Lymphoedema and lipoedema: the differences and the role of physiotherapy

Lymphoedema and lipoedema sound so alike that they are often confused. Both can show up as swelling or increased volume in the arms or legs, along with a feeling of heaviness. Yet their causes, the way they develop and the goals of treatment are quite different.

In this article I want to describe both conditions in plain language, summarise the key differences and explain where physiotherapy fits in. Let me say at the outset that a diagnosis must come from a doctor. What follows is general information.

What is lymphoedema?

The lymphatic system is a drainage network. It collects fluid and proteins from between the tissues and returns them to the circulation. When this system cannot keep up, fluid builds up in the tissues and causes swelling that can become long-lasting. This is lymphoedema.

Lymphoedema is usually described in two groups:

• Primary lymphoedema comes from differences in how the lymphatic system developed. It may be noticed at birth or appear later in life.
• Secondary lymphoedema develops when the lymphatic system is damaged later on. Surgery that removes lymph nodes, radiotherapy, infections and injuries are among the causes. Swelling in the arm after breast cancer treatment is a well-known example.

In the early stages, swelling may build up during the day and ease with rest. A ring, watch or shoe feeling tighter than usual can be one of the first things people notice.

In lymphoedema, swelling often begins on one side and can include the back of the hand or foot. Heaviness, tightness and a feeling of fullness are common. Over time the skin and the tissue beneath it may become firmer, and the risk of skin infection in the affected area can increase.

What is lipoedema?

Lipoedema is a long-term condition in which fat builds up symmetrically and out of proportion to the rest of the body, mainly around the hips, buttocks and legs, and sometimes the arms. It affects almost exclusively women and tends to become noticeable at times of hormonal change such as puberty, pregnancy or the menopause.

Common features of lipoedema include:

• Pain, heaviness and tenderness to touch in the legs
• Bruising easily
• A similar pattern on both sides
• Feet and hands usually unaffected, often with a clear “cuff” just above the ankle

Fat in areas affected by lipoedema may not respond to changes in diet and exercise in the way the rest of the body does. I want to stress this, because many women living with lipoedema spend years blaming themselves for not trying hard enough. Lipoedema is not the same as obesity, although the two can occur together. In later stages, lymphoedema can develop alongside lipoedema.

The key differences at a glance

This table is only a general guide. Every person is different, and the two conditions can also occur together. That is why a doctor’s assessment is essential to tell them apart.

Physiotherapy for lymphoedema: complex decongestive therapy

The core physiotherapy approach to lymphoedema is complex decongestive therapy (CDT). It brings together several components that support one another:

• Manual lymphatic drainage: a gentle, rhythmic hands-on technique that works on the skin to encourage lymph flow. It is quite different from a classic massage.
• Compression: multi-layer bandaging during the intensive phase, followed by compression garments fitted to your measurements.
• Exercise: movement performed while wearing compression activates the muscle pump and helps lymph circulation.
• Skin care: keeping the skin moisturised and healthy, and paying attention to small cuts and grazes, helps lower the risk of infection.
• Education and self-care: practical knowledge you can use every day makes the condition easier to manage in the long run.

CDT is usually planned in two phases. The first aims to reduce the swelling. The second focuses on maintaining that progress through compression, exercise and self-care habits. Consistency matters a great deal in this phase: wearing compression garments regularly and keeping up daily self-care count just as much as the sessions themselves.

Manual lymphatic drainage is not suitable for everyone. It is not used when there is an active infection, an untreated blood clot (deep vein thrombosis) or heart failure that is not under control. That is why a medical assessment is needed before treatment begins, and I plan treatment in line with your doctor’s diagnosis and recommendations. I explain how I work in more detail on the lymphoedema and lipoedema therapy page.

What physiotherapy aims for in lipoedema

In lipoedema, the purpose of physiotherapy is not to remove fat or to bring about weight loss. The aim is to ease symptoms and support quality of life: reducing pain and heaviness, keeping you mobile and helping your joints cope with everyday load.

This may involve:

• Compression garments that suit you
• Regular, joint-friendly exercise such as walking, exercise in water, low-load strength work or clinical Pilates
• Manual lymphatic drainage when there is associated swelling, or to help with symptoms
• Advice on daily habits and movement

Lipoedema has many sides to it. Care tends to be more balanced when it runs alongside medical follow-up and, where needed, support from a dietitian and a psychologist.

When to see a doctor

Any new swelling without a known cause should be checked by a doctor. In particular, see a doctor straight away, or go to an emergency department if needed, if you notice:

• Sudden swelling in one leg, with pain, redness or warmth
• Swelling together with a fever, shivering, or redness and heat spreading across the skin
• Leg swelling accompanied by breathlessness or chest pain

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If there is anything about lymphoedema or lipoedema you would like to ask, feel free to send me a message. I will be glad to answer your questions and think through the right next step with you.