By LJ Estrada-Brooks, PT, DPT, CLT, CDP
As a Certified Lymphedema Therapist, I often see clients and other healthcare professionals confused by the difference between lymphedema and lipedema. At Virginian Rehabilitation and Wellness, our CLTs (Certified Lymphedema Therapists) are specially trained to assess the clinical features of both conditions to determine the appropriate treatment. This blog breaks down the difference in presentation and treatment of both.
Lymphedema:
Lymphedema is a condition in which patients have dysfunction in the lymphatic system and can affect both upper and lower extremities. These clients can develop tissue swelling, changes, and hardening, and lead to complications such as infection. Lymphedema can be either congenital (something someone is born with), or it can be caused by a secondary issue, such as breast cancer surgery, radiation therapy, chemotherapy, or pelvic surgery where lymph nodes have been removed or damaged.
For clients with lymphedema, we often check for a “Stemmer sign” by checking for loose skin between the first and second toe. Lymphedema is typically asymmetric and often affects the feet.
The first step in treating lymphedema is to initiate Complete Decongestive Therapy (CDT), as part of an active phase of treatment. There are three primary components of CDT: manual lymphatic drainage, short stretch compression bandaging, and then performance of exercises designed for improving lymphatic function and increasing lymphatic drainage. In addition, some clients may utilize intermittent pneumatic compression pump. This device uses air bladders that compress the limb sequentially to help promote drainage of lymphatic congestion or swelling in the leg.
Lipedema
Lipedema, like lymphedema, can cause swelling of either the upper or lower extremities. The difference is that lipedema begins as adipose tissue that increases disproportionately involving the distal lower limbs or the upper arms. The swelling associated with lipedema is dysfunction in the fatty tissue versus fluid accumulation and primarily occurs in women. It is typically symmetrical in both limbs. Clients who have lipedema will often present with what we call a “cuff sign” where there is a notable difference in swelling above the ankle and the feet are not swollen. Lipedema almost always involves pain which is why it is often called "painful fat syndrome." You will sometimes see lipedema classified as a loose connective tissue disease.
As with lymphedema, lipedema responds to compression therapy, and along with CLT-prescribed exercises can help decrease the pain. Clients can perform activities at home like cycling, walking in a pool as they manage the lipedema. Many clients find pool walking is easier and less painful than walking on the ground.
Whether you are battling LYMPHedema or LIPedema, our CLTs closely monitor each patient's ability to perform treatments and exercise to help improve quality of life! Our therapists can help you with the “what” and show you the “how” and we will be with you every step of the way.
Schedule an appointment with one of our CLTs today and get on your path to recovery.