Types of Compression Therapy
Therapeutic compression may be passive or active. Passive therapy is less expensive and more comfortable for most patients. This therapy utilizes socks or stockings to apply pressure to the limbs. Active therapy utilizes a compression pump and limb sleeves to provide pressurized treatments. Active therapy offers more control over the amount of pressure delivered to the patient. It also allows for different types of pressure delivery dependent upon the pump features.
Bookmarks to answer common questions.
Below is a continuum of compression therapy. It graphically displays the different types of compression, the levels of compression, prescription requirements, medical grade products, compression options, and the different levels of intervention. Below the continuum is more descriptive material to help you choose the best compression therapy product for your specific needs.
Compression Therapy Continuum - Choosing the Best Option
Passive Compression Therapy
Passive compression is inexpensive and uses special elastic material in the form of socks, stockings, sleeves, or gauntlets. The elasticity offers pressure measured on the mercury scale as mmHg or millimeters of mercury. This type of compression usually ranges from 8 to 50 mmHg. These stockings provide treatment for edema, varicose veins, and other venous insufficiencies.
Passive therapy is static. It offers a simple means to provide pressure to support veins and blood flow. Stockings replicate muscle tissue to provide contraction in areas of restricted blood flow. This therapy is inexpensive and easy to apply. It also supports many patients by relieving pain and reducing swelling. In addition to stockings and gauntlets, there are also compression bandages, wrappings, layered-wrappings, and tubular bandages that offer compression therapy.
Some stockings offer uniform compression. That means that the stocking generally applies the same amount of pressure wherever it comes into contact.
Some stockings offer graduated compression that produces more pressure at the lowest part of the extremity such as the ankle and less pressure as you go up the leg to the calf and thighs. This system helps to reverse the effect of gravity on the venous fluids running through your limbs. Graduated pressure allows circulation to improve up through your legs and into your body. Respected brands of graduated compression stockings include CEP, Juzo, Mediven, and Sagvaris (listed alphabetically).1
Medical Classified Compression
There are three medical classifications for compression stockings, corresponding the level of pressure they provide. The first is Class I, which is 22 to 30 mmHg. This class is the most prescribed pressure level by physicians. The second is Class II, offering 30 to 40 mmHg. The third and last is Class III of 40 to 50 mmHg.
Currently, there is no prescription required for a passive compression device. These compression stockings for both legs and arms sell over-the-counter (OTC). However, patients should consult with their licensed physician to ensure they purchase and use the right stocking. Patients do not need to purchase a thigh high stocking when a knee high will do. Likewise, patients do not need to purchase a high compression garment that is less comfortable and more expensive when they only need a lower pressure stocking to accomplish the desired intervention.
Active Compression Therapy
Active therapy is dynamic. The user or caregiver can adjust the level of compression and the type of compression. Active compression therapy utilizes a pump to generate pressure. The pressure travels from the pump through tubing to sleeves equipped with air bladders. The pump has pressure settings that control the amount of pressure sent to the bladders. The user dials-in the amount of pressure prescribed by their physician. These devices offer 20 to 120 mmHg of adjustable compression. These pumps offer three different types of compression—circumferential, sequential gradient, and intermittent.
Circumferential compression is an active compression method that uses a single chamber sleeve to push distal and proximal fluid from the limb. This type of pressure forces tissue fluid when it is in the low protein stage back to the interstitium to reduce the early stages of edema. It does not offer gradient compression.2
Sequential Gradient Compression
Sequential gradient compression is an active compression measure that inflates a series of air bladders in a consecutive order to force blood to flow towards the torso. When used for lymphedema treatment, this type of pressure acts like a massage that forces lymphatic fluid up the limb. When used for DVT treatment, a sequential compression device (SCD) improves blood flow back to the heart and helps reduce the risk of blood clots. When used for DVT, it is a preventative measure and not a treatment.3 Please note that the design and function of lymphedema pumps are different than DVT pumps. These pumps do not provide cross-functional compression.
Intermittent compression is an active compression method that initially provides pressure to a limb and then alternates to lower pressure. This alternating cycle of high and low pressures acts as a pump device to force fluids from the limb. During the low-pressure cycle, fluid fills the passages. During the high-pressure cycle, fluids flow out of the passageways and up the limb.4
To purchase an active compression device for home use to treat a chronic condition, requires a prescription from a licensed physician.
Compression therapy helps provide four types of intervention or patient benefits. The first is to provide patient comfort or enhance performance. Low compression is comfortable for many patients, helping to relieve stress and providing support. Many compression therapy patients benefit from the added support stockings provide during sports events and travel. Individuals involved with strenuous sports find that firm compression aids in recovery after competitive events. Second, is compression to prevent illnesses. Compression can prevent fatigue, varicose and spider veins, deep vein thrombosis (DVT), orthostatic hypotension, and edema. Third, is treatment to cure illnesses or conditions. Compression can reduce pain, swelling, varicose veins, spider veins, DVT, edema, lymphedema, and fatigue. Lastly, compression manages illnesses for which there is no current cure; such as, venous ulcers, orthostatic hypotension, postural hypotension, dysautonomia (POTS), Ehlers-Danlos Syndrome (EDS), May-Thurner Syndrome (MTS), and post-thrombotic syndrome (PTS).
1 Lim, Chung Sim, and Alun H. Davies. "Graduated compression stockings." Cmaj 186.10 (2014): E391.
2 Siegal, Deborah, and Wendy Lim. "Venous thromboembolism." Hematology. Elsevier, 2018. 2102-2112.
3 Curtis, Crystal. "Protect Yourself from Deep Vein Thrombosis with Sequential Compression Device (SCD)." University of Michigan Health System. UMHS Nursing Units, (2013): 1.
4 "DVT Prevention: Intermittent Pneumatic Compression Devices." Johns Hopkins Medicine. Accessed June 20, 2019.