Compression apparel generally refers to unique, tight-fitting, elastic socks that provide gentle external compression on the lower extremities of the wearer’s body. Compression socks are popular among patients who suffer from circulatory problems and increased fluid accumulation (oedema) in the lower limbs. There are different types of compression apparel such as; sleeves, stockings, leotards and pantyhose, which come in a variety of pressure levels depending on the location and swelling the wearer happens to have. Compression apparel also comes in a variety of colours, length, textile material, design and can be bought from a variety of manufacturers. Most compression socks require a prescription for purchase, but some types are available for over the counter purchase at pharmacies. You can also purchase compression socks from an online retailer or at a medical supply company.
How do they work?
Compression socks basically act as a support system for blood circulation and lymphatic drainage in your feet and legs. Gravity continuously impedes the return of venous blood to the heart, having additional complications such as; inability to move legs especially after surgery or injury, weakness in venous walls (venous insufficiency) or spending a significant amount of your time on your feet or airplanes could result to blood pooling in the superficial veins of the lower limbs which could lead to the formation of a venous clot, pain in your legs, leg fatigue and swelling. Compression socks help by exerting a high degree of pressure on your legs, which is meant to aid your blood vessels to work better. This pressure ensures that blood in your veins flows upwards towards your heart instead of refluxing downwards to your feet or laterally to your superficial veins. It also reduces the diameter of major veins, thus increasing the amount of blood flowing through them and the speed at which it does so. The pressure exerted by the socks can also improve the flow of lymph, which enables better drainage of interstitial fluid (the fluid that bathes the cells). These actions, reduce swelling in the tissues increase the amount of oxygen flowing to the limbs (improve circulation), improve lymphatic drainage, cutaneous oxygenation and microcirculation, efficiency of skeletal muscle pumps due to reduced venous diameter, reinforce weakened venous walls (treat venous insufficiency) and provide comfort even in the absence of a medical condition.
Who can benefit from wearing compression socks?
The enhanced blood circulation as a result of wearing compression socks makes it harder to for blood to pool in the lower extremities. This effect may reduce the possibility of a deep vein thrombosis which occurs when a blood clot develops in the limbs and the pain, swelling and discomfort that ensue (post-thrombotic syndrome). Compression socks may also be useful in the prevention and treatment of spider and varicose veins, prevention of leg swelling in pregnant women, boosting of lower extremity circulation in bedridden patients or those who cannot move their feet and should increase comfort in people who have to spend a significant amount of time on their feet and on airplanes. Compression socks have also been used in the prevention of lower extremity muscle fatigue, reduction of post-exercise discomfort and improvement of performance and recovery time in athletes, although there is no proof that compression socks are effective in these ways. Compression socks may be prescribed by a health care provider in the following clinical conditions;
Primary chronic venous disease
Patients with this condition often experience symptoms of itchiness, edema, eczema, ulceration and pain in the legs. Although not curative, compression socks are often used in this condition as a means to relieve symptoms, alleviate discomfort and prevent further deterioration. Compression socks with a pressure gradient of 10-15 mm Hg should reveal significant improvement in pain and discomfort levels, activity levels and overall well-being.
Chronic venous insufficiency
Compression socks are a generally accepted intervention for the management of chronic venous insufficiency. There is overwhelming evidence that compression therapy has the capacity to facilitate rapid healing of the venous ulcers associated with this condition. The average time it takes to heal venous ulcers is significantly lower and is characterized by a lesser degree of pain when compression socks are used instead of bandages. High compression socks (30-40 mm Hg) are generally more effective than medium and low compression socks in the promotion of ulcer healing and prevention of recurrence.
AS stated earlier, post-thrombotic syndrome refers to complications such as pain, swelling, skin changes and ulceration that occur after deep vein thrombosis. Patients with deep vein thrombosis should wear compression socks with an ankle pressure that exceeds 23mm Hg for two years after initial diagnosis to prevent the occurrence of post-thrombotic syndrome and alleviate symptoms of leg pain and swelling.
Sometimes the body may retain fluids in specific areas within the body such as the legs, arms and the abdomen. This retention occurs as a result of impaired lymphatic drainage of interstitial fluid and may cause chronic swelling in the limbs known as Lymphedema. Compression therapy is often employed in the second phase of treatment as a long term intervention for the maintenance of lymphatic drainage. For chronic lymphedema, the highest level of compression tolerable is recommended as the most likely to be beneficial while lower levels of compression can be used for patients with milder forms of lymphedema or general leg edema.
Compression socks assist in the management of this condition by relieving local symptoms such as pain and swelling and preventing the spread of venous thrombosis.
Pregnancy often carries additional complications such as edema, pain and swelling in the legs. The use of compression socks may improve the degree of venous drainage and alleviate the discomfort associated with such complications.
Do you need compression socks?
If you are having problems with leg pain and swelling, it may be beneficial to ask your health care provider if compression socks could help alleviate your symptoms. It may also be worthwhile to consider wearing compression socks with a low level of compression if you spend a lot of time on airplanes or in your feet to increase comfort and prevent the occurrence of spider and varicose veins. Although the benefits of wearing compression socks have not been proven for this use, you may want to consider the supposed benefits of wearing compression socks if you are an athlete. If compression therapy does not improve performance and recovery time for you, it will reduce the pain and discomfort often associated with high performance sports.
For more information on the types of compression socks and pressure gradients involved in compression therapy click on our next article.