Monday, July 28, 2025

Connective Tissue Disorder & Microvascular Dysfunction. Which came first?

Connective Tissue Disorder &

Microvascular Dysfunction.

Which came first in Lipedema?

As I continue deep diving into the "whys" & "hows" when it comes to understanding My Lipedema Life, why it started and how to manage it, my next step was to understand the connections between all of the underlying pieces individually.

This article helps us to understand the connection between the Connective Tissue aspect and the Microvascular Dysfunction. I also wanted to understand if one came before the other... again, back tracing to the "origins".

The relationship between Lipedema as a connective tissue disorder and its associated microvascular dysfunction is increasingly understood as an intricate, possibly cyclical, process rather than a simple linear "chicken or the egg" scenario.

Current research suggests they are intimately linked and likely develop in parallel, or even mutually exacerbate each other, rather than one strictly preceding the other in all cases.

Let's break down the current understanding:

The Intertwined Nature: It's Not Just Fat

Lipedema is not simply "fat accumulation." It's recognized as a chronic, progressive adipose tissue disorder with significant involvement of the extracellular matrix (ECM) / connective tissue, the microvasculature (small blood vessels and capillaries), and the lymphatic system. Chronic inflammation and hormonal influences (especially estrogen) play central roles in driving these changes.

How They're Connected and Affect Each Other in Lipedema Physiology:

Genetic Predisposition & Initial Vulnerability:

It likely starts with a genetic predisposition. While specific genes are still being pinpointed, it's hypothesized that certain genetic variations make the connective tissue and/or the microvascular structures inherently weaker or more susceptible to dysfunction from the outset (Source 1.2, 1.3, 5.1).
This means that individuals might be born with a subtle vulnerability in the collagen, elastin, or other proteins that form the scaffolding of both the vessel walls and the surrounding subcutaneous tissue.

The Role of Hormonal Triggers (Estrogen):

Puberty, pregnancy, and menopause are pivotal. The surge or significant fluctuation of estrogen during these times is thought to interact with this genetic predisposition (Source 3.1, 4.1, 5.1).
Estrogen's Impact on Permeability: As we've previously discussed, estrogen can directly affect endothelial cell tight junctions, increasing vascular permeability (Source 4.1). In a predisposed individual, this effect might be exaggerated or detrimental, leading to fluid leakage.
Estrogen and Adipose/Connective Tissue: Estrogen also influences fat cell growth (adipogenesis) and the remodeling of the extracellular matrix within the fat tissue (Source 4.1).

Microvascular Dysfunction & Capillary Fragility (The Leakage):

Early Feature: Research increasingly points to microvascular dysfunction and increased capillary fragility/permeability as an early and fundamental feature of Lipedema, possibly even preceding noticeable fat accumulation or significant connective tissue breakdown (Source 1.1, 1.2, 2.1).
How it Happens: In Lipedema, the capillaries are not only "leaky" but also often appear abnormal (dilated, tortuous). This may be due to:

Weakened Vessel Walls: If the connective tissue scaffolding within the capillary walls themselves is genetically compromised, they are inherently fragile.
Inflammatory Damage: Chronic low-grade inflammation (often driven by diet, gut issues, or even mechanical stress on fat cells) directly damages the endothelial cells lining the capillaries, increasing their permeability (Source 1.1, 2.1).
Dysregulated Angiogenesis: There may be an increase in the formation of new blood vessels (angiogenesis), but these new vessels might be immature and more prone to leakage (Source 8.1, 8.2).

Result: This increased permeability means that fluid, proteins, and even red blood cells leak out of the capillaries into the interstitial space more readily (Source 1.1, 2.1). This directly causes the characteristic edema and easy bruising seen in Lipedema.

Connective Tissue Breakdown & Remodeling (The Disorder Aspect):

"The extracellular matrix (ECM)

in Lipedema is altered."

