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Joachim Zuther, Lymphedema Specialist. Read more
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Compression Therapy and its Role in the Treatment of Lymphedema

 

Compression therapy applied by padded short-stretch bandages, compression garments, or alternative materials, such as adjustable compression devices, is an integral part of lymphedema management. The goal of compression therapy is to maintain and improve the reduction of the swelling achieved during lymphedema treatments.

It is important to understand that although the swelling in lymphedema may be reduced to a normal or near normal size during treatments, the damage to the lymphatic system which caused the onset of lymphedema is permanent. In addition to the underlying damage to the lymphatic system, the elastic fibers in the tissues affected by lymphedema are damaged as well. These fibers loose their elasticity and tend to harden, especially in extreme cases (lymphostatic elephantiasis) and untreated lymphedema present over a long period of time. Without proper long-term management the evacuated fluid, in most cases, will re-accumulate in the affected body part.

Compression garments by themselves will not reduce existing swelling and must therefore not be worn on an untreated, swollen extremity. Patients with lymphedema graduate from padded short-stretch bandages, which are applied by the lymphedema therapist in the intensive phase of complete decongestive therapy (CDT) to elastic compression garments only when the affected extremity is decongested.

Compression garments, much like hearing aids or eyeglasses, become part of the patient’s life and have to be worn on a daily basis in order to preserve the treatment success achieved during the decongestion of the edematous limb.

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Bandage Liner

Some individuals may benefit from alternative and adjunct compression systems that can be used in combination with traditional compression garments or bandages. Short-stretch bandages applied by the therapist during the intensive phase of CDT may be combined with bandage liners that are filled with foam particles and “built-in” channels to help direct the flow of lymph; swell spots can be used underneath compression bandages for added compression in localized swelling, or to protect bony prominences.

Strapping systems, which provide gradient compression by use of low-stretch adjustable bands, can be used as an alternative for individuals having difficulty donning compression garments.

Adjustable Strapping System

Manufacturers of compression garments provide a wide variety of styles and variations, such as sleeves, gauntlets, stockings, pantyhose, vests, etc. They can be ordered in a large selection of standard sizes and different compression classes, which are determined either by the physician or the lymphedema therapist. Adjustable strapping systems for upper and lower extremities are also available in a variety of  styles and sizes and while most patients’ measurements will fit within the parameters of the manufacturer’s standard sizes, some compression garments and strapping systems have to be ordered custom made. The correct size of the garment needs to be determined by the lymphedema therapist, or a certified fitter.

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24 comments to Compression Therapy and its Role in the Treatment of Lymphedema

  • cm taylor

    my problem is that even custom garments are a problem because manufacturers are limited in measurements. i’m tall and the affected leg and thigh has a high circumference. and then there’s the matter of the “hump” on the inside thigh of the affected leg. any suggestions? and there’s also the exorbitant price.

    • Joachim Zuther

      Compression garments should be only worn following treatment with CDT applied by a trained lymphedema therapist. Trained therapist know how to take appropriate measurements for custom made garments. Compression stockings need to fit well in order for them to work.

  • Thanks for good, easy to understand article on compression. I have a client whose Dr. recommended compression hose for her LE. It’s frustrating medical community is not up to date with current LE treatment protocol: CDT.

  • Ciro Davino

    HOW CAN I GET HELP, I LIVE IN NY…………….

    • Joachim Zuther

      Ciro, please click on the “find a therapist” tab on top of this page in order to locate a trained lymphedema therapist in your area.

  • lisa marie calderon

    I have lymphedema bilat lower extremity. Ive been thru cdt.. bandages.. reid sleeves and currentlybolhave a pump. I am unable to wear comlression garments due to skin allergy. Ive tried 5 kinds including diabetic silver. Any suggestions? I have a sedentary job. The pump helps but im only able to do it at night which gets them backnto normmal but next day im back at square one.

  • Terrie Haynes

    I wear the thigh high compressions hose ..I have only water on top of my legs bottoms arew just real reddish purplr..I been doing the sleeves compression for awhile now and its working some but to me its not doing anything I do one leg in morning and one leg in evening…I really believe and now my doctor i dont have the lymphedema but the lipaphedema..There is no doctor that knows that much about it in the state of Indiana..What should (I do differently?I’d like to see a real doctor that can tell me excaety which one I have ..Please help …THank you

  • CIRO ESPINDOLA

    Joa where its possible buy a adjustable strap ( Circ Aid ) here in Europe?, i need for my patients.
    Thanks in advance

  • Kimberly Arnhold

    I am appealing to insurance for “strapping” which my insurance does not cover. Dr has submitted paper, is there anything else out there or standard letters that I soul also send?
    Thanks

  • Pamela Hain

    I just returned from a visit to a lymphedema therapist. I had surgery for cancer 7 years ago with 27 lymph nodes removed followed by radiation. For the last year I have had pain in my legs usually at night. Then in February I had to stop walking for exercise due to the pain. All tests done for peripheral neuropathy, MRI of the brain, ex rays, blood work for diabetes, etc are negative. The therapist said lymphedema does not cause pain, and begins shortly after surgery, not years later. She suggested acupuncture or celiac diet. From what I have read, I have early stage lymphedema. She did agree my left arm was significantly larger than right. Should I find another doctor?

  • Beth Holmes

    Thank you so much for this blog, it is extremely informative. My 17 year old daughter has just been diagnosed with lymphedema in both arms after a 1 1/2 year process of finding answers to what began as hand swelling then arm swelling. Is wrapping the only answer to the nightly therapy? Is there a mechanical compression pump for home use that works well enough?

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  • Thanks for sharing your thoughts about medical. Regards

  • Beverly

    Is there any way we can convince Medicare that these garments are a necessary DME and should be covered by insurance? Walkers, wheel chairs, etc. are covered, why not compression garments, pumps, circaids, etc.?

  • Thaanks fօr finally talking аbout > Compression Therapy аnd its Role
    in tҺe Treatment of Lymphedema

  • Annette

    I was diagnosed in my late teens and have been using fitted compression garments for years. Now in my late 40′s, I’ve notice over the past few years that the compression garments for my leg that are closed toe, do not help the swelling in my toes and has even led to additional problems. Is it possible to make a leg garment with separated toes? Or is there a better garment that addresses this issue?

    • Joachim Zuther

      Dear Annette: It is possible to order compression garments with individual toe caps; however, these kind of garments are always custom made and tend to be expensive. There is also the option of applying gauze bandage to your toes in order to decongest and/or prevent further swelling.

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