PHT 5216: Unit 1 — Compression Therapy

1) What compression does (core idea)

External pressure raises interstitial (tissue) hydrostatic pressure, reducing the gradient that drives fluid out of vessels → less fluid extravasation, better edema control. With cold, compression enhances cooling and can reduce pain, swelling, blood loss post-op.

2) When to consider compression (indications)

Post-trauma/post-op edema

Peripheral edema from venous insufficiency/poor calf pump

Lymphedema (UE common after breast cancer; LE after gynecologic cancer)

Systemic edema (cardiac/pulmonary/renal) → typically medical management first; PT uses careful adjuncts per plan of care

DVT prophylaxis (hospital use), ischemic limb due to PAD, venous stasis ulcers (with IPC)

3) Edema assessment (high-yield skills)

Location: focal vs diffuse; edema vs effusion (intra-articular)

Pitting scale (indentation persists after pressure)

Girth measures

Figure-8 at wrist/ankle

Circumferential: 3+ sites (at the involved area, distal, proximal); record distance from bony landmarks for reproducibility (e.g., “10 cm proximal to lat malleolus”).

4) Physiological effects of compression

↑ Effect of cryotherapy (greater drop in tissue temp; less pain/swelling/blood loss post-op)

↑ Tissue hydrostatic pressure → ↓ fluid loss from vasculature

↓ Bleeding (slows flow; supports clot formation)

5) Types of compression & where they shine

A) Elastic wraps (Ace/SPICA, with or without cold)

Common acute care/clinic use; also to secure ice

Typical “50% pull / 50% overlap” yields ~40–50 mmHg, but high variability between appliers; evidence on exact dosing is limited

Do not wear while sleeping; remove if pain, N/T, discoloration; check capillary refill <2–3 s; ensure comfort.

B) Intermittent Pneumatic Compression (IPC) / Vasopneumatic devices

Post-op edema, venous insufficiency, lymphedema, DVT prevention, PAD, venous stasis ulcers

General edema (post-acute):

Pressure: >30 mmHg to exceed capillary pressure

Cycle: 1:1, 30–60 s on / 30–60 s off

Time: 20–60 min

Upper limit: Sometimes set just below DBP (≈ DBP − 10 mmHg) when appropriate.

Acute (≤48 h) injury: avoid high pressures; very gentle compression only if used at all.

Lymphedema: commonly 30–60 mmHg, ~60 min, 1×/day; more is not better—30–40 mmHg can be sufficient.

DVT prevention (hospital sequential IPC): continuous, 1:4 on/off, 30–50 mmHg.

PAD ischemic limb: distal→proximal sequencing, 3–6 h/day for ~3 months, short cycles, high pressures (reported up to ~120 mmHg) in studies.

Venous stasis ulcers: 1–2 h/session; protocols vary; evidence suggests accelerated wound closure.

C) Cold-compression systems (e.g., Game Ready)

Combine cooling + compression for acute injury/post-op care.

D) Specialized lymphedema bandaging/garments

Multi-layer wraps & custom garments; see course text Table 8-2 (e.g., LymphaPress parameters).

6) Step-by-step: IPC application (exam + clinic)

Screen: PMH, limb exam, mentation/sensation

Explain purpose/risks; obtain permission

Remove jewelry/clothes on limb

Record vitals (HR, BP, RR) → DBP helps set max (≈ DBP − 10 mmHg if using that guideline)

Pre-treat measures: circumferential girths (≥3 sites)

Position comfortably with elevation

Stockinette for hygiene → proper sleeve size

Provide call bell; monitor vitals if indicated

Set parameters; start treatment

Post-treat: skin check, repeat girths, add therex, apply wrap/garment to maintain gains

Assist to sit/stand—watch for dizziness.

7) Precautions, contraindications, complications

Precautions

Recent skin graft

Acute skin infection

Impaired sensation and/or mentation

Contraindications

Acute pulmonary edema

Congestive heart failure

Recent/acute DVT

Acute fracture

Uncontrolled hypertension

Watch for complications — STOP and reassess

New swelling elsewhere

Shortness of breath (concern for fluid overload/PE)

Numbness/tingling (possible nerve compression)

If SOB doesn’t resolve, call physician/911 per protocol.

8) Outcome measures (before/after)

Edema: Girth / Volumetrics

Pain: VAS

ROM: Goniometry

Function: Gait, AROM, movement quality/guarding

9) Documentation essentials (plug-and-play)

Vitals: pre / (during) / post

Position: limb elevated or not

Parameters: pressure (mmHg), duration, on/off cycle, device

Wrapping technique (if elastic wrap; e.g., “50/50 SPICA”)

Skin/tissue response; patient response

Outcome measures (girths, VAS, ROM, gait/AROM)

Sample line:

IPC to LLE for post-op edema: 45 mmHg, 1:1 (45 s on/45 s off), 30 min with limb elevated. Vitals stable (pre 138/82 → post 134/80). Skin intact. Girth at mid-calf ↓ 1.2 cm post. Applied 50/50 elastic wrap afterward; instructed to avoid wear during sleep, remove if pain/N/T/discoloration, and to re-wrap with capillary refill <2–3 s.

10) Quick compare: Elastic wrap vs IPC

Feature Elastic Wrap IPC

Cost/Access $ $$$

Dosing control Low (user-dependent) High (device-controlled)

Acute use with cold Excellent Excellent (cold-compression units)

Lymphedema Bandaging/garments Common adjunct (30–60 mmHg; ~60 min)

DVT prevention — Standard of care (1:4; 30–50 mmHg)

PAD ischemia — Distal→proximal sequencing; long daily duration