Deep Tissue Massage and Lipedema

Lymphatic Massage vs Deep Tissue Massage

Lymphatic Massage is an important part of the treatment of lipedema. Lymphatic Massage is a type of massage using a technique developed by Vodder and others. The technique gently stretches the skin, activating the lymphatic capillaries and stimulating lymphangions in concentric motions either toward lymph nodes or towards lymph node. Lymphatic massage is proven to help lymphedema and lipedema with secondary lymphedema. There are many different deep tissue massage techniques, but they rely on greater pressure focused on tissues below the superficial lymphatics.

Deep Tissue Massage Types

There are many types of deep tissue massage. The most well known are Hot Stone Massage, Tui Na an ancient Chinese massage technique which means grab and push, Gua Sha another ancient Chinese massage technique which uses a scraping instrument, and Instrument Assisted Soft Tissue Mobilization, IASTM. The research on these different techniques is relatively sparse and I can find no head to head comparison trials of the different deep tissue techniques. Most of the research on the deep tissue focus on the use of the deep tissue techniques for sports injury and recovery, treatment of chronic low back pain, neck and other acute and chronic muscular skeletal conditions.

Proposed Mechanism of Deep Tissue Massage

The mechanism behind the therapeutic effects of deep tissue is not completely known, but based on some animal studies and our understanding of injury repair the mechanism is thought to involve the deep pressure or even minor trauma to stimulate healing. Microvascular and capillary hemorrhage, along with localized inflammation, occurs and which restarts the healing process. It is thought that deep tissue The soft tissue healing process that is restarted involve increased secretion of fibronectin and increased attraction and proliferation of fibroblasts. When a stimulus is applied to the injured soft tissue using a forceful thumb or an instrument, the activity and the amount of fibroblasts are increased and the amount of fibronectin is increased. It is thought that deep tissue massage improves venous vasculature as well as the subcutaneous fat tissue. These changes facilitate the synthesis and realignment of collagen is one of the proteins that makes up the extracellular matrix (Davidson et al., 1997);
 

Some Early Results of Deep Tissue Massage and Lipedema

Dr Karen Herbst published the result of a small study using a type of deep tissue massage called Quadrivas Therapy. The paper titled “Pilot study: whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema” was published online. The study found Limb fat over total body fat mass (p = 0.08)[ not quite statically significantly decreased] and trunk fat over total body mass trended down from baseline (p = 0.08)[ not quite statically significantly decreased] measure by Dual X-ray absorptiometry (DXA) scans. Leg volume and caliper assessments in eight of nine areas (p < 0.007), LEFS (p = 0.002) and average pain (p = 0.007) significantly decreased from baseline. Fibrosis significantly decreased in the nodules, hips and groin. Ultrasound showed improved SAT structure in some subjects. Side effects included pain, bruising, itching, swelling and gastroesophageal reflux disease. All women said they would recommend SAT therapy to other women with lipedema. The conclusion of this pilot study is that subcutaneous massage therapy in 4 weeks improved tissue structure, perceived leg function, and volume in women with lipedema.
 

How Deep Tissue Massage Might Work in Lipedema and Dercum’s Disease

Instrument Assisted Soft Tissue Mobilization, IASTM massage and Quadrivas Therapeutic Massage hold the most promise as they can cause inflammation and or induce tissue remodeling. Instrument Assisted Soft Tissue Mobilization is actually not new. The ancient Greeks used an instrument called a strigil and the ancient Chinese used a deep tissue technique with a scraping instruments call Gua Sha. Lipedema and Dercum disease are two fat disorders characterized by increase fibrosis in the fat tissue. Lipedema and Dercum’s disease have tenderness and swelling consistent with inflammation and over time develop fibrosis and tissue thickening. The fibrosis in the skin is responsible for the nodules in lipedema and the lipomas in Dercum’s Disease. In many ways, Lipedema and Dercum’s disease behave like a disease of chronic inflammation with impaired healing. We know that impaired healing leads to fibrosis. So it is possible that IASTM massage could restart the healing process and allow for more complete healing and less fibrosis in both lipedema and Dercum’s Disease.
References:

Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL

Med Sci Sports Exerc. 1997 Mar; 29(3):313-9. [PubMed]

Fibroblast responses to variation in soft tissue mobilization pressure. Gehlsen GM, Ganion LR, Helfst R Med Sci Sports Exerc. 1999 Apr; 31(4):531-5. [PubMed]

Pilot study: Whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema https://www.degruyter.com/view/j/hmbci.ahead-of-print/hmbci-2017-0035/www.degruyter.com/view/j/hmbci.ahead-of-print/hmbci-2017-0035/hmbci-2017-0035.xml
To learn more, watch Dr Hebst discuss her study: https://www.youtube.com/watch?v=j8IzweESelo
Pilot study whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema. Herbst KL, Ussery (2)

Subcutaneous adipose tissue therapy reduces fat by (1)

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Dr. Wright

Meet Dr. Thomas Wright, medical director of Laser Lipo and Vein Center. Dr. Wright is a board certified Phlebologist and cosmetic surgery specialist, with over 15 years of practicing experience. A graduate of the University of Missouri Columbia medical program, Dr. Wright was one of the first two hundred surgeons to become a diplomate in Phlebology.

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