Complex Decongestive Physiotherapy and Lipedema

By August 31, 2023 June 23rd, 2024 No Comments

I’d like to tell you about a paper by a group of researchers in Ankara, Turkey today. It is entitled The Effects of Complex Decongestive Physiotherapy Applications on Lower Extremity Circumference and Volume in Patients with Lipedema. It was published in the medical journal Lymphatic Research and Biology in 2020. 

This study aimed to investigate the effect of complex decongestive physiotherapy, or CDP, with the addition of a pneumatic pump on limb circumference and volume in patients with lipedema. 

This same research group previously investigated if a CDP alone or when combined with a pump was superior for treating lipedema, as reported in Flash Briefing Episode 189. 

Who are the participants?

23 women diagnosed with lipedema were included in this study. It did not state what criteria they used for making a lipedema diagnosis. 

Participants were excluded from the study if they had chronic venous insufficiency, lymphedema, or a blood clot. 

The average age of participants was 43 years, average weight was 218 lbs (99 kg), and mean BMI was 37.1, which classified the average participant as obese. Measurements of limb circumference and volume were completed using a perometer which uses infrared light. 

Data Collection Phase

All the participants went through Complex Decongestive Physiotherapy (CDP) and a pneumatic pump for 5 days per week for a total of 24 treatments. CDP included manual lymph drainage (MLD) for 45 minutes provided by a therapist trained by the Foeldi College, 30 minutes with a pump, and compression bandaging. All of them were also asked to exercise daily by walking. At the conclusion of the 24 treatments, the participants were fitted with class 2 or 3 compression stockings. 

Why include MLD?

The authors discuss the value of including MLD for patients with lipedema, although the effectiveness of this specific component of therapy was not examined in this study. They acknowledge that while the evidence for using MLD with patients with lipedema is mixed, they believe that there may be a benefit when lymphatic transport is impaired and when there is evidence of easy bruising.

What are the results?

Here are the results of this study. When before and after volume measurements were compared, both legs showed a statistically significant decrease in volume. Specifically, the average circumferential measurements in the left leg reduced in 3 of the 5 points and 4 of the 5 measurement points in the right leg. 


Although this study is limited by the lack of a control group, the findings demonstrate that a combination of complete decongestive physiotherapy and a pump may be a good option for the treatment of lipedema. Further study is needed to evaluate further the importance of including manual lymph drainage in treatment, but this modality should not be excluded at this time due to its potential benefits. 

For more related content, be sure to check out Lipedema Simplified’s Flash Briefings, our daily mini-podcast with tips, tools, helpful research, and other resources pertaining to lipedema.

~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project

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