Compression Garments: An Overview
After you have completed Manual Lymphatic Drainage (MLD) therapy and reduced the excess fluid in the interstitial tissues, it will be time to select your garment to maintain your leg circumference. Keep in mind these facts when choosing your garment.
1)Stage of lipedema/fat disorder
2)Size of limb
3)Shape of limb (Does the limb contain large lobes of fat?)
4)Pain level of the limb
5)Ability to put compression garment on limb (Are you able to reach your toes?)
6)Cost of garment
It can be difficult to tolerate the pressure of massage and wrapping. MLD therapy and bandaging does not always have the desired effect of reduction of limb size and loss of fluid in the fat disordered limb. Therefore, many people will ask, “Why do I need compression when my leg doesn’t shrink in size?” Unfortunately, to date, there has been little documented research regarding compression garments and their efficacy with fat disordered limbs. Compression stockings are meant to contain edema by applying pressure to the skin. Compression may help to improve the lymphatic pumping by pressing the lymphatics against the muscles, thus as the muscles move, the garment assists with the movement of fluid through the lymphatic system.
Here are some of the possible benefits to wearing compression when you have a fat disorder:
•Compression helps slow the fat cell growth
•Compression improves lymphatic flow
•Compression, once on, actually can help reduce pain. It is a matter of finding the right garment for the fat disordered limb that can be comfortable and fit properly.
•Compression may help the limbs feel less heavy
•Compression may help one from advancing to the next stage
Take time to educate yourself on the variety of available garments. Speak to qualified garment vendors, your therapist and physician, and then decide what works for you and your limbs.
Circular Knit and Flat Knit Garments
Over the counter compression stockings are made of circular knit, usually a nylon material. They have four way stretch; they stretch lengthwise and they stretch the width of the garment. They range from an 8/15 mHg compression strength. These nylon stockings are thin and they contain the skin by being smaller than the limb. They are also gradient compression, meaning they will have more compression at foot and ankle than knee or thigh. Please note because the material is thinner when the garment bunches behind the knee or at the ankle it may cause more pain than thicker products. Once the stockings are on, the garments should feel supportive to the leg. There are assistive devices to help you get the garment on properly which should lessen the possibility of the garment slipping, bunching and causing pain.
Prescription or Custom Made garments are higher in compression levels, usually a 20/30 mHg or 30/40 mHg compression strength. They are made from several kinds of materials, usually thicker and circular knit made of nylon or a nylon-cotton blend, and flat knit which has a seam and is two way stretch. Flat knit is often preferred for the bigger limb or the abnormally shaped limb. Many people will say that the thicker flat knit hurts less. The disadvantage to the flat knit is that the stretch is only two way which makes it more difficult to fit since it is less forgiving. It is also more expensive than circular knit. Flat knit is often used if there is over hang at the ankle, or lobes on the thighs or knees.
The following are examples of garment brands that come in circular knit and in flat knit. Many of these manufacturers also carry over the counter stockings.
Micro Massaging Garments
Micro massaging garments started out as anti cellulite garments and are still utilized in Europe for anti cellulite purposes. They utilize a 3 d knit material that is textured. The theory behind these garments is that they stimulate the superficial lymphatics by stretching the top layer of skin through movement. These garments have low compression levels usually ranging from 12/21 mHg compression strength.
Because they are lighter in compression, and the material is made out of a cotton, poly, spandex knit it is a better tolerated material. It has the most stretch out of any of the garments. Most therapists are on the fence when it comes to micro massaging garments due to the compression levels being the opposite of what they have been taught. Stronger compression contains the limb better than the lighter compression. These garments focus on only the superficial lymphatics and the micro massaging effect they have on the skin.
The advantage to the micro massage garments is that there is a high rate of patient compliance. They are not painful to wear and they are by far the easiest to get on the limb. These garments come in different styles; leggings, ankle wear, stockings, sleeves, abdominal binders and high waisted leggings. It is easy to poke a hole into these garments with your fingertips and it is advised to utilize gloves and the palm of your hands when donning the garments. But the beauty of these garments even with a hole in them is that they do not run.
