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Licensed Unlicensed Requires Authentication Published by De Gruyter September 20, 2017

Pilot study: whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema

Karen L. Herbst ORCID logo EMAIL logo , Christopher Ussery and Alyna Eekema



Lipedema is a common painful subcutaneous adipose tissue (SAT) disorder in women affecting the limbs. SAT therapy is a manual therapy to improve soft tissue quality.


Determine if SAT therapy improves pain and structure of lipedema SAT.


Single arm prospective pilot study.


Academic medical center.


Seven women, 46 ± 5 years, weight 90 ± 19 kg, with lipedema.


Twelve 90-min SAT therapy sessions over 4 weeks.


Dual X-ray absorptiometry (DXA) scans, SAT ultrasound (Vevo 2100), leg volumetrics, skin caliper assessment, tissue exam, weight, resting metabolic rate, pain assessment, lower extremity functional scale (LEFS) and body shape questionnaire (BSQ) at baseline and end of study.


Weight, resting metabolic rate and BSQ did not change significantly. Limb fat over total body fat mass (p = 0.08) and trunk fat over total body mass trended down from baseline (p = 0.08) by DXA. 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.


Small number of subjects.


SAT therapy in 4 weeks improved tissue structure, perceived leg function, and volume although shape was not affected. While side effects of SAT therapy were common, all women felt the therapy was beneficial.


The authors wish to thank Yvonne Russel for measuring leg volume, and Marisol Allen for measurement of REE.

Author Statement

  1. Research funding: This study was funded by a gift from the Lipedema Foundation which played no role in the study design or collection, analyses and interpretation of data.

  2. Conflict of interest: Alyna Eekema owns the Quadrivas Clinic & Academy in the Netherlands where she instructs practitioners in SAT therapy, called Quadrivas Therapy.

  3. Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human use complied with all the relevant national regulations and institutional policies, the study was approved by the University of Arizona Human Subjects Protection Program and all women were consented prior to participation to comply with the World Medical Association Declaration of Helsinki regarding ethical conduct of research involving human subjects.

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Received: 2017-5-26
Accepted: 2017-6-23
Published Online: 2017-9-20

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