Lipoedema – Compression Strategies to Support Long-Term Management

In this episode of Lymphoedema Insights, Maree speaks with Helen Eason, a physiotherapist specialising in lymphoedema and lipoedema management. Together, they explore the role of compression therapy in lipoedema care, highlighting the need for individualised assessment rather than a one-size-fits-all approach. 

The conversation unpacks when compression may be appropriate, when it may be deferred, and how factors such as inflammation, pain, and metabolic health influence decision-making. Helen also discusses the impact of misinformation, particularly from social media, and shares practical ways clinicians can support patient understanding and engagement. 

About our guest speaker – Helen Eason 

Helen Eason is a highly experienced physiotherapist specialising in oncology rehabilitation and lymphoedema and lipoedema management. 

With over 25 years of experience, Helen is an Australian Physiotherapy Association–titled physiotherapist, an Australasian Lymphology Association–accredited lymphoedema therapist, and a PhD candidate at the University of Sydney researching lipoedema assessment. She was also among the first clinicians in Australia trained in Fluoroscopy Guided Manual Lymphatic Drainage (FG-MLD). 

As Founder and Director of Helen Eason Physiotherapy, Helen is passionate about improving access to best-practice care, supporting patients to restore function, confidence, and quality of life. She is also a respected educator and speaker at national and international conferences. 

Sponsor

This podcast is proudly supported by Haddenham Healthcare. Lipoedema presents unique challenges for compression management, including pain sensitivity, disproportionate limb shape, and long-term wear tolerance. Haddenham supports clinicians with a range of compression solutions designed for lipoedema management, including adjustable wraps, custom-made garments, and night-time compression options that support comfort, function, and adherence.  