The two companies that we know of that have micro massaging material are:
Inelastic garments are made from a non stretch material. Some companies use the theory that the only way to not “re-swell” is to make the garments out of something that doesn’t stretch. This way the garment emulates more of the bandaging technique as it will act as a cast upon the limb, thereby keeping the limb from further swelling. It has been noted that giraffes have very long legs that need high pressure to properly circulate lymphatic and venous fluid up and out of the giraffe’s leg. Researchers observed that giraffe’s legs never swell and that it is the giraffe’s skin that is “non stretch” and keeps the leg contained.
Inelastic garments are not stretched and pulled on, they are Velcroed in place. They usually have a spine that runs down the back of the limb and neoprene straps attached to the spine that Velcro in place. The benefits of these products are that they can be used for a variety of needs. Limbs that are shaped like an upside down champagne bottle, have an overhang around the wrist or ankle, those with venous and or lymphatic disease, lipo-lymphatic issues and limbs with pain are examples of limbs that benefit from inelastic garments.
Donning the inelastic garment may be difficult. You will need two hands to apply this garment. It requires strength in the hands to get the garment on tight enough due to its lack of stretch. If you cannot reach to the end of your limb, it may be necessary to have someone assist you. Sometimes the base of the garment will slide down and bite the top of the foot or end of the limb but overall this is a great alternative to other garments. It is definitely not pretty and the garment is thick and bulky. Only one of the companies has done enough research to verify exactly how much compression is applied to the limb.
Several companies that use these types of garments are:
•Circaid (the inventor of the inelastic)
Short Stretch Compression Garments
Short Stretch compression garments are made of material that has, just what is says - short stretch. Short stretch stretches only about forty percent of the length of the material. The bandages utilized in wrapping after Manual Lymphatic Drainage (MLD) therapy are short stretch. Ace Bandages are long stretch; they stretch over one hundred percent of their length.
Short Stretch provides low, steady levels of resting compression, but higher compression when you stand up or are active. The result is a more comfortable garment that reacts to the needs of the limb, providing more compression when you need it, and less when you don't. This adaptable compression technology significantly improves venous and lymphatic function and aids active muscle assistance to the veins.
This garment has a comfortable spine in the back. The material is a cotton elastic material, with short stretch elastic bands attached to the spine and Velcroed in the front of the limb. Because the short stretch garment is not a stocking that is smaller than the limb, it is easier to don than the typical nylon type, over the counter stocking. You will still need two hands to pull each side and to close them but you don’t need as much strength. If there is still swelling in the limb, the short stretch garment will assist the limb to continue to shrink in size. As the limb shrinks, the garment needs to be adjusted or it may fall down a little and bunch at the top of the foot and ankle.
The short stretch garment comes in four pieces, the foot, the ankle to the knee, the knee and the thigh. The knee and thigh can be difficult to keep in place and many will utilize those pieces at night time only when not moving much. Some will utilize a cover up to keep it in place. Please be aware that if you have frail skin, this garment will need a padded sleeve protector or a lining to protect the skin. Also if utilized every day the elastic stretches out and the Velcro causes knit balls making the garment not as attractive. The short stretch garment is not as bulky as the non-elastic garment, but it does not last as long as the non-elastic either.
To date there is only one garment on the market with short stretch and that is the Farrow Wrap. Farrow is the inventor of the short stretch garment.
Post Surgical Garments
Post surgical garments are usually made of a nylon and spandex blend. They are not always made with a graduated compression as many times the garment’s material thickness will vary depending on where in the body the surgery was performed. Due to size options and ease of donning the garment, it may be recommended for a patient to wear post surgical garments in lieu of compression garments.
The benefit of the post surgical garment is that it can be custom made for larger sizes. They are comfortable and cause less pain and trauma when getting them on and off when compared to other types of garments. Post surgical garments are great for people that have an abnormally shaped limb. Due to the thickness of the fabric and the slickness of the undergarment, post surgical garments don’t cling to other surfaces, such as bed linens or clothing.
They are many companies that provide post surgical garments, below are a just a few from which to choose. Ask your therapist for assistance when choosing or finding a company for your post surgical garments:
•Make Me Heal
Sometimes it is not enough to just wear compression during the day. Remember that stockings have four-way stretch and you may refill during the daytime. Companies have made thick padded garments that you apply to the limb to help break up fibrotic tissue and to reduce the swelling during the night. The purpose of nighttime garments is to help you reduce and not to regain over time. The padding in the garment may help soften fibrotic tissue. Be aware that fitting your garment properly may take several visits to the fitter, especially if you have a larger or differently shaped limb. Fluid retention and weight fluctuations also may necessitate periodic refitting of your garment.
