Lymphedema is a chronic condition characterized by persistent swelling, typically in the arms or legs, that results from a failure in the lymphatic system to properly drain fluid from the tissues. Compression garments are a standard, primary treatment used to manage this swelling and prevent its reaccumulation. It is understandable to feel anxiety about applying pressure to an already swollen limb, leading to the question of whether this treatment could actually be harmful. While compression therapy is an effective intervention, improper use or specific underlying health issues can indeed cause adverse effects and worsen the condition.
Understanding the Role of Compression Therapy
Compression garments manage lymphedema by providing external pressure that counteracts the fluid buildup within the tissues. This sustained pressure helps reduce the rate of fluid leaking out of the capillaries (ultrafiltration) while simultaneously increasing the pressure within the tissue itself. The elevated tissue pressure encourages fluid to move back into the remaining functional lymphatic and venous vessels for transport away from the limb.
For this mechanism to be effective, the garment must apply a specialized pressure gradient. This design ensures the highest pressure is exerted at the furthest point of the limb, such as the ankle or wrist, and progressively decreases toward the trunk of the body. This gradient is essential because it mechanically guides the lymphatic fluid flow in the correct, upward direction, preventing fluid from pooling distally. Compression products are made from various materials, including inelastic short-stretch fabrics, which are preferred in the initial treatment phase because they provide a high “working pressure” when muscles contract during movement.
Scenarios Where Compression Can Worsen Lymphedema
The primary way compression garments can negatively affect lymphedema is through incorrect sizing or fitting, which creates a destructive “tourniquet effect.” If a garment is too tight near the body, such as at the groin or shoulder, or if the material bunches or rolls down, it forms a constrictive band. This band acts like a dam, blocking the outward flow of lymphatic fluid and venous blood from the distal limb, causing swelling to worsen below the constriction point.
Furthermore, using the wrong type of compression product can impede progress. Garments made from highly elastic, long-stretch materials, or certain over-the-counter support hose, may not generate the necessary resistance to muscle movement needed for effective decongestion. These less-stiff materials may simply stretch as the limb swells, failing to prevent stagnation of the fluid.
Compression therapy must also be temporarily stopped or modified if certain medical conditions are present. One major contraindication is an active infection, such as cellulitis, as the pressure can potentially spread the infection through the lymphatic system or damage inflamed tissue. Similarly, patients with severe peripheral arterial disease (PAD) should not use standard compression, as the external pressure could further compromise already reduced blood flow to the limb, risking tissue damage.
Strategies for Safe and Effective Garment Use
To ensure compression is beneficial, the process must begin with a professional consultation from a Certified Lymphedema Therapist (CLT) or trained fitter. These specialists are trained to take precise measurements and select the appropriate pressure level and garment type based on the individual’s limb shape and stage of lymphedema. Measurements are used to order custom-made, flat-knit garments that maintain consistent pressure across the limb, which is especially helpful for limbs with deep skin folds or irregular contours.
Patients are responsible for mastering proper donning techniques, often utilizing special aids, to ensure the garment is smoothed over the limb without creases or folds that could create localized pressure points. Routine skin checks are necessary before and after wearing the garment to look for any signs of irritation, excessive pressure marks, or blistering, which indicate a fitting problem. Garments must be replaced typically every six months, or sooner if they lose their elasticity, as the consistent pressure needed for fluid management will diminish over time.
The Role of Complete Decongestive Therapy
Compression garments function optimally when they are part of a larger, integrated treatment plan called Complete Decongestive Therapy (CDT). CDT is the comprehensive approach for managing lymphedema and involves four primary components:
- Manual Lymphatic Drainage (MLD): A light massage technique used to stimulate lymphatic vessels and reroute fluid away from the swollen area.
- Therapeutic exercise: Movement that encourages muscles to contract against the external compression, effectively pumping fluid out of the limb.
- Meticulous skin and nail care: Used to prevent infections like cellulitis, which could necessitate a temporary halt to compression.
- Compression bandaging or garments.
These adjunctive therapies are used to maximally reduce the limb’s swelling during an intensive phase before a permanent compression garment is applied. By decongesting the limb first, CDT ensures the garment’s primary role is to maintain the reduced volume, minimizing the risk of the garment worsening symptoms.