You can find more information at www.hadhealth.com.au 

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Transcript

Speaker 0:05

Today we are exploring compression therapy for those that have lympoedema, shared in recognition of lymphoedema awareness month, a time to increase understanding, challenge misconceptions, and highlight best practice care for those living with this often underrecognised condition. Welcome to Lymphoedema Insights for Health Professionals. I'm Maria O'Connor, physiotherapist at Lymphoedema Education Solutions, where we empower health professionals with the tools and knowledge to manage lymphoedema confidently and effectively. This podcast is for educational purposes and is intended for health professionals only. It does not replace individual clinical judgment or medical advice. So please consult appropriate guidelines and qualified professionals when making decisions in practice. Thank you to Hadnham for sponsoring this episode. To help us unpack this topic, I'm joined by Helen Easton, a highly experienced physiotherapist specializing in lipoedema and lymphoedema management as well as oncology rehabilitation. With over 25 years of experience, Helen is an Australian Physiotherapy Association titled physiotherapist, an Australasian Lymphology Association accredited lymphoedema therapist, and a PhD candidate at the University of Sydney researching lipoedema assessment. As founder and director of Helen Eastern Physiotherapy, Helen is passionate about improving access to best practice, supporting patients to restore function, confidence, and quality of life. She is also a respected educator and speaker at national and international conferences. Helen, welcome and let's dive into today's conversation all about compression therapy. When do you usually start compression therapy for someone with lipoedema and what factors influence that timing? Well, I think we've got to acknowledge, Marie, that lipoedema is a huge spectrum of presentations. And so it's really individualized for every single patient. Look, if I go back to where I started in my career, it used to just be put a garment on them. That was the mainstay 25 years ago. But the research is showing us that lipodema is so diverse, we've really got to take a step back and assess the individual. So I don't always immediately start compression for everyone. First thing is, have they got lymphoedema? And as a clinician, if you can see a woman with lipodema also has a lymphatic element to their problem, you've got to put compression on them straight away. However, many patients don't always have lymphoedema. And sometimes we assess our lipoedema patients and we do the pitting test, we use our SOZOs, our lymph scanners, whatever tools we've got. And you start to realize maybe this woman in front of you does not have oedema. So the way I do things now is I assess whether they've got oedema, and if they have, it's a no-brainer, you go forwards with it. But many of them come with non-pitting oedema and pain. And yes, you can talk about compression with them to manage their pain from the inflammation. But with many of those patients as well, I actually start with nutrition and exercise first. So what I want to do is see what the woman's metabolism is like. And look, if if I send them up for blood tests and their metabolism isn't very good, if they're pre-diabetic, they're going to be making some fluid because of that. And sometimes actually changing what they're eating can help reduce that inflammation and their leaky vessels. So a lot of my patients now, like I say, starting with nutrition and movement first and investigating that effect over a couple of weeks before I rush in with compression. Um, if somebody has absolutely no oedema whatsoever and they're not in pain and they've got a lot of abdominal adiposity, I actually want some weight loss first. We've got to remember as well that these women don't get any subsidies for their compression. So sometimes they don't have any money, they don't, they're not eligible for SWEP or enable and any of those things. And we want to see how we can tackle the symptoms sometimes without compression. Um, and so it's really starting it is individualized, I think, from all of those factors. And when you talk about, it's a good point about not jumping into compression therapy because there might be something out else else going on. If you don't look at that, then you may actually be really just you know going down a rabbit hole and putting them in compression for a long, long time when there could have been something else that avoided the situation, which is absolutely important as well. Absolutely. I I I with my patients, I treat every individual like a little science experiment, and I say that to them. In science, we change one variable at a time, and sometimes taking that step back and starting with nutrition and exercise and just seeing what that does for your lipodema patient. If they get benefit from that, then you get buy-in from your patient for those elements, which sometimes are difficult to instigate, and then they don't say that all their symptoms have got better because of compression. So you can then say what variable is actually changing that patient's symptoms. Yep, for sure. So when educating patients about lipodemia, how do you introduce compression therapy, explain its benefits, and address common misconceptions? Oh, this is a good question, Marie, because the misconceptions because of social media and the misinformation and disinformation that these women receive from social media is massive. So the first thing I do even before I tell a woman a diagnosis that I think she's got lipodema, I'll always say, What do you know about lipodema? Where did you get that information from? And find out what preconceived ideas they're coming with, which is massive. So generally, women will come to me and say, Oh, um, I think I've got lipodema. And then you say, Well, how did you find out about it? Social media, and they'll say, Um, diet and exercise doesn't work. Um, and they've read all the comments and other people's ideas about my compression hurts me, I can't get my compression on, what's the point? Um, and you've got to actually take them through that and deal with that first to actually get your compression in and explain that that's that patient's um interpretation, that's and that your situation may be very, very different to theirs. The other thing that can happen as well, the preconceived ideas can come from when they've been in hospital from other medical problems, and they get thrown a TED stocking at them, which is a round knit, it's not going to contour, and they've found it painful. So I actually then talk them through compression isn't always round knit, that we use flat knit with patients. I think it's very important to get my swatches out and show them that there's