jersey stitch on the affected limb if necessary. Place the cuff on the edematous limb to be treated and connect the cuff to the pump.

Adjust the pump settings for lymphatic drainage is this program B as advised by your treating physician, then turn on the pump.

The cuff will alternately inflate and deflate, providing a gentle massage. This stimulates blood and lymph flow in your affected limb. If the pressure is too high and you experience discomfort, you can reduce the pressure setting on the pump. This can be done even during the therapy session already in progress.

It is important that you follow the instructions given to you regarding duration and frequency of use. An edema therapy session lasts between 30-90 minutes.

After completing edema therapy, the cuff and any cotton bandage should be removed. If you are wearing compression garments, you can put them back on. Experience over many years has shown that very few problems have been experienced by persons using this system. However, if you become short of breath or your limb becomes swollen or painful, or if the skin becomes red and inflamed during treatment, you should stop immediately and inform your treating physician as soon as possible.

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