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COMPRESSION THERAPY

 INTRODUCTION:

  • Compression Therapy is a mechanical force that increases external pressure on the body or body part.

Types:
1.Static Compression
2.Intermittent Compression

Uses of Compression

  • Improve fluid balance (by increasing hydrostatic pressure in the interstitial space)
  • Improve circulation
  • To modify scar tissue formation.
  • Clinical Application
Compression is used for

  • Control of peripheral edema
  • Prevention of DVT
  • Residual limb shaping
  • Healing of venous ulcers
Effects of Compression
  • Improve Venous and lymphatic Circulation
  • Limit the shape and size of tissue
  • Increases tissue temperature
Venous and lymphatic Circulation.

  • Both static and intermittent compression devices can be used but intermittent compression is more effective than static.
  • It can cause a wave of vessel constriction moving in a proximal direction.
  • Improving circulation can benefit patients with edema & DVT(Deep vein thrombosis).
  • Shape and size of Tissue.
  • Static compression garments can limit the shape and size of new tissue formation.
  • This type of compression device acts as a second skin, which, having less elasticity than skin thus limit the shape and size of tissue.
The compression garments can be used over:

a.Residual limb after amputation
b.Burn damaged skin
c.Edematous limb

  • Tissue Temperature
  • Compression devices increase superficial tissue temperature by insulating the area to which it is applied.
  • It is proposed that warmth produce by compression garments increases the activity of temperature sensitive enzyme which breakdown collagen such as collagenase.
Clinical indications
1.Edema
2.Prevention of deep vein thrombosis
3.Venous stasis ulcers
4.Residual limb shaping after amputation
5.Control of hypertrophic scarring

Edema

Causes:

  • Venous or lymphatic obstruction
  • Increased capillary permeability
  • Increase plasma volume
  • Exercise
  • Trauma
  • Surgery
  • Burn
Pathology:

  • Normal fluid equilibrium is maintained by balance between hydrostatic and osmotic pressure inside and outside the blood vessels.
  • When there is disturbance in this normal mechanism edema occurs.
  • A healthy diet, vascular system and muscular contraction act together to ensure that appropriate amount of fluid exits in veins and flow back to heart.
  • Dysfunction in any of these mechanisms can result in increased movement of fluid from the vessels into the extra vascular fluid.
  • Edema caused by venous insufficiency
  • The peripheral veins function is to carry deoxygenated blood from the periphery back to heart.
  • When the calf muscles contract they exert a pressure of 200 mmHg on veins and pushes the fluid proximally.
  • After contraction, pressure on veins falls allowing veins to refill.


pic

Venous insufficiency can be the result of:

  • Lack of physical activity
  • Dysfunction of venous valves
  • Mechanical obstruction of the veins by tumor
  • Phlebitis
Lymphedema

  • Lymphatic system consist of large network of vessels and nodes through which lymph flows and drain into circulatory system for elimination.
  • By any mechanism/cause if there is disturbance in this normal mechanism, lymphedema occurs.

    Etiology:

  • Decreased level of plasma protein
  • Mechanical obstruction of lymphatics
  • Abnormal distribution of lymphatic vessels or lymph nodes
If the plasma protein level drops below 3.3 gm/dL, lymphedema likely to occur.

pic

Types of lymphedema:
i.Primary lymphedema
ii.Secondary lymphedema

Adverse effects of edema

  • Impaired ROM
  • Limitation of function
  • Pain
  • Induration of skin
  • Increase risk of infection
  • Cellulitis
  • Ulceration
  • Amputation
  • Dermatitis
  • Brown skin pigmentation

pic

Principles of compression therapy:

  • Compression controls edema by increasing extravascular hydrostatic pressure and by promoting circulation.
  • The hydrostatic pressure in the interstitial space becomes greater reducing the outflow of fluid from the vessels.

Prevention of DVT:

  • Deep venous thrombosis (DVT) is a blood clot in the deep veins which occur with reduced local circulation.
  • Any intervention that increases the circulatory rate may therefore reduce the risk of thrombus formation.
  • Compression improves venous flow and inhibit thrombus formation.
Risk factors for DVT include:

  • Older age
  • Surgery
  • Trauma
  • Paralysis
  • Varicose veins
pic DVT

Immobilized patients

  • Thrombus may become embolus that travels in blood and may block blood supply in lung which causes pulmonary embolism which result in shortness of breath, respiratory failure, or death.
Venous Stasis Ulcers:
  • Venous Stasis Ulcers are areas of tissue breakdown and necrosis that occur in the areas of impaired venous circulation.
  • Elevation in venous


  • Multi-layered or high pressure compression therapy is more effective for the treatment of venous stasis ulcers.
  • Most effective position is supine lying as compared to standing.
  • The mechanism by which compression facilitates healing of venous stasis ulcers include improved venous circulation, reduced venous pooling and reflux and improved tissue oxygenation.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

 SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER

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