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How do Compression Stockings Work?

Compression stockings are flexible, elastic garments that fit tightly around the legs, ankles, and feet, improving blood circulation and preventing further progress of health issues related to dysfunctions of veins, especially deep vein thrombosis (DVT). Typically, they are loose around the feet so that inflammation is reduced mostly around legs and ankles.

“Compression therapy is still the cornerstone of many venous diseases. Although in the last decades research in this field has contributed to more evidence and understanding of this treatment, many aspects of compression therapy are not yet fully understood. There are adequate technical guidelines, which describe the requirements of compression devices in relation to their desired working action.

Characteristics of medical elastic compression stockings

Medical elastic compression stockings (MECS) are per definition a part of the elastic compression modality in compression therapy. Elasticity results in a pressure on the skin known as the interface pressure. Classically, MECS are arranged according to different compression classes with the idea that a amore severe disease would require stronger compression. Medical elastic compression stockings are also divided into tailor-made / flat knitted and ready-to-wear / round knitted hosiery. This difference is only of relative importance compared with the crucial role of pressure and elastic property of the material. However, the declaration of these characteristics by the producers to date is highly unsatisfactory and confusing for the users.”1

 

“Graduated compression stockings have been used as a mechanical method of deep vein thrombosis prophylaxis for several years. They are preferred to other mechanical and pharmacological methods as they are both inexpensive and easy to use. Several studies have demonstrated an increase in mean deep venous velocity, reduced venous pooling, and an improved venous return in hospital patients who wore graduated compression stockings. A possible improvement in venous return during and after exercise may facilitate the clearance of metabolites produced during exercise.”2

 

Types of compression stockings

  • Graduated or medical compression stockings
  • Graduated compression stockings exert the greatest degree of compression at the ankle, and the level of compression gradually decreases up the garment
  • They are often used to treat chronic venous disease and edema
  • They are designed for ambulatory patients and are manufactured under strict medical and technical specifications, including consistency and durability, to provide a specific level of ankle pressure and graduation of compression

 

Antiembolism stockings

  • Antiembolism stockings are used to reduce the risk of deep vein thrombosis
  • Like graduation compression stockings, they provide gradient compression
  • They are designed for bedridden patients and do not meet the technical specifications for use by ambulatory patients
  • Although the terms “antiembolism stockings” and “graduated compression hosiery” are often used interchangeably and both types of stockings offer graduated compression, they have different levels of compression and indications

 

Nonmedical support hosiery

  • Nonmedical support hosiery, including flight socks and elastic support stockings, are often used to provide relief for tired, heavy and aching legs
  • They usually exert considerably less compression than graduated compression stockings
  • The compression is uniform and not graduated
  • They do not need to meet the strict medical and technical specifications as those of graduated compression stockings
  • They can often be bought over the counter without a prescription.”3

Compression stockings come in different sizes and materials. Even though low-pressure compression stockings can be purchased at pharmacies over the counter, a doctor’s recommendation is best. They know the level of compression that you should be aiming for.

 

Who usually needs compression stockings?

  • People with blood circulation issues due to venous insufficiency (when veins do not function properly, the blood they should be taking to the lungs for oxygenation is severely delayed), varicose veins (enlarged expanded veins, sometimes painful), DVT (blood clots that form due to poor blood circulation), lymphedema (accumulation of lymph fluids), or diabetes.
  • Athletes
  • Patients with mobility impairments due to inflamed or sore legs.
  • Individuals who need to stand-up for long periods of time at work, like nurses or surveillance workers.
  • Pregnant women (pressure on the vena cava, which returns blood to the heart can cause their legs to swell).

 

How do compression stockings work?

Compression therapy is the basic and most frequently used treatment of varicose veins, venous edema, skin changes, and ulcerations. Compression is recommended to decrease ambulatory venous hypertension to patients with CVD in addition to lifestyle modifications that include weight loss, exercise, and elevation of the legs during the day whenever possible.

 

Medical compression hosiery and classes

Medical compression stockings are made of elasticated textile. According to their length, they are classified as knee-length, thigh-length and tights (panty style). They may be custom-made or off the shelf and are available in standard sizes. Different compression classes are available according to the pressure exerted. The pressure profile for each compression class varies among different countries and is measured by various non-standardized methods.”4

 

“Different compression classes are available according to the pressure exerted. The pressure profile for each compression class varies among different countries. Therefore it is recommended to classify stockings rather by mmHg than by compression classes. By applying two stockings over each other pressure and also stiffness of the final compression sleeve is increased. The combination of two superimposed stockings has been introduced by some companies for the management of leg ulcers (‘‘ulcer kits’’): the basic ‘‘liner’’ keeps the ulcer dressing in place and is worn day and night, while the outer stocking is worn over the liner during day time. These systems can be handled by the patients themselves who are also able to have a shower, in contrast to the situation with a fixed bandage which is usually changed by trained staff every few days.”5

 

The different forms of ambulatory compression techniques and devices include elastic compression stockings, paste gauze boots (Unna boot), multilayer elastic wraps, dressings, elastic and nonelastic bandages, and nonelastic garments. Pneumatic compression devices (such as an ICP), applied primarily at night, are also used in patients with refractory edema and venous ulcers.138 The rationale of compression treatment is to compensate for the increased ambulatory venous hypertension. Pressures to compress the superficial veins in supine patients range from 20 to 25 mm Hg. When upright, pressures of 35 to 40 mm Hg have been shown to narrow the superficial veins, and pressures 60 mm Hg are needed to occlude them.