a spectrum of different materials available, and the textiles for lymphoedema and lipodema are completely different. Um I'll tell them to try and put their preconceived ideas aside and then start talking them through the different circular flat knit. Um, the that we've got beautiful fabrics that are good for moisture wicking and dealing with the heat, and that's particularly our flat knits as well. And so get rid of some of these preconceived ideas. So, in reducing compression, you've got to be able to say to patients, deal with the misconceptions that they've learned. Make sure you're educating them about why exactly you're using it for them, and it might not be for oedema, it may well be for pain and inflammation management. It may be for aesthetic purposes that we're not dealing with pain or inflammation at all, but we're actually trying to contour the fat into the body. The woman gets a better aesthetic and it also changes their biomechanics as well. So it's explaining all of those differences for each individual patient. So it's not a random spiel that you give to everyone, it's really individualized for that person, that woman coming in about why compression's going to be right for her. It's not a one-style suits all, it's not a one brand fits all. And that's it, isn't it? It's regardless if it's you know, lipodema, lymphoedema, and the TED stockings is funny because as you know, I'm sort of in the aged care sector at the moment. And the other area that you they go is the chemist. Oh, well, if you want to try something, go to the chemist. And you know, that's where that heads are. A lot of lipodema ladies, because of the amount of knowledge that's out there on the internet and especially social media, they've already a lot of them tried a few things, and they're buying these things that have popped up in their feed that aren't designed for their shape at all. A lot of them are around knit. People come in with bags of things and show me what they've tried, and that they're very hesitant to try and spend money on something else, and we've got to get through that. Do you think that if you compare the two groups, the pure, you know, lipoedema versus your lymphoedema cohort, is that they're much the lipodema much more savvy on the internet? Oh, without a doubt. And that's because the awareness in our medical and health professionals is so low, and these women are desperate for knowledge, it's the only place they can go to get knowledge. They're not going to get that knowledge from their GP, their practice nurse, their consultants they've seen. Um, and so that's where they go for their knowledge. And women are helping other women, but sometimes that it's not for the best. So, this is a real shout out to all health professionals in this area that before you start, you need to ask them what they know already. I think that's I think that's a real key question for that person. Absolutely. You have to unpack that, otherwise, the engagement is not going to happen, really. So um, that's really important. So, coming back now to someone that has purely got lipoedema is not going to have surgery. Yeah. What sort of gums, where would you start? What compression, what sort of fabrics generally? Do you know what I mean? And I suppose that will depend on the spectrum too. Yeah, it's very different to oedema, though. Do you know what I mean? Where you might go straight away as a class two or whatever. Do you know what I mean? What are you looking at? Well, that's it. First of all, if they've got oedema, and if they've got definitely lymphoedema, we're going down following our lymphedema guidelines. You know, you need a higher class, you need a you need to follow your stride. If you if people haven't read the stride document, that's really helpful, you know, um, to follow that shape, textile, refill, the issues they've got, the dosage you need. And if it's lymphoedema, they're going to need a firmer um textile to hold them. And flat knit, obviously, for lipodema, is really good because of the contours that we're dealing with, so it doesn't um cut in. Some of the you know, earlier stage, I don't like stages, but for this podcast, I'll use the word stage. For earlier stage ladies, they may get in around it, that's fine. But most of the patients who do have folds and cuffs, they're gonna need a flat knit to skim over those um indentations so we don't get tourniqueing. Um fabric-wise, the thicker, more rigid fabrics for lymphoedema. But if we're not dealing with a lot of oedema, we don't need to use your Lvarexes, your Medi550s, your Hadnham Goldpunct, your JUSO experts. You can go in these softer fabrics um that have got more stretch in them, so they're easier for the women to don, but they're still going to give a nice compression. And cotton rich is great for these ladies. That's why flatten it is really good. They're moisture wicking, you know, they they've got a bit of breathability. The women are big, which can make you bigger, but a lot of the women who see me, they're perimenopausal, they're hot and they're having hot flushes. So fabric absorbency and wicking problem wicking qualities are really, really good. Um so then, as well, that you've got to think about do they want a colour for your fabric? You know, do you want something funkier? And let them know that's available. We're looking at class, look, a lot of them can get into a class one, and a lot of them don't need class two plus because they don't have lymphoedema, and these women have pain. So we've got to really know that pressure, if you've done your assessment and you've done your pitting test and they're really tender with that pitting test, they're not gonna um get away with a class two anyway, they're not gonna tolerate it because of pain. So you can start them with a class one. Um, and think about as well how are they gonna get this garment on? Where do they actually need the compression? Look, we were told back in the day everyone needed a class two pantyhose and a flat knit, and I've thrown that out the window because we don't always need that. If they get oedema, and if the oedema is intermittent, it's generally below the knee. So sometimes they need specifically a garment, maybe for when they get that oedema at the end of the day to prevent it, and it might be a class one knee high, is all they need. You know, if the if if that if that's all they need, or they only need that for the summer months, you can get them a knee high. I don't like thigh highs particularly with my lipidema ladies. Um, and a lot of them will ask for them and I go, I wouldn't if I were you. Um, unfortunately, with the grip tops on the top, they get a huge mushrooming effect. It makes the leg look like the atomic bomb cloud because it flows over like a mushroom at the top. Aesthetically, it's horrible and also tender where that grip top sits. So I generally don't