ECM Changes:
It may contain fewer or disorganized collagen fibers, altered elastin, and increased amounts of certain proteoglycans (large molecules that attract water).
Consequence of Leakage: The constant leakage of fluid and proteins from the capillaries into the interstitial space creates a perpetually wet and inflammatory environment within the subcutaneous tissue. This fluid buildup puts mechanical stress on the connective tissue fibers and can contribute to their breakdown and disorganization (Source 1.1, 1.2, 2.1).
Inflammation's Role: Chronic inflammation within the adipose tissue (often triggered by the fluid buildup itself, by immune cell infiltration, and by adipocyte dysfunction) releases enzymes (like matrix metalloproteinases) that actively degrade collagen and elastin (Source 1.1, 1.3). This directly contributes to connective tissue "disorder."

The Vicious Cycle / Feedback Loop:

Vascular Leakage -> Connective Tissue Breakdown: The leaky capillaries dump fluid and inflammatory mediators into the tissue. This fluid and inflammation physically stress and chemically degrade the surrounding connective tissue, making it weaker and less able to support the vessels or drain fluid effectively.
Connective Tissue Breakdown -> Worsened Vascular Leakage: As the connective tissue (the "scaffolding") breaks down and becomes disorganized, it provides less structural support to the already fragile capillaries and lymphatics. This lack of support can make the vessels even more prone to collapse, stretching, and leakage, further impairing fluid return. It also creates more "space" for fluid to accumulate.
Inflammation Perpetuates Both: Chronic inflammation is often at the center, driving damage to both the vascular endothelium and the connective tissue, thus perpetuating the cycle.

Which Comes First? A More Integrated View:

Based on current evidence, it's less about one strictly "breaking down" the other, and more about an initial genetic predisposition creating vulnerability in both the microvasculature and connective tissue.

Then, hormonal triggers and chronic inflammation (potentially fueled by gut issues) act as accelerants:

The microvascular fragility (leaky capillaries) seems to be a very early and primary feature, leading to initial fluid extravasation (leakage).
This constant fluid leakage and the accompanying inflammation then actively contribute to the progressive breakdown and disorganization of the surrounding connective tissue.
This breakdown, in turn, exacerbates the vascular and lymphatic dysfunction, creating a reinforcing negative feedback loop.

So, while the microvascular dysfunction might be one of the earliest observable pathologies in Lipedema, it's deeply integrated with the connective tissue changes, with chronic inflammation and hormones constantly fanning the flames of both. This understanding emphasizes why a multi-faceted approach targeting inflammation, vascular integrity, and connective tissue support is so critical for managing Lipedema.

On my next deep dive, I'm attacking the obvious next step backwards... our leaky guts. Watch for that article to be out in the next few days. Comment below and let me know if this information helped you.

All My Love & Light,

~Brooklynn~

*Author's Note: I AM NOT A PHYSICIAN OR MEDICAL PROFESSIONAL OF ANY KIND. This information is the culmination of my own research, opinions, and experiences. Always search for your own medical professional, primary care physician, or plastic surgeon who IS KNOWLEDGABLE about Lipedema.*

Monday, July 21, 2025

Deep Tissue Massage & Lipedema... DON'T DO IT!!!

Deep Tissue Massage & Lipedema...

DON'T DO IT!!!

Here's WHY.

The Story... (Then, The Research)

Last Thursday I got in with my Massage location for a last minute appointment. I was scheduled with someone I hadn't seen before but was super excited because I desperately needed a massage. The ladies had told me that this gentleman is more normally suited for Firm Pressure/Deep Tissue Massage, but he could also do a Medium Pressure.

So I get there, get checked in, meet my therapist, and discuss what I need for that day. During that conversation, he and I talked about my Lipedema and my frustrations with Lymphatic Drainage. Now, while this therapist wasn't specifically certified in Lymphatic Drainage, my experience over the years has been that ALL massage was helpful. I've RARELY had any kind of negative outcome from a massage. I mean, come on... someone rubbing all of your limbs and muscles is amazing... normally.

As my therapist gets going on my massage, I'm fully relaxed and loving every moment. He had great technique, starting with my head, face, then arms, hands, and feet. Then I flipped onto my stomach and he worked on my back for a long time and then moved to my legs. Now keep in mind, during my entire 90 minute massage up to this point, my therapist was using a combination of medium to firm pressure throughout my body. Which felt absolutely AMAZING. There were no complaints coming from me. But as he moved to my legs, and after continuing to talk through ways to help my body and my legs because of my Lipedema, the experience changed just a bit. The pressure he was using on my legs was slightly painful but mostly no big deal and honestly it was a "hurts so good" kind of sensation. There were a couple times that it was too intense, but he quickly lessened the pressure so it was no big deal... I thought.

