Compression Therapy Definition
- Compression Therapy is a mechanical force that increases external pressure on the body or body part.
Types:
1.Static Compression
2.Intermittent Compression
Uses of Compression
- Improve fluid balance (by increasing hydrostatic pressure in the interstitial space)
- Improve circulation
- To modify scar tissue formation.
- Clinical Application
- Compression is used for
Control of peripheral edema
Prevention of DVT
Residual limb shaping
Healing of venous ulcers
Effects of Compression
Improve Venous and lymphatic Circulation
Limit the shape and size of tissue
Increases tissue temperature
Venous and lymphatic Circulation.
- Both static and intermittent compression devices can be used but intermittent compression is more effective than static.
- It can cause a wave of vessel constriction moving in a proximal direction.
- Improving circulation can benefit patients with edema & DVT(Deep vein thrombosis).
- Shape and size of Tissue.
- Static compression garments can limit the shape and size of new tissue formation.
- This type of compression device acts as a second skin, which, having less elasticity than skin thus limit the shape and size of tissue.
- The compression garments can be used over:
a.Residual limb after amputation
b.Burn damaged skin
c.Edematous limb
- Tissue Temperature
- Compression devices increase superficial tissue temperature by insulating the area to which it is applied.
- It is proposed that warmth produce by compression garments increases the activity of temperature sensitive enzyme which breakdown collagen such as collagenase.
Clinical indications
1.Edema
2.Prevention of deep vein thrombosis
3.Venous stasis ulcers
4.Residual limb shaping after amputation
5.Control of hypertrophic scarring
Edema
Causes:
Venous or lymphatic obstruction
Increased capillary permeability
Increase plasma volume
Exercise
Trauma
Surgery
Burn
How edema occurs?
- Normal fluid equilibrium is maintained by balance between hydrostatic and osmotic pressure inside and outside the blood vessels.
- When there is disturbance in this normal mechanism edema occurs.
- A healthy diet, vascular system and muscular contraction act together to ensure that appropriate amount of fluid exits in veins and flow back to heart.
- Dysfunction in any of these mechanisms can result in increased movement of fluid from the vessels into the extra vascular fluid.
- Edema caused by venous insufficiency
- The peripheral veins function is to carry deoxygenated blood from the periphery back to heart.
- When the calf muscles contract they exert a pressure of 200 mmHg on veins and pushes the fluid proximally.
- After contraction, pressure on veins falls allowing veins to refill.
- Venous insufficiency can be the result of:
Lack of physical activity
Dysfunction of venous valves
Mechanical obstruction of the veins by tumor
Phlebitis
Lymphedema
- Lymphatic system consist of large network of vessels and nodes through which lymph flows and drain into circulatory system for elimination.
- By any mechanism/cause if there is disturbance in this normal mechanism, lymphedema occurs.
Etiology
Decreased level of plasma protein
Mechanical obstruction of lymphatics
Abnormal distribution of lymphatic vessels or lymph nodes
- If the plasma protein level drops below 3.3 gm/dL, lymphedema likely to occur.
Types of lymphedema:
i.Primary lymphedema
ii.Secondary lymphedema
- Adverse effects of edema
- Impaired ROM
- Limitation of function
- Pain
- Induration of skin
- Increase risk of infection
- Cellulitis
- Ulceration
- Amputation
- Dermatitis
- Brown skin pigmentation
- How compression reduces edema?
- Compression controls edema by increasing extravascular hydrostatic pressure and by promoting circulation.
- The hydrostatic pressure in the interstitial space becomes greater reducing the outflow of fluid from the vessels.
- Prevention of DVT
- Deep venous thrombosis (DVT) is a blood clot in the deep veins which occur with reduced local circulation.
- Any intervention that increases the circulatory rate may therefore reduce the risk of thrombus formation.
- Compression improves venous flow and inhibit thrombus formation.
- Risk factors for DVT include:
Older age
Surgery
Trauma
Paralysis
Varicose veins
Immobilized patients
- Thrombus may become embolus that travels in blood and may block blood supply in lung which causes pulmonary embolism which result in shortness of breath, respiratory failure, or death.
- Venous Stasis Ulcers
- Venous Stasis Ulcers are areas of tissue breakdown and necrosis that occur in the areas of impaired venous circulation.
- Elevation in venous
pressure cause
endovascular and
inflammatory changes
lead to ulcer formation.
- Multi-layered or high pressure compression therapy is more effective for the treatment of venous stasis ulcers.
- Most effective position is supine lying as compared to standing.
- The mechanism by which compression facilitates healing of venous stasis ulcers include improved venous circulation, reduced venous pooling and reflux and improved tissue oxygenation.