go for a thigh high. And if they need a panty hose, are they able to be able to get it on? And a lot of the time it's really hard for a bigger bodied lady to get a pantyhose on one foot than the other and pull it up. So I layer a lot as well. I love a layer with lipodema. I do a knee high with a caprice style um pantyhose garment a lot, and I like that layering as well because it gives the woman options. If they get too hot, it means they can keep their knee high on and they can just remove the caprice style in the heat, and at least the area which is more prone to swelling has still got some compression on. Um, so yeah, there's a lot of the different ways how we can work with them. If you're going custom made, there's a lot of different options which help as well. So they can get things around the knee, like a comfort knee or a functional um knee zone for the ladies who get a lot of discomfort by the knee can be helpful. Um, the tee heel, obviously, I love a tee heel to give them comfort around the ankle. Uh, the oblique groin seam, as well, is a really nice thing to make it sit in the groin, especially if the woman does sit a lot, either sedentary lifestyle or sitting in a job for comfort. And the other thing is we can get different crutch openings for these ladies. And this is really important because it takes a lot of effort to get these garments on and off. I particularly like a mesh crutch for my ladies to give a bit of air around that areas for if they're heat intolerant. And they also the mesh crutches you can get if they if they want to try an open crutch, they can actually cut the mesh out as long as they don't disturb the stitching of the actual garment. The mesh can come out, and then they can try an open crutch and see if they prefer that as well for toileting. Um, in your off the shelves as well, something I've just forgot to talk about there when I was talking about off the shelf is look, the brands are providing a lot more sizing that's available and off-the-shelf, but these extra wide calf sizes as well are really, really good since they've come out to be able to fit our women in some of our women that couldn't 10-15 years ago go into an off-the-shelf, they can fit um off the shelf. And the last thing I think is I come up the body and think as I come up the body, I'm at the waist and the hip now. Some of my ladies have got an enormous buttock shelf and hip um adipose deposits. So I've got some ladies 150 plus around the the hips, the H measurement. Now, if you've got a 92 centimetre waist and 156, that's what I fitted last week. 92 centimetre waist, 156 hips. You you can't actually get the waist bit on over the hips. So, with that, I love a side zip or a side velcro so that they can don them and get the waist bit on over the hips, and then it actually will contour around that smaller size as well. So that it's there's a lot to think about when you're fitting a lipadema lady in the compression. Before we continue, I'd like to thank our episode sponsor, Hednum Healthcare. Lipoedema presents unique challenges for compression management, including pain, sensitivity, disproportionate limb shape, and long-term wear tolerance. Hednum supports clinicians with a range of compression solutions designed for lipoedema management, including adjustable wraps, custom-made garments, and nighttime compression options that support comfort, function, and adherence. You can find more information at www.headhealth.com.au. Just with that um talking about the you know the perimenopause or menopause and all that, they're gonna have a bit of fluid anyway. And some people look at just purely, if this is purely lipodema, no, no oedema, is purely caprice and nothing on the foot. What or midfoot up? Like, so it makes them look like they're wearing sort of the sporty type. Yeah. Absolutely. When would you choose how often do you choose nothing on the foot for pure lipoedemas? I question my ladies very specifically about foot oedema. I think that's really important. You see them on the day they've got no oedema in the foot at all, and you've got to say, do you ever have you ever noticed any swelling in your feet on a plain hot weather? And if the answers, they never ever ever see that. Yeah, footless. Some ladies though can't tolerate where it ends as a footless because of the pressure on that ankle cuff, so we go a foot to hold it. Um, but yes, I do use footless as well sometimes with my ladies. Um, I see a lot of the bigger ladies as well with lipodema come to me for a second opinion. So some of those ladies, you know, they need the feet in there, um, but you can you need to assess really carefully before you take that plunge into an expensive garment without the foot. Um, it's much easier, I think, to layer them in a knee high with a capri to start them off and just see how they go. And then maybe they've got a footless pair in there, I call it their compression wardrobe, because you need some different items for different um circumstances, and they may have a footless in their compression wardrobe, but always that they've got one pair of knee highs just in case, um, with the foot in for those times where they may have never had fluid before, but they've got it there. So, when we talk about getting engaging someone with compression, and we've done all the great things, we've looked at nutrition, we've looked at exercise, all those things. You say you think now, yes, you're pure lipodema, but I think you're going to benefit from compression. What are the benefits for that person? How do you describe them? How do you say it might help with your inflammation, therefore, your pain? How do you word that to them? Yeah, so I Obviously, the lymphoedema ones are easy. It's going to take away this swelling. That's easy. For the ladies who who don't have a lot of oedema there, it is about saying the pain you have, the research shows it's predominantly inflammation. And the fluid leak that may be there in your tissues is incredibly small. It's actually more inflammatory cytokines. So I use a lot of diagrams and show them about what happens in their tissue. And that from our venous research, we know that it reduces these inflammatory chemicals. And that is why you need to use specifically for your um lipodema compression in combination with your diet to reduce the inflammation you're putting in your body, in conjunction with good sleep management, in conjunction with stress management, which increases the inflammatory chemicals. And that you actually need to move in your garments as well to pump the blood through to flush the inflammatory chemicals away because your body's always making them. We need to use all of those things in combination. And that's the way I talk them through it. What about the role of more textured garments versus the flat knit? Like I know flat knit, you know, you get the micro-massage and all