Lipedema and physiotherapy in managing the condition

Chronic pain, legs that are disproportionate to the rest of the body, spontaneous bruising, and difficulty moving. Lipedema is a condition that is still not widely recognized and is often confused with obesity or lymphedema. For many patients, however, the issue is not merely aesthetic: the pain and its impact on quality of life can become disabling.

In this context, physiotherapy plays a central role. This is explained by Valeria Reverdito, a physiotherapist from Turin and co-founder of Human Project Studio, a practice specializing in rehabilitation, exercise training, lymphology, lipedema, and oncological rehabilitation.

Reverdito is also a member of the Accademia Lipedema Italia, which focuses on education about the condition, and serves on the board of SIFE, a scientific society dedicated to phlebology, lymphology, and hemodynamics.

Physiotherapy as practical symptom management

At present, there is still no definitive cure for lipedema. For this reason, physiotherapy focuses primarily on managing symptoms.

«Physiotherapy is essential in the management of lipedema, especially for pain control – explains Reverdito – Everything we do aims to improve the patient’s quality of life and tissue mobility».

Treatment varies according to the stage of the disease. In the early stages, therapy is mainly conservative and focused on reducing pain and improving function. After surgery, however, rehabilitation becomes even more important.

«In the postoperative phase, especially after liposuction, physiotherapy is crucial and should be carried out very intensively».

When lipedema Is suspected

One of the main challenges of lipedema is delayed diagnosis. Many women live for years with symptoms that are underestimated or simply attributed to body weight.

According to Reverdito, clear indicators often emerge during the initial consultation: «Patients frequently describe symptoms of lipedema, often before they have received a formal diagnosis».

Their stories tend to be remarkably similar: legs that are disproportionate to the trunk, difficulty reducing the size of the lower limbs even when losing weight, pain when touched, and frequent bruising. «Many patients report losing weight only in the upper part of the body, while their legs remain unchanged».

During the clinical assessment, practitioners also look for characteristic signs of the condition. «On palpation, we find very specific painful points, and we often observe the so-called ‘cuff sign’ or ‘sock sign’», explains the physiotherapist, referring to the distinctive shape of the ankle or wrist that is typical of lipedema.

The importance of a multidisciplinary team

For Reverdito, addressing lipedema with a single treatment approach is one of the biggest mistakes. «Because it is such a complex condition, a single therapy rarely produces satisfactory results».

Effective management relies on collaboration among different professionals: physiotherapists, physicians, nutritionists, trainers, and specialists working in a coordinated manner.

«It is essential to have a team that understands the condition and speaks the same language, including from an assessment perspective».

In clinical practice, the benefits become particularly evident over the long term. «Patients who are followed by a truly multidisciplinary team achieve more stable outcomes and more effective long-term monitoring».

The most common mistakes

One of the issues Dr. Reverdito most frequently addresses is patients’ relationship with physical activity. Many arrive convinced that exercise will worsen their pain. «One of the most widespread myths is that physical activity should be avoided because ‘the legs hurt’».

In reality, movement is considered fundamental, provided it is tailored to the individual. «Physical activity should be adapted to the different stages of the condition, but it should not be discontinued».

Another common problem involves extreme dieting. «These diets often lead to significant weight loss in the upper body but provide little satisfaction in terms of changes in the lower limbs». According to the physiotherapist, this can have both physical and psychological consequences. «There is a risk of entering a negative cycle associated with the yo-yo effect and eating disorders».

Misinformation and myths

In recent years, lipedema has become a widely discussed topic online. Alongside accurate information, however, many misconceptions have also spread. «We live in an era of information overload, and patients often arrive believing they already know everything».

For this reason, Dr. Reverdito emphasises the importance of relying on qualified professionals and trustworthy sources. One of the most persistent myths is the belief that lipedema will inevitably worsen.

«Lipedema can progress, but it does not necessarily have to get worse». This is an important concept, especially for those who have just received a diagnosis and are experiencing fear and uncertainty. «If the condition is managed properly, it can remain stable over time».