The therapist put in some time on my legs. I mean seriously working and rubbing... deep and hard. Again, for the most part, it wasn't unpleasant and I honestly thought this forceful movement and activating of all the muscles, tissue, and fluid build up in my legs was going to be SUPER beneficial. Man oh man was I wrong.

Now, I want to take a moment in this story to reiterate that when you suffer from Lipedema ( especially when you are in the later stages) you are at times DESPERATE for healing, answers, and relief. The DAILY pain, discomfort, frustration, limitations, and negative body image haunt you, gnaw at you under your subconscious. You hate that part of you... at times you hate your body. The next 3 days, I would be feeling exactly that. I felt like I had gone into what I "thought" was a helpful and healing self care technique only to learn the hard way how my body, in this Stage 3 of Lipedema, reacts to Firm Pressure. I was discouraged and felt as though my body was working against me. Ugh...

For the next 2 days I was miserable. Over that 48 hour period, the fluid increase in my legs, and the inflammation and joint stiffness throughout my body was insane and so super painful. It hurt to walk, sit, stand, and bend. None of my "normal" practices (leg elevation, vibration plate use, hydrating) of trying to relieve the swelling in my legs would work. I was drinking a ton of water, some with electrolytes and taking ibuprofen, but my urine output actually slowed way down.

By Sunday morning, I couldn't take it any longer and had to find some relief. As you can see in the pictures above, my skin was stretched to the max. It was so tight and my lower calves and ankles were red and hot to the touch. So as I was laying in bed in misery, racking my brain and trying to think about what would work and what I hadn't tried, it hit me.

So I got out of bed, took some pics of my legs, and then jumped in a tub of lukewarm water. I sat in the tub for over an hour, gently sloshing my legs back and forth. It felt amazing. I could literally feel the swelling starting to go down, the pressure starting to subside.

So for the remainder of the next SEVERAL days, I would spend time in the tub multiple times daily while drinking lots of water and imploring additional techniques, food, medications, and supplements to aid in reversing the damage I had done. In short, I completely traumatized my body and activated a "Triggered Lipedema Event". I don't know if that term is specifically used in the current research on Lipedema, but if it is not, I am adding it there now. Because that's exactly what I did. I inadvertently and without fully understanding my body, traumatized my own tissue and lymphatic system. By participating in the deep/firm pressure massage, I believe I broke capillaries, damaged already fragile veins, overloading my lymph system and perpetuating clogs throughout because my system couldn't handle the forced release of so much fluid at one time. Hence, why Lymphatic Drainage Techniques are SO soft and gentle.

The Research...

Now, let's delve into WHY my body responded the way it did.

Understanding the Scenario: Deep Tissue Massage and Lipedema

My body's reaction to the deep tissue massage points directly to the delicate balance of the lymphatic and microvascular systems, which are already compromised in Lipedema.

Deep Tissue Massage vs. Lipedema/Lymphatic System:

Did I create an Inadvertent Lymph Drainage Issue? (YES!): As some search results (Source 1.1, 5.1, 5.2) emphasize, traditional massage techniques, especially deep tissue, are generally not recommended for lymphedema (and by extension, Lipedema, which often has lymphatic impairment).

Too Much Pressure: Our lymphatic vessels are very delicate and lie just beneath the skin's surface. Deep pressure can collapse or damage these tiny vessels, effectively blocking lymphatic fluid flow rather than stimulating it (Source 5.1).

Overloading an Impaired System: Our lymphatic system in Lipedema is already working inefficiently (dilated, tortuous lymphatics, impaired flow) (Source 3.2). Applying deep pressure can overwhelm an already stressed system, leading to further congestion and increased fluid accumulation in the interstitial spaces (Source 1.1).

Increased Inflammation (Active Hyperemia): Deep tissue massage can cause "active hyperemia" (increased blood flow to the area) (Source 1.1). While this is generally beneficial for muscle recovery in healthy individuals, in the context of an impaired lymphatic system in Lipedema, this increased blood flow brings more fluid into the tissues than the compromised lymphatics can remove. This results in more water accumulating in the interstitial spaces (Source 1.1) and potentially exacerbating inflammation, leading to my joint stiffness.

