Compression

Compression refers to articles of ‘medical’ clothing that literally compress the tissue underneath it. Think of it as giving your skin some extra help in propelling lymph fluid back to the trunk so your body can process it. By gently compressing tissue, fluid should not build up and cause problems. Compression is often prescribed to assist with varicose veins and for lymphedema.

There are a variety of compression options, each with its own pros and cons. When you have a fat disorder, wearing a compression garment:

·       Reduces fluid build-up

·       Improves lymphatic flow when used appropriately

·       Reduces pain as long as the garment is properly fitted

·       Can make the limb feel less heavy

·       May help prevent your disorder from progressing

In short, the proper compression garment can improve your quality of life. We recommend that you speak with your therapist, your physician and a qualified garment vendor in order to decide which option works best for you and your limbs.

Compression styles vary by start point (capri, footless, open-toe, closed toe) and end point (thigh, waist, high waist). Arm compression is generally full-arm and may go behind the shoulders. Hand gloves or gauntlets and foot socks are available.

Every patient is different, but most typical lipedema patients benefit from wearing something that starts below the ankle (such as mid-foot), runs up the entire leg, and over the abdomen (lipedema tissue and fluid buildup can occur up through the bra line). For arms, something that starts below  the wrist cuff and runs up the whole arm is likely to be best.

Compression also varies by customizability and therefore by price. Standard sizes and shapes can be purchased on the internet and at drug stores BUT those are made for people with standard shapes, NOT necessarily for lipedema-shaped bodies. It is very important to have more pressure applied further from your trunk than closer to your trunk (this is called ‘graded’ or ‘gradient’ compression). Applying more pressure closer to the trunk actually impairs the lymphatic flow and encourages more swelling further out which is the opposite of what we are trying to accomplish. Customized garments are ideal, but you must find someone who can fit your body appropriately and have them made for your body. Custom garments can be hundreds or thousands of dollars and take a long time to manufacture, which can be problematic when people’s bodies change quickly.

Circular Knit and Flat Knit Garments

Circular knit compression garments are sold both over the counter and through prescription/custom made and work to contain the skin by being slightly smaller than the limb for which they are fitted. Those that are sold over the counter are typically made of nylon, have four-way stretch (meaning they stretch both in length and in width), and range in compression strength from 8-15 mmHg.  They’re thin, which can make them more comfortable, and they have gradient compression, meaning they’ll be tighter at the foot and ankle than at the knee or thigh.  The downside of the thinner material is that the garment may bunch behind the knee or ankle, causing discomfort. 

Prescription or custom made garments are usually a thicker circular knit made of nylon or a nylon-cotton blend, or a flat knit, and have a higher compression strength range from 20-30 or 30-40 mmHg. The flat knit also has a seam, and is often preferred for larger or abnormally shaped limbs. Many patients find that a thicker flat knit compression garment is less painful than its circular knit cousin. The downside is that the flat knit stretch is only two-way, making it both more difficult to fit, and less forgiving.  It’s also more expensive.  

Brand names:  Jobst, Juzo, Medi, Sigvaris

Micro Massaging Garments

Micro massaging garments use a textured 3D knit cotton/poly/spandex material that’s designed to stimulate the superficial lymphatics by stretching the top layer of skin when the body is moving. They have a low compression level, ranging from 12-21 mmHg, and the most stretch of any of the garments, which is their biggest advantage. Because they aren’t difficult to get on or painful to wear, they have the highest rate of patient compliance. However, these garments only focus on the superficial lymphatics and don’t contain the limb as well as stronger compression garments.

Brand names: Bioflect, Solidea

Inelastic Garments

Inelastic garments have very little stretch, the theory being that the only way to not “re-swell” is to make them out of something that acts almost like a cast upon the limb. Since there’s no “give” to the material, they’re held in place with neoprene straps and Velcro. Inelastic garments may be suited for limbs that are shaped like an upside down champagne bottle, have an overhang around the wrist or ankle, have venous and/or lymphatic disease, lipo-lymphatic issues or are painful.

The downside to inelastic garments is that they’re difficult to get on. It not only requires strength in the hands, but if you can’t reach to the end of your own limb, you’ll need assistance. The base of the garment may slide down and bite the top of the foot or end of the limb.

Brand names: BiaCare, Circaid, Farrow, Juzo, Solaris

Short Stretch Compression Garments

Short Stretch compression garments are made of a cotton/elastic material that stretches only about forty percent of its length, providing a steady, low level of compression when resting that increases when you stand or are active.  The result is a more comfortable garment that can react to the actual needs of your limb. This adaptable compression technology not only significantly improves venous and lymphatic function, but also aids active muscle assistance to the veins.

This garment has a spine in the back with short stretch elastic bands that attach with Velcro in front of the limb. It’s easier to put on than either a circular knit/flat knit or inelastic garment, and if there’s still some swelling in the limb, it will  help it to shrink in size. If you have frail skin, this garment will need a padded sleeve protector or lining. The short stretch garment isn’t as bulky as the in-elastic garment, but it does not last as long either.

Brand names: Farrow Wrap

Nighttime Garments

Some patients may require an additional compression garment at night to break up fibrotic tissue and reduce swelling. The outside of these garments is typically made of a spandex wicking fabric, padded with foam chips or seams that follow the channels of your lymphatics. You can also buy a padded sleeve to wear with short stretch bandages.  The advantage of nighttime garments is that they’ll help you to maintain your limb size without frequent trips to the therapist.  The disadvantage is that they’re thick and bulky, which can be both uncomfortable and hot, as well as expensive. Costs can vary from several hundred to several thousand dollars.  Many insurance companies will cover night time garments with a prescription from your physician. Be sure to contact your insurance company to discuss pre-approval and coverage options.

Brand names: BiaCare, Circaid, Jovi Pack, Peninsula Medical, Solaris