Lymphedema, Lipedema, and Aquatic Therapy with Professional Yoga TherapyMaureen Mason, MS PT WCS CCI PYT-C provides a guest blog for Professional Yoga Therapy Institute, highlighting how medical therapeutic yoga can be combined with aquatic therapy for lipedema and lymphedema. We extend our gratitude to Maureen for thinking outside the usual boundaries of health care, addressing a patient population that many may not be familiar with, and finally for sharing her wealth of experience. Professional Yoga Therapy principles can be applied to complex client care. Do you know about Lipedema?
LipedemaLipedema is a condition of abnormal, excess adipose tissue deposition in the abdomen, hips, thighs and lower legs, yet it spares the feet below the ankles. It is viewed as a rare disease with frequent misdiagnosis as obesity or lymphedema. Lipedema's pathogenesis and management are a current area of research. Onset of lipedema appearance classically begins at puberty. Lipedema may also occur post surgery, trauma, pregnancy, or peri-menopause. Lipedema may expand into the trunk and upper extremities over time in some individuals. Internet research will identify varied medical opinions regarding its treatment, from recommended liposuction, laser surgery, complex decongestive therapy, and other methods. Calorie restriction and other methods of dieting do not reduce the limb size or adipose deposition in lipedema. This condition affects an estimated 11% of women. Individuals I have met have encountered shaming and other negative experiences as related to their appearance. Individuals with lipedema will have challenges in exercise performance due to large limb size. With aging and potential weight gain into higher BMI levels, physical performance and functional abilities will become challenged. The intent of this post is to educate other health care providers and professional yoga therapists about lipedema and offer yoga as a health care option for health and wellness.
LymphedemaLipedema may be associated with a tendency to develop lymphedema over time. Lymphedema is most commonly recognized as a potential upper extremity complication post op breast cancer surgery, radiation and/or chemotherapy with lymph node treatment. Lower extremity lymphedema may occur following surgery as well, such as ovarian cancer intervention with inguinal lymph node removal. Physical therapists commonly work as a team with the oncologist and other specialists to create a sustainable treatment plan for lymphedema. This includes addressing skin care guidelines and using compression garments and wraps, exercise, and complex decongestive therapy. Lymphedema has been extensively studied. Lymphedema has stages and associated treatment protocols, from prevention strategies, to treatment protocols for stage one, two, and three.
Pranayama as TherapyPranayama, or the regulation of the breath, may be a therapeutic adjunct in assisting lymphatic movement into the thoracic duct, cysterna chyli, and other transport sites. It has not been studied as a treatment or in combination with aquatics and yoga. (Personal note: I have measured 2 to 4 cm circumferential limb volume reduction pre/post pool therapy in a client with lipedema and Stage III lymphedema). Individuals with lymphedema may encounter a decline in their quality of life over time, including the inability to exercise and to travel for local outings or extended trips with auto or air travel. Lymphedema also carries risk for infection and potential sepsis due to reduced skin, circulatory and lymphatic integrity in the affected tissues. In both lipedema and lymphedema we can consider application of Medical Therapeutic Yoga (MTY) for health and wellness of body, mind, and spirit.
DoshasThe ayurvedic model of constitutional dosha physical attributes helps us consider the genetics and unfolding epigenetics that can present in the clinic or yoga studio, as pertains to lipedema and lymphedema. Larger, rounder bodies that are slower moving and tend to fluid and mucous congestion may be viewed from the lens of Kapha dosha, as having Kapha excess. Offering and guiding the Kapha excess client into balance includes encouraging positive Pitta elements such as heat and structured exercise formats, and positive Vata elements such as mobility, creativity, and flow.
Medical Therapeutic Yoga: for Body, Mind, and SpiritMTY for exercise, pranayama, meditation, and use of sound and aromatherapy can be offered for the lipedma and lymphedema client to optimize health and wellness. MTY may utilize treatment tables that are elevated and larger in size, or recliner chairs, as needed. A 30 to 60 minute session may be provided and serve the client more therapeutically than conventional exercise classes or challenging personal training workouts.
Internalizing the Guiding Principles of YogaIn order to optimize programming and address the mind, body and spirit, a client may be educated as to the guiding principles of yoga beyond the Asana (postures) and Pranayama (breath) training, which can include client education regarding:
- Yamas, Niyamas, Tapas: MTY uses application of these moral and spiritual paradigms that may promote feelings of peace, self-acceptance, and encourage discipline and focused effort to the client.
- The Yama of: Ahisma, non-violence, on the part of the client and therapist, serves as a safety factor to prevent injury. A gentle, repetitive, practice can build strength slowly for safety, and honors the principle of non-violence to self and others. (Current popular training methods such as “The biggest loser” as seen on T.V. promote an opposite approach, that of aggressive, forceful exercise programs which have a basis in military boot camp protocols for combat readiness, and are not appropriate for a client with lipedema or lymphedema, and often including shaming tactics to encourage compliance.)
- The Niyamas: Santosa, contentment, focus on the present moment.
- Tapas: perseverance of effort, with persistence, discipline.