The principle is very simple: blood circulation is improved due to the pressure exerted by stockings on the legs, which in turn allows more oxygen to get to tissues, organs, and muscles. This is due to arteries and veins performing enhanced jobs.

“Compression therapy is the gold standard in the treatment of venous ulcers and results in the highest healing rates. It involves employing external and layered pressure, using special bandages, ready-to-use layered compression bandage systems, and, in the case of small ulceration which does not weep, compression stockings. A systematic literature review shows that every form of properly employed compression favorably influences the process of venous ulceration healing, and it is difficult to determine which method is the most effective.”6

 

For some people, compression stockings have proven to reduce leg inflammation and soreness and prevent worsening of health disorders like varicose veins. This in turn, has reduced pain and fatigue. However, more research is needed to fully confirm their effectiveness in these areas.

“Compression therapy is the basic and most frequently used treatment of varicose veins, venous edema, skin changes, and ulcerations. Compression is recommended to decrease ambulatory venous hypertension to patients with CVD in addition to lifestyle modifications that include weight loss, exercise, and elevation of the legs during the day whenever possible. The different forms of ambulatory compression techniques and devices include elastic compression stockings, paste gauze boots (Unna boot), multilayer elastic wraps, dressings, elastic and nonelastic bandages, and nonelastic garments. Pneumatic compression devices (such as an ICP), applied primarily at night, are also used in patients with refractory edema and venous ulcers. The rationale of compression treatment is to compensate for the increased ambulatory venous hypertension. Pressures to compress the superficial veins in supine patients range from 20 to 25 mm Hg. When upright, pressures of 35 to 40 mm Hg have been shown to narrow the superficial veins, and pressures 60 mm Hg are needed to occlude them.”7

 

Since compression stockings are constantly pushing blood, clots have a harder time building up. If you have venous insufficiency and valves in your veins are not working adequately, blood can collect in your legs. When this happens, your doctor will probably recommend you to wear compression stockings.

Compression stockings will not cure illnesses, but rather alleviate symptoms and prevent health conditions from deteriorating. To prevent DVT from developing however, higher pressure intensity compression stockings need to be worn.

Stockings should not be up folded, because that can make them too tight and cause blood circulation issues; a good fitting is most important to assure effectiveness of treatment. Nurses and medical caregivers trained on these matters are competent medical staff, you should heed their advice.

Who should avoid wearing compression stockings?

  • Patients with cardiac issues or pulmonary edemas.
  • Individuals with leg infections.
  • People with excessive leg inflammation, allergies, or skin reactions to the stocking fibers.

Consult your doctor, nurse or caregiver for more information and medical advice concerning your symptoms and specific needs before wearing compression stockings!

 

References:

(1) Neumann, H. A., Partsch, H., Mosti, G., & Flour, M. (2016). Classification of compression stockings: report of the meeting of the International Compression Club, Copenhagen. International angiology: a journal of the International Union of Angiology, 35(2), 122-128. Available online at

https://www.researchgate.net/publication/272188829_Classification_of_compression_stockings

(2) Ali, A., Caine, M. P., & Snow, B. G. (2007). Graduated compression stockings: physiological and perceptual responses during and after exercise. Journal of sports sciences, 25(4), 413-419. Available online at

https://www.researchgate.net/publication/6440925_Graduated_compression_stockings_Physiological_and_perceptual_responses_during_and_after_exercise

(3) Lim, C. S., & Davies, A. H. (2014). Graduated compression stockings. Cmaj, 186(10), E391-E398. Available online at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081237/

(4) Gloviczki, P., Comerota, A. J., Dalsing, M. C., Eklof, B. G., Gillespie, D. L., Gloviczki, M. L., … & Padberg, F. T. (2011). The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of vascular surgery, 53(5), 2S-48S. Available online at:

https://www.jvascsurg.org/article/S0741-5214(11)00327-2/pdf

(5) Partsch, H. (2003). Evidence based compression therapy. VASA-SUPPLEMENTUM-, 1(63), ALL-ALL. Available online at :

https://www.researchgate.net/publication/285908917_Evidence_based_compression_therapy

(6) Mościcka, P., Szewczyk, M. T., Cwajda-Białasik, J., & Jawień, A. (2018). The role of compression therapy in the treatment of venous leg ulcers. Advances in clinical and experimental medicine: official organ Wroclaw Medical University. Available online at:

http://www.advances.umed.wroc.pl/ahead-of-print/78768.pdf

(7) Nicolaides, A., Allegra, C., Bergan, J., Bradbury, A., Cairols, M., Carpentier, P., … & Georgiou, N. (2008). Management of chronic venous disorders of the lower limbs guidelines according to scientific evidence. International angiology, 27(1), 1. Available online at :

https://www.researchgate.net/publication/5575377_Management_of_chronic_venous_disorders_of_the_lower_limbs_Guidelines_according_to_scientific_evidence

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