Making a Change to Clinical Practice post-Lipoedema Conference
A recent Haddenham newsletter featured highlights from the Lipoedema Conference shared by their clinical advisors, who are also lymphoedema practitioners. LES was keen to explore this further, including interviews with Gillian Buckley, Physiotherapist, Helen Smenda, Registered Nurse, and Tamryn Riemann, Occupational Therapist.
Source: Herbst, Karen. The role of compression therapy in Lipoedema. Oral presentation at Lipoedema Australia Conference. Melbourne, Australia. June 2024
Benefits of Compression Therapy for Lipoedema
Gillian: I was privileged to attend the breakfast on Saturday morning, where Karen Herbst presented on the benefits of compression therapy for lipoedema. She highlighted the following benefits:
- Smooths out shape and supports lobules
- Encourages more fluid out of the interstitial spaces
- Reduces inflammation
- Reduces pain
- Moves fluid away from nerves, reducing neuropathy
- Reduces risk of cellulitis and fibrosis
- Supports distended veins, improving flow to the heart
- Puts pressure on fat, sending a message to fat cells that there is less need to grow
- Improves posture
- Provides comfort, like a hug
Maree: Gillian, Karen Herbst highlighted several advantages of compression therapy for managing lipoedema in her presentation. How has this influenced your clinical approach?
Gillian: Best practice guidelines and research papers on compression have focused on the benefit for lymphoedema and chronic oedema management. Karen’s documentation of some of the benefits of compression for the management of lipoedema has helped guide my patient discussions/collaborations and decision-making. This includes guidance for lipoedema patients who have been reticent or unwilling to use compression regularly, especially in the hot weather, or perhaps have not seen benefits when using compression in the past.
Understanding Deep Leg Pain in Lipoedema: The Role of Fascia
Helen: Lipoedema patients often talk about deep leg pain, the cause of which has been unclear for many years. Recent research by Karen Herbst suggests that this pain may be related to the health of fascia. When fascia doesn’t glide, nerves running through it can become trapped, causing pain.
Sciatica can also be common, with rigidity between the deeper layers of fascia sometimes called scar tissue or fibrosis. This new research can guide our clinical thinking in managing fascia and its restrictions, which can interfere with lymphatic flow.
Maree: Helen, you mentioned during the conference that recent findings by Karen Herbst link deep leg pain to fascial health. How do you plan to integrate this insight into your clinical practice?
Helen: The new research into fascia by Karen Herbst, will influence my practice into understanding better the source of deep leg pain that some Lipoedema ladies experience. And so, in my discussions with my Lipoedema ladies into what we understand about Lipoedema and management of pain we now have a better understanding of its source and thus a better way forward with pain management.
Clinical Assessment
Maree: Tamryn, you mentioned updating your lipoedema assessment form following the conference. Could you share some of the key updates or insights derived from this?
Also, was there any mention of recent publications at the conference especially from Karen?
Tamryn: Yes, I did mention updating my clinic’s lipoedema assessment template after the Lipoedema Australia conference. Here are some key updates and insights derived from the conference that I have put into practice:
The presentation by Sharyn Frantz, “2023 Lipoedema Australia Survey – Diagnosis Journey,” stood out for me because it highlighted the voices of persons living with lipoedema. It reminded me of the person behind the diagnosis and prompted me to add self-reporting questionnaires as a default to my assessment. This helps capture the full picture of where the person is not only physically but also psychologically, thus keeping a close eye on their quality of life.
Karen Herbst presented multiple informative sessions, and I was again reminded of the importance of understanding the whole picture of a person’s diagnosis. I have updated my lipoedema assessment to routinely include possible comorbidities such as ADHD and various autoimmune disorders/diseases. Additionally, I have incorporated the waist-to-height ratio, which many presenters discussed and which I was not using before. Karen suggested adding half-stages to the staging criteria, a concept I quite like and have also included in my initial consultation and staging. I believe that the more we document, the easier it is to identify trends and share our findings. This more holistic approach also helps me identify other contributing factors and guides my therapy approach.
Karen Herbst spoke extensively about the correlation between Mast Cell Activation Syndrome and its role in lipoedema. She raised important questions about whether we should be testing for this before sending our patients for surgery, and how to identify the signs and symptoms when they are so intertwined with lipoedema. This new information intrigues me, but I certainly need to review it again once Karen has written and published it, as the manuscript is still in preparation for publication.
