Compression Garments

Either as a primary or secondary condition, many chronically ill patients find themselves needing compression to manage swelling, blood pressure fluctuation, and other conditions. This area of durable medical equipment can change daily life, but often seems hidden away in basements of hospitals and rehab centers. Here are basics about compression, what to expect if you are sent for a fitting, and a gathering of resources from around the internet.

Four Pillars of Containment.

Fluid science dictates the amount of containment you need based on your condition and your vascular and lymphatic systems. First off, let’s dispel the #1 myth: tightness is not the goal of compression. Whether you are replacing your lymph system after cancer treatment, keeping your blood pressure from bottoming out with POTS, or supporting vessels with weak connective tissue, the goal of compression is CONTAINMENT. There are four pillars of containment:

1. FIT — your garments must fit your actual measurements. Not your clothing size. Not your height and weight. Your actual centimeters or inches around the area to be contained and the places above and below the swelling. You do not want the smallest size you can squeeze yourself into. You want the right size for your actual body that you have right now. Avoid dangerous situations, pain, and frustration with the right size garments.

2. KNIT — all compression garments include some combination of elastic fabrics. But the garments you buy over the counter are majority elastic circular knit; they do not have a visible seam and are engineered to squeeze around (like pantyhose). They can accommodate a range of measurements at each size. There are medical grade elastic fabrics available through certified fitters and manufacturers.
   
   The highest and best containment comes from flat knit fabrics. These fabrics are stronger, hold their shape, and are sewn to fit your exact measurements. These garments have seams as they are handmade for each patient. Flat knit garments do not squeeze; they press against swelling. They are more comfortable for longer periods of time, less likely to stretch throughout the day, and able to return to their shape after a hand wash.

3. LENGTH — If your lymphatic or vascular system is impaired, you may need longer coverage than just the specific area that is swelling. Your OT or oncologist or vascular doctor will recommend the length that will be best for you, whether only the most distant places like fingers and toes, calf or arm length, or full leg or waist high, etc. Often, wearing compression socks can cause a subsequent swelling of fluid above the knee, so your length may have to adjust based on how your body responds to containment.

4. PRESSURE — The most recognized characteristic is the degree of graduated pressure:

   class 1 (10-20 mmHg)
   class II (20-30 mmHG)
   class III (30-40mmHg)
   class IV (40mmHg+)

   Sometimes these are referred to as Light, Firm, Extra Firm, and Firmest categories for non-medical grade products. These numbers signify how much pressure the fabric will exert on the skin when fitted correctly. The higher number is the pressure at the lowest point of the garment, and pressure decreases as it approaches the heart. This is how compression garments encourage the proper flow of fluids around the body. The amount of pressure you need will be based on your condition and the expertise of the Occupational Therapist or compression fitter in partnership with your doctor. If you feel better with greater or lesser pressure, make sure to share this with your medical professional so they can take this under consideration. The higher the pressure, the harder the garment will be to don and doff, though a well-fitting garment should never ever require intense struggle or cut off circulation.