Compression garments (stockings, sleeves, and wraps) are medical devices that apply external pressure to a limb. This pressure assists the body’s natural circulatory and lymphatic systems. The primary mechanism narrows the diameter of superficial veins, increasing the velocity of blood flow back toward the heart, which enhances venous return. This external support counteracts gravity and prevents blood and fluids from pooling in the extremities (edema). By preventing pooling, compression reduces swelling, improves circulation, and supports the removal of metabolic waste and inflammatory substances.
Managing Chronic Circulatory Conditions
For chronic conditions, compression therapy is a continuous daily necessity to manage symptoms and prevent disease progression. This sustained external pressure is often graded, meaning it is strongest at the ankle or wrist and gradually decreases up the limb. This gradient aligns with natural fluid movement, actively pushing blood and lymph fluid toward the center of the body.
Chronic Venous Insufficiency (CVI) and varicose veins involve damaged vein valves, which prevents the backflow of blood and causes pooling and high venous pressure. Compression stockings mechanically support the vein walls, helping damaged valves function and reducing internal pressure. Daily compression reduces plasma leakage from capillaries into surrounding tissue, reducing swelling and easing painful symptoms like leg heaviness and fatigue.
Lymphedema, the buildup of protein-rich fluid due to a compromised lymphatic system, requires compression to maintain fluid balance. External pressure facilitates the reabsorption and transport of lymph fluid back into the circulatory system, preventing tissue accumulation. Consistent use of custom-fitted garments sustains improvements achieved during initial decongestive therapy and prevents the condition from worsening.
Compression is also used long-term after a deep vein thrombosis (DVT) to prevent Post-Thrombotic Syndrome (PTS). PTS is a complication characterized by chronic pain, swelling, and skin changes in the affected limb. Wearing graduated elastic compression stockings for at least two years after a DVT diagnosis can reduce the incidence and severity of PTS symptoms. This application improves venous blood flow and reduces venous hypertension, minimizing the risk of complications like venous leg ulcers.
Short-Term and Preventative Applications
Compression is used in temporary, situational, or proactive scenarios to prevent issues or aid recovery. A common preventative use is preventing deep vein thrombosis (DVT) during prolonged immobility, especially for air travel exceeding four hours. Prolonged sitting causes blood flow below the knees to decrease, making compression socks a simple tool to improve circulation and lower the risk of clot formation.
Post-surgical recovery involves temporary swelling as the body initiates its inflammatory healing response. Compression garments minimize the buildup of excess subcutaneous fluid and encourage quicker re-absorption of accumulated fluid. This pressure reduces discomfort, decreases bruising by containing blood leaks, and promotes faster healing.
For individuals whose jobs require long hours of standing or sitting (e.g., nurses or office workers), compression garments alleviate daily fatigue and swelling. Standing for extended periods strains the circulatory system, and sitting causes blood to pool in the lower limbs. Moderate compression (often 15–20 mmHg) provides sufficient support to improve venous return and reduce leg heaviness throughout the workday.
Compression is applied after intense exercise to reduce muscle soreness and fatigue during athletic recovery. The pressure helps clear metabolic waste products, such as lactic acid, more efficiently by enhancing blood flow. This improved circulation delivers oxygen and nutrients to muscle tissue, accelerating the repair process and minimizing delayed onset muscle soreness.
Immediate Use for Acute Injuries
For sudden trauma (sprain, strain, or bruise), compression is immediately applied as part of the RICE (Rest, Ice, Compression, Elevation) protocol. Compression provides mechanical support to the injured soft tissue and minimizes immediate swelling following the trauma. By limiting the space for fluid accumulation, an elastic bandage or wrap helps control the inflammatory response.
The wrap should be applied firmly enough to achieve containment but not so tightly that it restricts healthy blood flow to the area. Signs that the compression is too tight include numbness, tingling, increased pain, or coolness in the area below the bandage. This acute phase application is typically maintained for the first 24 to 72 hours following the injury to reduce swelling, which helps manage pain and speeds up the healing process.
Conditions Where Compression Should Be Avoided
Compression therapy is not appropriate for everyone, as certain conditions make its application harmful. Severe Peripheral Arterial Disease (PAD) involves narrowed arteries that already restrict blood flow to the limbs. Applying external pressure can further impede arterial circulation, potentially leading to tissue damage, critical ischemia, or ulceration.
Individuals with decompensated heart failure, where the heart cannot pump blood efficiently, should avoid standard compression. Compression rapidly increases the volume of blood returning to the heart, potentially overloading the failing organ and worsening symptoms. Increased venous return can exacerbate fluid accumulation in the lungs in cases of severe, uncontrolled heart failure.
Acute skin or soft tissue infections, such as cellulitis or an abscess, are contraindications. Compressing an area with an active infection can spread bacteria or worsen the inflammatory process, delaying healing. Caution is also necessary with severe peripheral neuropathy, often associated with diabetes, as reduced sensation prevents recognizing if a garment is applied too tightly. Consulting a healthcare provider for a thorough assessment is necessary before starting compression therapy, especially if underlying conditions are present.