Compression Therapy

What is compression therapy?

Compression therapy is a common treatment to help improve blood flow in your lower legs. It usually involves the use of elastic stockings or wraps. The elastic provides compression on your legs, ankles and feet. This helps prevent blood from pooling and fluid from building up in these areas.

What are the types of compression therapy?

The types of compression therapy devices include:

• Compression stockings: Stockings that go up to the knee are the most common type of compression apparel. If swelling extends above your knee, you may need longer stockings or tights that come up to your waist.
• Bandages and wraps: Elastic bandages and Velcro wraps may be easier to apply for people who have difficulty putting on socks. Bandages are usually applied in multiple layers.
• Inflatable devices: These garments fully cover the legs and inflate to provide pressure. They are mostly used by athletes.

Manufacturers rate compression socks based on how much pressure they provide. The amount of compression you need depends on your condition. The units for measuring compression are mmHg, or millimeters of mercury. There is no standard scale for rating compression stockings. In general, the categories of pressure are:

• Low (less than 20 mmHg).
• Medium (20 to 30 mmHg).
• High (greater than 30 mmHg).

Stockings that provide low compression are available over the counter. They may be a good choice if you stand or sit for long periods of time or are pregnant. Consult your healthcare provider before purchasing over-the-counter compression stockings.

Stockings rated 20 mmHg or higher require a prescription.

When should compression therapy be used?

Healthcare providers recommend compression therapy for conditions caused by poor blood circulation. These include:

Chronic venous insufficiency

This is a common condition that affects veins in the legs. It occurs when the walls of veins are weak and the valves inside the veins do not work as they should. Blood flow from the legs to the heart becomes impaired. As a result, blood builds up in the legs.

Chronic venous insufficiency can be a result of deep vein thrombosis (DVT). It can also occur with age and prolonged sitting or standing.

Compression therapy can reduce chronic venous insufficiency by squeezing your leg muscles. This helps push blood against gravity back to the heart.

Varicose veins

These veins are caused by chronic venous insufficiency. Varicose veins look like raised, winding ropes under your skin. Compression therapy can help relieve swelling and pain associated with varicose veins.

Deep vein thrombosis (DVT)

This is a blood clot that develops in a deep vein in the body, often in a leg. Because the clot blocks blood flow, blood and swelling can build up behind it.

Healthcare providers may recommend compression therapy for people at risk of deep vein thrombosis. Some risk factors include:

• Carrying excess weight.
• Chemotherapy.
• Physical inactivity or immobility.
• Pregnancy and postpartum, up to six weeks after birth.

If you already have deep vein thrombosis and take blood thinners (anticoagulants), then it’s reasonable to consider compression therapy. However, speak with your healthcare provider before first before starting compression therapy and see if it is right for you.

Swelling (edema) of the feet, ankles or legs

Swelling occurs when fluid becomes trapped in your tissues. Fluid has a tendency to pool in your legs because of gravity but our body is able to prevent pooling in many different ways. However, there are conditions where pooling still occurs. In your legs, ankles and feet, swelling can be a result of:

• Chronic venous insufficiency.
• Congestive heart failure.
• Lymphedema.
• Pregnancy.
• Sitting or standing in one place for a long time.

Compression therapy helps by using pressure to move fluid and prevent it from accumulating.

Leg ulcers and wounds

Ulcers are open sores. They can occur anywhere on your body but often affect the legs, ankles and feet. People with diabetes, varicose veins and poor circulation are at higher risk of developing ulcers on the lower legs and feet.

Compression therapy can enhance recovery from leg ulcers and wounds.

Orthostatic hypotension

This is a rapid drop in blood pressure that occurs when you stand up. Low blood pressure can make you feel dizzy or lightheaded. Orthostatic hypotension is due to poor blood return to your heart from your legs when you stand. Compression therapy can help treat this condition by squeezing blood from your legs back up to your heart.

Should athletes use compression therapy?

Some athletes involved in endurance sports use compression therapy on their legs during or after exercise. The increased blood circulation is thought to improve muscle recovery and reduce soreness. Some research studies support these beneficial effects.

What happens before compression therapy?

Your provider will determine the level of compression you need based on the health condition you’re experiencing. In addition to the pressure rating, other important considerations include:

• Size and fit.
• How to put them on correctly.
• How long to wear them.

Usually, you fill your prescription at a medical supply store. Trained staff will measure you to ensure a good fit and instruct you on how to put them on and take them off. Some people have trouble grasping socks and pulling them on. There are devices that can help with these concerns.

What happens during compression therapy?

By squeezing your lower legs, compression therapy helps the veins return blood to your heart and prevent the pooling of blood and swelling. Your healthcare provider may recommend compression therapy alone or combined with other treatments.

How often should you use compression therapy?

In general, you will wear compression socks or stockings while you are awake and take them off when you sleep. Bandages for certain types of conditions, such as ulcers or wounds, may stay on overnight. Be sure to follow your provider’s instructions.

What is compression in physical therapy?

Physical therapists may use compression therapy to reduce swelling and help with the rehabilitation process.

What are the advantages of compression therapy?

Compression therapy can improve blood circulation in the legs and reduce pain and swelling. In addition, it can help:

• Heal ulcers and wounds caused by blood pooling.
• Manage conditions such as chronic venous insufficiency and orthostatic hypotension.
• Prevent deep vein thrombosis.

What are the risks of compression therapy?

Most of the problems people experience with compression therapy are not severe. They include:

• Skin irritation.
• Discomfort or pain.
• Bacterial or fungal
• Swelling of the lower foot and toe area (where compression is usually lower).

Rarely, severe side effects can occur, such as:

• Nerve damage.
• Soft tissue damage.
• Superficial thromboembolism.

How can I minimize the risks of compression therapy?

In many cases, you can avoid problems by making sure your compression therapy garments fit properly and you are using them as prescribed. Other tips include:

• Check stockings for wrinkles or bunching.
• Do not fold the top of the stockings over.
• Make sure your skin is completely dry.
• Protect socks by wearing slippers or shoes.
• Replace socks if they become worn or stretched out.

When should I see my healthcare provider?

Talk to your provider right away if you experience:

• Skin changes, such as redness, irritation or infection.
• Pain.
• Tingling or numbness.

A note from Cleveland Clinic

Compression of the lower legs is an effective way to improve blood flow. It can reduce pain and swelling associated with poor circulation. Stockings, bandages and inflatable wraps are examples of compression therapy devices. You can obtain devices that provide mild compression over the counter. But higher levels of compression are available only with a prescription. If you have swelling in your legs, ankles or feet, talk to your provider about whether compression therapy is right for you.