Typically the outside of the garment is made with a spandex wicking fabric. It is padded with foam chips or seams that follow the channels of the lymphatics. You can even buy a padded sleeve to use with the short stretch bandages. You put the sleeve on your limb and wrap the short stretch around your garment. These extra sleeves and bandages can be particularly beneficial if your insurance only allows for a few treatments, or if you live far from a therapist and need to continue with therapy and self maintenance.
The disadvantage to these garments is that they are thick and bulky. If you can’t sleep with all the bulk or get hot flashes this might not be the best choice for you. If you believe you need nighttime garments you might want to train your body slowly to get acclimated to the bulk. Leave them on for a few hours in the evening or at bed time and remove you feel claustrophobic or uncomfortable. Once you get accustomed to the bulk then increase your time. They can be pricey but they last for a long time.
The advantage to these garments is that they help you maintain your limb size without having to make frequent trips to the therapist. It is always recommended to have follow-up visits with your therapist who can help you to be able to maintain the benefits of therapy and improve self care. Sometimes, your therapist may suggest using these nighttime garments during the day or for several days in order to maximize the reduction in limb circumference. Many Lipo-lymphedema patients wear these nighttime garments to help maintain their limbs.
Some of the companies that have nighttime garments are:
•Farrow Wrap (has the padded sleeve and the short stretch to apply over it)
Cost varies greatly from several hundred to several thousand dollars. Many insurance companies will pay for the nighttime garment if you show need. You may need to get a prescription from your physician in order for you to obtain insurance coverage. Be sure to contact your insurance company for preapproval and coverage options.
To Pump or Not to Pump
Pumps are used to move lymph from the limbs back to the core for processing.
Years ago pneumatic compression pumps (PCP) or sequential pumps were considered harmful due to high uniform pressure and single chambers (the small areas that are filled with air within the garment) forcing debris-filled lymphatic fluid out of the interstitial tissues without breaking it down first. This action damaged the small one-way valves of the lymphatic vessels leaving them unable to close completely and function properly. It would often cause fibrotic cuffs at the top of the leg or push fluid into the abdominal or genital area.
Currently, pumps are utilizing improved technology. They employ variable pressure settings, are specifically designed to use less pressure and they can even cover the trunk area to prevent genital and abdominal edema.
PCPs are not meant to replace Manual Lymphatic Drainage (MLD) therapy, compression garments, or any other prescribed treatments; their purpose is to augment the home treatment. Often, subjective findings are that legs feel lighter, fibrosis is softer, and it is reported that legs have less pain after treatment. One limb receives the focused treatment per session. Your physician and/or therapist will design a treatment plan specifically for you.
To obtain a pneumatic compression pump, you will need a prescription from your physician. Your physician will consider your results after treatment has been completed and compression garments are worn for a period of time to decide on your need for a PCP. Many insurance plans pay for Pneumatic Compression Pumps. Depending on your insurance policy, some companies will cover the PCP at 100% or at a lesser rate. Be sure to call your insurance company for pre approval and a definitive answer on coverage.
Two of the most popular pumps using the current technology are, FlexiTouch and Lymphapress. There are also less advanced pumps on the market that continue to utilize the older technology. The key to safe usage is that the PCP needs to be programmable for light compression, use variable pressure settings and be designed with multiple chambers. These features should maximize the opportunity for a PCP to further break up the debris rich lymphatic fluid into manageable sized molecules that can flow freely through the lymphatic system without damaging the valves. You should do your homework and speak to various vendors regarding the technology they use, their success rates and insurance coverage prior to ordering. Your physician and therapist may have reason for one particular pump over the other for your case, so be sure to open that dialogue.
As you can see, the Lympha Press has higher pressures, and fewer chambers per side (12), but more chambers than the old school pumps. Pull on and if it’s too big for the limb, a pillow can be stuffed in the area.
Flexi touch has 32 chambers per limb and has lower variable pressures. The Velcro on the Flexitouch is a little harder to don but great for abnormal limb shapes.
Find videos that clearly demonstrate what pumps are and how they can be used by searching online.