Week 2- Compression PPT PDF

COMPRESSION PHT 1217 – PRINCIPLES AND PROCEDURES SPRING, 2025 REBECCA OVERDORF, PT, DPT  COMPRESSION: OVERVIEW Inward-directed mechanical force that increases external pressure on the body or a body part Generally used to improve fluid balance and circulation or modify t...

COMPRESSION PHT 1217 – PRINCIPLES AND PROCEDURES SPRING, 2025 REBECCA OVERDORF, PT, DPT  COMPRESSION: OVERVIEW Inward-directed mechanical force that increases external pressure on the body or a body part Generally used to improve fluid balance and circulation or modify the formation of scar tissue Improves fluid balance by increasing hydrostatic pressure in the interstitial space so that pressure becomes greater in the interstitial space than in the vessels → This can limit or reverse fluid outflow from blood vessels and lymphatics Allows fluid to circulate through body instead of remaining in peripheral tissues COMPRESSION: CLINICAL APPLICATIONS Control peripheral edema → Primary application Prevent DVT formation Facilitate residual limb shaping after amputation Facilitate healing of venous ulcers Control scar formation. EXTERNAL COMPRESSION: EFFECTS Improves venous and lymphatic circulation Limits shape and size of tissue Increases tissue temperature 4  IMPROVED VENOUS AND LYMPHATIC CIRCULATION Both static and intermittent compression can improve circulation Both increase hydrostatic pressure in interstitial spaces Intermittent compression may be more effective than static “Milks” fluids from distal to proximal vessels 5  SHAPING AND SIZING OF TISSUE Elastic static compression garments or bandages can provide a form that limits the shape and size of new tissue growth Can be especially helpful for: Residual limbs after amputation Skin damaged by burns Edematous limbs SHAPING AND SIZING OF TISSUE (Contd.)  INCREASED TISSUE TEMPERATURE Most compressive devices increase superficial tissue temperature Compression devices insulate area of application → Tissue warmth is retained Warmth increases activity of temperature-sensitive enzymes that break down excessive collagen formation (e.g., collagenase) This can help control scar formation 8  COMPRESSION: INDICATIONS Edema Prevention of deep vein thrombosis (DVT) Venous ulcers Residual limb shaping status post amputation Scar management  EDEMA Excess accumulation of fluid in interstitial spaces caused by imbalance between hydrostatic and oncotic pressures Hydrostatic pressure: Force pushing fluid out of blood vessels (BP, gravity) Oncontic (osmotic) pressure: Force pulling fluid back into capillaries (high concentration of proteins) Hydrostatic pressure is normally higher than oncotic pressure Healthy lymphatic system returns interstitial fluid to venous circulation HYDROSTATIC AND ONCOTIC PRESSURE: EFFECTS ON TISSUE FLUID BALANCE  EDEMA: CAUSES Systemic illness (e.g., heart / kidney / liver Increased capillary permeability (exercise, failure) trauma, surgery, burns, infection) DO NOT TREAT WITH COMPRESSION!!! Air travel Venous or lymphatic valve dysfunction Immobility / reduced physical activity Venous insufficiency (e.g., phlebitis) Pregnancy Venous obstruction 12 VENOUS AND LYMPHATIC VALVES NORMAL ABNORMAL  EDEMA: ADVERSE CONSEQUENCES Impaired ROM Limited function Pain Tissue fibrosis / skin induration May lead to disabling contracture or deformity Infection (e.g., cellulitis) LYMPHATIC CIRCULATION  LYMPHEDEMA Chronic disorder characterized by an abnormal accumulation of lymph fluid in the tissues of one or more body regions Can be primary or secondary Primary: Caused by a congenital or hereditary condition Secondary: Caused by disease or dysfunction  COMPRESSION AND EDEMA Static or intermittent compression increases extravascular hydrostatic pressure and promotes circulation With sufficient compression, hydrostatic pressure becomes greater than oncotic pressure → Reduces fluid outflow and drives interstitial fluid back into vessels / circulation Intermittent sequential compression may also help move fluid proximally through vessels (i.e., “milking” mechanism) 17  COMPRESSION: DVT PREVENTION Risk of DVT increases with reduced local circulation Compression can increase circulation / reduce risk of DVT formation Most effective when used in combination with other forms of DVT prophylaxis (e.g., anticoagulants, active movement) CONTRAINDICATED WHEN DVT IS ALREADY PRESENT 18  COMPRESSION: VENOUS ULCERS Venous ulcer: Area of tissue breakdown and necrosis that occurs in areas of impaired venous circulation Compression can prevent or facilitate healing of venous ulcers by: Improving venous circulation Reducing venous pooling and reflux Improving tissue oxygenation Compression is the gold-standard, first-line approach for treating and preventing the recurrence of venous ulcers → Is the cornerstone of treatment 19 VENOUS STASIS ULCER COMPRESSION: RESIDUAL LIMB SHAPING After amputation, the residual limb needs to be reduced and shaped in preparation for functional weightbearing on a prosthetic device Compression reduces residual limb size by controlling postsurgical edema and preventing soft tissue stretching from fluid accumulation Both static and intermittent compression are used Intermittent compression can reduce the residual limb in approximately half the time required by other techniques 21  COMPRESSION: HYPERTROPHIC SCARRING Hypertrophic scarring: Excessive scarring within boundaries of original skin injury Common complication of deep burns / other extensive skin injuries Not pliable Have a hard, raised appearance Have no clearly defined skin layers Can result in development of contractures that may restrict ROM and function Compression is standard first-line approach Compression acts as a mold for growth of new tissue 22  CONTRAINDICATIONS AND PRECAUTIONS: ALL TYPES OF COMPRESSION THERAPY CONTRAINDICATIONS PRECAUTIONS Edema caused by venous or lymphatic Stable CHF / cardiomyopathy blockage Neuropathy → Patient should be carefully Active infection or malignancy in affected monitored extremity Be careful when applying and removing Symptomatic heart failure compression bandages or garments → Avoid Existing or recent DVT trauma to healing tissue or fragile skin Phlebitis  CONTRAINDICATIONS: COMPRESSION PUMPS INTERMITTENT AND SEQUENTIAL COMPRESSION PUMPS ARE CONTRAINDICATED FOR: Symptomatic heart failure or pulmonary Acute local skin infection (e.g., cellulitis) edema Significant hypoproteinemia (protein Recent or acute DVT, thrombophlebitis, levels