Microvascular Damage Leading to Increased Inflammation (Plausible):

Lipedema itself involves leaky capillaries and microvascular dysfunction. While deep tissue massage isn't typically cited as a direct cause of microvascular damage in the sense of physically breaking capillaries (though bruising is common with deep tissue), the increased interstitial fluid and inflammation it can trigger in an already vulnerable tissue can certainly exacerbate existing microvascular issues and lead to further leakage and swelling.

The increased fluid and inflammatory mediators create a vicious cycle that further stresses the capillaries and impairs lymphatic drainage.

Increased Swelling & Lack of Urine Output:

When the lymphatic system is overwhelmed or damaged, fluid gets trapped in the interstitial spaces (the areas between our cells) rather than being properly drained back into the circulatory system.

Our body isn't "dehydrated" in the common sense, but rather the fluid is "misplaced." It's in our legs and tissues, not circulating efficiently in our bloodstream to be filtered by the kidneys. This means our kidneys aren't receiving the signal of "fluid overload" that they would if the fluid were properly returned to the central circulation. Hence, reduced urine output despite significant fluid retention in my limbs. Our body's internal fluid balance is completely thrown off.

The 6 lbs of water weight gain is a direct result of this fluid accumulation in the interstitial space due to the impaired lymphatic return.

Relief from Warm Water Soak and Movement (Immersion Diuresis and Lymphatic Flow):

Immersion Diuresis: My experience in the tub is a classic example of "immersion diuresis" (Source 4.2).

When our body is immersed in water, especially up to our hips or chest, the hydrostatic pressure of the water exerts external compression on our limbs. This "squeezing" effect helps to displace excess fluid from our lower extremities and push it back towards your central circulation (heart and lungs) (Source 4.1).

Our body interprets this increased central blood volume as a fluid overload, which suppresses the production of antidiuretic hormone (ADH). Lower ADH levels then signal our kidneys to immediately produce more urine to lower the centrally circulating blood volume. This is why I then experienced dramatic urine output.

Movement in Water: Sloshing our legs back and forth adds gentle, rhythmic compression and muscle pumping. In water, this movement is easier and puts less strain on already painful joints. This gentle, active movement helps to:

Further encourage lymphatic flow, pushing the trapped fluid.

Improve venous return by activating the muscle pump, which is crucial for moving blood and lymph against gravity.

The buoyancy of the water also reduces the gravitational pull and pressure on our legs, making movement less painful and more effective at mobilizing fluid.

Conclusion and Path Forward

My hypothesis was very accurate. It's highly probable that the deep tissue massage, while perhaps well-intentioned, significantly exacerbated my Lipedema and underlying lymphatic dysfunction. It likely overwhelmed my already compromised lymphatic system, leading to increased inflammation (joint stiffness) and massive fluid trapping (swelling, water weight, lack of urination).

The action of soaking in warm water and moving my legs was an excellent intuitive response, tapping into the body's natural mechanisms for fluid redistribution and diuresis. This provided the necessary external compression and gentle internal pumping to get that trapped fluid back into circulation for elimination.

Moving forward, this experience reinforces the critical importance of gentle, specialized manual lymphatic drainage (MLD) over traditional deep tissue massage for Lipedema. MLD uses very light, rhythmic strokes designed to stimulate the superficial lymphatic vessels without collapsing them.

The reality is that those of us who suffer from Lipedema encounter events like this ALL THE TIME. And you know why?!? BECAUSE WE HAVE NOT BEEN EDUCATED! To date, the amount of medical professionals in the United States who actually know about, practice, and can diagnose Lipedema correctly WITH helpful information and resources, is EXTREMELY limited. That needs to change. We need to get the word out. And when we do something like I did last week, we need to give ourselves some grace. Because the truth is the research, understanding, and educating of the medical community is ever evolving. We will have moments where it feels like 1 step forward and 2 steps back as far as healing.

But when we do, we will get through it, learn from the lesson, and move forward with renewed hope that someday our Lipedema Life won't feel so heavy.

If you found this article or information helpful or insightful, I'd love to hear from you via the comment section below.

All My Love & Light,

~Brooklynn~

Monday, July 28, 2025