An Overview of Compression Therapy
- Mon, 10/18/10 - 11:25am
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Compression therapy has been used to treat a number of conditions ranging from tired, aching legs to varicose veins, chronic venous disease, and deep venous thrombosis (DVT). It has recently gained media attention due to the increased incidence of economy-class syndrome (blood clots resulting from long distance air travel become dislodged and travel to the heart and lungs, causing sudden death).1 Furthermore, as the population ages, chronic venous disease is becoming more prevalent.2 Compression therapy is also finding uses in sports medicine to help athletes recover.3
With respect to wound and ulcer care, the first step in the treatment process involves management of the underlying pathology. Compression therapy plays a key role in this, with healing rates of 40-70% (after 3 months), and 50-80% (after 6 months), being reported.4,5 Bandages, stockings, and intermittent pneumatic compression (IPC) devices can be used to deliver compression therapy. Of these, bandages and stockings are more widely used.
COMPRESSION BANDAGES
There are many different types of compression bandages available on the market. They are mainly divided along the lines of extensibility or stiffness. Short-stretch, or inelastic and semi-rigid bandages, have a high stiffness factor. They supply large amounts of pressure when the wearer is active by rigidly opposing the increase in calf muscle volume. However, they deliver relatively little pressure when the wearer is at rest. These bandages are often left in place for a number of days, but have a tendency to lose significant amounts of pressure within the first few hours of wear.Sup>6,7
Long-stretch bandages are more elastic in nature, utilizing this recoil force to provide compression during both activity and rest. Although they are not able to achieve the same levels of pressure as short-stretch bandages, they are able to maintain a more constant pressure profile for a longer amount of time.6,7
Short- and long-stretch bandages can be used together in a multi-layer system. Bandage systems have an advantage in terms of compression therapy because they can fit an unlimited range of patients. In general, short-stretch bandages are used to provide focal compression, while long-stretch bandages are used to hold this wrapping in place. This is particularly useful for preventing veins from refilling after radiofrequency (RF) and Laser ablation or sclerotherapy procedures.8
Both short- and long-stretch bandages have been shown to achieve similar healing rates, and there is no strong evidence to suggest that one is better than the other.6 However, the effectiveness of bandages is heavily dependent upon how they are wrapped.5-7 Unfortunately, without some means of feedback, most people cannot accurately gauge the amount of pressure being applied.4,6 If bandages are wrapped too loosely, it may take longer to see a reduction in swelling, and the wound will not close as quickly.5 However, if bandages are too tight, blood flow may be reduced to dangerously low levels and the tissue will become necrotic.5 Many people find long-stretch bandages easier to use6, but safe levels of pressure can be achieved with either provided that sufficient training and feedback is available.7
1. Dalen JE. Economy class syndrome: too much flying or too much sitting? Arch Intern Med. 2003 Dec 8-22;163(22):2674-6.2.
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3. Ali A, Caine MP, Snow BG. Graduated compression stockings: physiological and perceptual responses during and after exercise. J Sports Sci. 2007 Feb 15;25(4):413-9.
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7. Ramelet AA. Compression therapy. Dermatol Surg. 2002 Jan;28(1):6-10.
8. Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg. 2002 Jan;28(1):38-42.
9. Sigel B, Edelstein AL, Savitch L, Hasty JH, Felix WR Jr. Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency. Arch Surg. 1975 Feb;110(2):171-5.
10. Partsch B, Partsch H. Calf compression pressure required to achieve venous closure from supine to standing positions. J Vasc Surg. 2005 Oct;42(4):734-8.
11. Partsch B, Partsch H. Which pressure do we need to compress the great saphenous vein on the thigh? Dermatologic Surgery. 2008 Dec;34(12):1726-8.
12. van Geest AJ, Veraart JC, Nelemans P, Neumann HA. The effect of medical elastic compression stockings with different slope values on edema. Measurements underneath three different types of stockings. Dermatol Surg. 2000 Mar;26(3):244-7.
13. Mani R, Vowden K, Nelson EA. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2001;(4):CD001899.
14. Roland J. Intermittent pump versus compression bandages in the treatment of venous leg ulcers. Aust N Z J Surg. 2000 Feb;70(2):110-3.
15. Smith PC, Sarin S, Hasty J, Scurr JH. Sequential gradient pneumatic compression enhances venous ulcer healing: a randomized trial. Surgery. 1990 Nov;108(5):871-5.
16. Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg. 1999 Aug;86(8):992-1004.
17. Liu R, Kwok YL, Li Y, Lao TT, Zhang X, Dai XQ. Objective evaluation of skin pressure distribution of graduated elastic compression stockings. Dermatol Surg. 2005 Jun;31(6):615-24.
18. Segers P, Belgrado JP, Leduc A, Leduc O, Verdonck P. Excessive pressure in multichambered cuffs used for sequential compression therapy. Phys Ther. 2002 Oct;82(10):1000-8.
19. Simmons A. Compression hosiery. Available at:
20. “Medical compression hosiery quality assurance ral-gz 387/1,” January 2008.
21. van den Berg E, Borgnis FE, Bolliger AA, Wuppermann T, Alexander K. A new method for measuring the effective compression of medical stockings. Vasa. 1982;11(2):117-23.
22. Gaied I, Drapier S, Lun B. Experimental assessment and analytical 2D predictions of the stocking pressures induced on a model leg by Medical Compressive Stockings. J Biomech. 2006;39(16):3017-25. Epub 2005 Dec 22.
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Very interesting findings.
Reply to this comment »Excellent review. It seems to me that compression and compliance are inversely proportional - the greater the compression the lower the patient compliance in using the device... In some cases, some compression is better than none and OTC devices may not be the answer, but compression hosery would be... Emphasizing early morning (upon arising) application may facilitate compliance. Rotating compression pairs, powder pre-application and below the knee devices may also encourage long term use.
Enjoyed the read...
AMC
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