that sort of stuff. But what about more textured garments? What do you think there's benefits for someone with lipodema or not? Yes, to well, it's an individual thing again. Um, so some of these textured garments don't always fit women because they're done on height and weight um rather than leg size. So if they've tried a textured garment themselves, to actually measure them for one where you're taking the thigh measurements, the hips, the ankles to get a better fit as well. Um, and the textured ones, look at I get a 50-50. Some women love them. Some people find that they just don't work so well for them. Plus, they're more man-made fibre. So a lot of my ladies like to have the cotton rich flat knits, but putting a textured one into their um compression wardrobe is a good way for them to trial and error what works for them specifically. Um, and yeah, they've got a role, definitely. Are there any benefits of nighttime or not? A lot of my ladies like the idea of nighttime because they don't have to go out in them in the day. So I do have some ladies in comfy waves at night um to try and see if it does make a difference on their symptoms. But I think we've got to realise when we work with lymphoedema patients, our nighttime garments are vital for fluid management. And these ladies are different. This is inflammation, and inflammation needs movement. So, look, if a lady is really, really resistant to a compression garment, I think they've got a role as something else to try to see if that helps get compression into their regime. But for me, compression with lipodema is it's compression with movement. And of course, we've got the ladies who can't or won't go into compression garments for many, many reasons. They can't get them on, they find them too painful, they find them too hot. And this is where our pumps come in as well, because pumps are obviously compression. That sometimes some ladies can't or won't accept compression garments, but that they can accept sitting on a pump for an hour while they watch TV at the end of the day for symptom management as their symptoms build up. Um, and that's another option we can offer these ladies. Would um textured garments under your pump help reducing, I mean you may not know the answer to this, um reduce the inflammation versus just a straight sleeve, pump sleeve? Look, you can try it. So yeah, if if the pump on its own was doing a little bit and you the lady still had, you know, residual symptoms, something, something to add in. Absolutely, just more movement on the tissues. The other thing that the big textured um garments have got the really bulky ones that we've got, um, they could actually with the pump be working more on fibrosis as well. So I don't think you know, our lightly textured garments do they really work on fibrosis deep inside? We need some research on it. That's another one to add to my postdoc studies, of which in my brain I've got about 100 different studies I need to do. But that is another thing that needs more um investigation about what do these things actually do for lipodema. So finally, are there any new approaches or technologies in compression therapy for lipodema that you're excited about? Well, if we look at what's happened in the last 15 years, Marie, there's so much that has happened. We've got, you know, we've got bigger sizes, different skin tones at last, we've got patterns, we've got colours, we've got things that look like sportswear. And I think the compression manufacturers have been in the early days have been lymphoedema, lymphoedema, but now they're really thinking about our lipodema cohort. Um, the wraps, they're making wraps now in custom-made sizes, because we haven't talked about wraps, have got a role as well for ladies so that they can adjust them. I think we're gonna get more and more tailored items as well. Hopefully, we're gonna get a lot more research as well into what compression actually does. Um, and I hope as well they're gonna they're gonna look um more at compression and emerging development is hopefully in the future that lipodema will be, we'll get some evidence to show that compression does reduce inflammation. And if we get that evidence, then hopefully there'll be some financial help for these women from the government subsidies, um, because that's one of the biggest barriers for our ladies, and we need that we need that to emerge that they're going to get some financial help. And I think that would help a lot of more women use compression for their lipodema management. Yeah, and I think it as you say, we're and under your research as well, is that we're getting better diagnosis, you know what I mean? So that should work. And then when we're looking at management as such, as you said, if you can get that evidence, then it shouldn't be any different to lymphoedema, really. You know what I mean? When you're looking at subsidies, it should be taken on its own as such. Absolutely. And I when I was at the Lipoedema Australia conference last year, I got to spend a lot of time with Dr. Gabrielle Ferber from Germany, and we were comparing and contrasting Germany to Australia, and it's really, really interesting because everyone in Germany uses compression garments, all the women. She's and we've I found out that's because they're free in Germany. And the German women, she said it's very difficult to win them over to embrace nutrition and exercise. Whereas Australia, in our conference, she was astounded how many um women were using nutrition and exercise as their primary way of managing the lipodema because they couldn't afford the garments. And so that the treatments, the patients are embracing different things, and it's coming down to cost. And I found that really fascinating that they're free over there. Yeah. And I think also in regards to suppliers, too, I think the thing that now that we see is they've got their own range. Do you know what I mean? It's it's the lymphoedema, yeah, that's fine. But there's the lipodema range, and they're really targeting it, which I think is really exciting, and then putting all the education to say around it, um, which is fantastic. So watch this space. Helen, we'll have to have you back because I think there'll be lots of new things coming through that we'll need to hear about. So thank you so much for joining us and sharing your expertise with us today. Thank you for having me. Thank you to our listeners for joining us for this episode of Lymphoedema Insights for Health Professionals. If you found this episode helpful, be sure to subscribe and share it with your colleagues. For more education and resources, visit Lymphoedema Education Solutions. Stay tuned for future podcasts to empower you with the tools and knowledge to manage lymphoedema and chronic oedema confidently and effectively. Until next time, keep supporting your clients with evidence-informed care.