Compression in various forms has been used since the time of ancient Rome. Scattered documentation of its use dates back to the time of Hippocrates and the science of compression continues to evolve. Originally, compression therapy was used to help people with varicose veins (a condition where the leg veins become twisted and dilated so that the valves become inefficient in preventing the backflow of venous blood). Today the science of compression has evolved and research has shown compression also is beneficial in the support of lymph fluid circulation, in wound healing, prevention of fibrotic skin changes due to long standing edema formation and to help athlete’s muscles recover faster and improve their performance.
COMMON USES OF COMPRESSION GARMENTS
Varicose veins that cause mild, moderate to severe heaviness, fullness and leg discomfort OR as prevention for those with spider veins.
After cosmetic surgery to reduce swelling and aid healing (liposuction, breast or facial surgery)
During pregnancy to help with leg swelling and discomfort
In hospital after some surgeries to prevent deep vein thrombosis (DVT)
Leg wounds related to vein disease
During air travel to help prevent blood clots
Chronic swelling related to vein or lymphatic dysfunction (lymphedema)
Lipoedema (a condition of increased fat cell production causing pain, easy bruising and leg shape distortion)
Athletes wear compression sleeves on their arms or legs to help circulation during exercise and to aid in muscle recovery after exercise
The uses of compression in the above list are so varied that the style, compression level and fabric used cannot be the same for each situation. A person with mild venous insufficiency who has mild swelling will have very different compression requirements than someone with lymphedema who has a larger leg size and skin changes. It would be like putting a square peg in a round hole, driving a transport truck into a small tunnel or wearing a bathing suit in the middle of winter. The right fit, compression level, and fabric type are key to managing each unique need and one size does not fit all.
BENEFITS OF COMPRESSION (reference 1)
a) Increases reabsorption of fluid in the tissues into lymphatic and venous systems
b) Graduated compression helps to bring fluid from areas that are not working properly to other areas that are working better
c) Reduces venous backflow and promotes blood return to the heart
d) Improves lymphatic function by stimulating small contracting pumps located in lymph vessels
e) Maximizes calf muscle pump needed by lymphatic vessels to aid in lymph fluid flow
f) Softening of hardened skin tissue
g) Reduced release of inflammatory chemicals
h) Increase in quality of life through a decrease in pain and movement difficulties
i) Prevention of lymphedema stage progression and complications of lymphedema such as infection, fluid weeping and skin changes.
HOW DO YOUR LYMPHEDEMA THERAPIST AND FITTER HELP YOU DECIDE WHICH GARMENT IS RIGHT FOR YOU?
There are many factors to consider when deciding which garment would suit you best including:
a) Your health history. Compression must be modified if you have sensation changes or decreased arterial blood flow to your limb. Therefore, a medical health history is needed to help in the decision process.
b) Your functional mobility status: How do you move? Will you be able to pull up a compression stocking or armsleeve? These are very important factors to consider. Arthritis, weakness, dizziness, inability to reach the part of the body that needs the compression to be applied and previous injuries can all play a role in helping to decide what type of garment would be best for your needs.
c) Skin integrity: The presence of wounds, lymph fluid leakage, skin nodules or fibrosis play a role in deciding pressure level, fabric type and compression method.
d) Shape of the limb: Is your limb more uniform in shape or does it bulge in areas? The shape of the limb plays a role in deciding whether you fit into a standard sized garment or whether a custom garment is needed.
e) Extent of swelling: Where is the edema? How far up the limb does it extend? Assessing this will inform you on which type of garment is needed (thigh high, knee high, gauntlet or glove).
f) Financial considerations: Medical compression garments can be pricey. Beware of garment sellers on the internet however as some of the “cheap” garments are not graduated compression or have not been manufactured with rigorous testing. Your therapist or fitter will help you apply for any government program available for funding or provide a list of service clubs that may be able to help you with the financial aspect of garment funding. (see my previous blog on the cost burden of lymphedema).
HOW DO YOU KNOW IF YOUR GARMENT IS WORKING FOR YOU?
Most people develop a trusting relationship with their lymphedema specialist fitter or therapist. This relationship can be one sided, however, in that the person needing the compression garment will follow the direction given by the specialist without question. Today, we must be our own health advocate as your therapist or fitter is not with you daily and cannot assess you regularly. Additionally, your specialist is not super-human and cannot know your body like you can.
Your compression needs will change over time and recognizing these changes will help to keep your lymphedema maintenance on track. Here are some questions and things you should do from time to time to ensure that the compression you are wearing is working for you.
1. Does my garment allow my limb to get bigger by the end of the day? Is your limb visibly larger at the end of the day? Do you have to self-bandage to get your swelling down? If your garment is expanding with your swelling by the end of the day, it is not doing a good job of containing your swelling.
2. Are there any red lines of constriction that are causing “bumps of trapped fluid” in the area, pain or skin irritation? Alterations in the garment can be made to increase comfort.
3. Does the garment slip down when you are wearing it? Skin adhesives such as “It Stays” can be used to hold it up or changes to the silicone topband or silicone grippers can be added to the garment to hold it in place. For thigh highs, garter type belts are available, but not widely used.
4. Do you have pockets of fluid in the top of your foot or hand? Pockets for pads can be sewn into your garment to add extra pressure in these areas or you can slip your own swelling pocket preventer pad into these areas under your garment. Juzo has a “Therapad”, Soft Compress or malleolus pads for the ankles, Solaris has Swell Spots and other companies have products to help with this problem. Check with your fitter or therapist for your options.
5. Is your garment over 4 months old? Compression in a garment depletes over time. This is called garment fatigue. If your garment has runs in it, slips on easily in the morning without the use of a donning aid or is loose anywhere you probably need to consider replacing it. A garment that loses its ability to contain your swelling allows your limb to get bigger.
HAVE YOU EVER WONDERED HOW YOUR STOCKING IS MADE?
The following is a video from “How It’s Made” from the Sigvaris compression stocking manufacturer.
Note: Notice how these stockings are made in a uniform shape to fit into categories, usually small, medium and large or extra large. These are not custom, made-to-fit garments, they are considered OTC (over the counter) for people who fit into these size categories. As this company states, their product goes through a rigorous testing protocol as do other recognized manufacturers such as Juzo, Medi or Jobst.
The choice of compression type is based on many factors, and you need to be a partner in your care with your lymphedema specialist fitter and therapist. Compression garments are not made equal and your unique health situation will help define what garment will be best for you.
1. Bjork R, Ehmann S. (2019). S.T.R.I.D.E: Professional guide to compression garment selection for the lower extremity. Journal of Wound Care 28(6 suppl): 1-44. https://www.magonlinelibrary.com/doi/epub/10.12968/jowc.2019.28.Sup6a.S1