To compress or not to compress?

Jennifer Dunn helps us understand the use of compression therapy and when it is needed.

After the removal of lymph nodes, whether in the neck, armpit or groin, patients will often be told to seek out a compression garment to reduce the risk of long-term swelling (lymphoedema). Research has taken us in many directions over the past few years when it comes to compression, making it difficult to make the right decision.

What is compression therapy?

In simple terms, compression therapy is when an external force from outside the body is used; it’s considered the most effective non-surgical management of venous and lymphatic diseases.

In most instances, this compression will take the shape of a stocking or sleeve but can also be a provided by a wrap or foam sock.

Compression garments are either flat knit or circular knit; this refers to the way the garment has been stitched together.

As a rule of thumb, circular knit garments are usually recommended for vein-related problems and flat knit for lymph-related problems, although they are used interchangeably depending on individual needs. A flat knit garment is generally more rigid while a circular knit has more stretch and give.

Compression garments are rated according to the amount of pressure they exert on the body and are classed as:

  • Class 1 (15 – 20mmhg)
  • Class 2 (20 – 30mmgh)
  • Class 3 (30 – 40mmgh)
  • Class 4 (40 – 50mmgh)

According to the STRIDE document, published in 2019, which serves as a guide to health professionals on prescribing compression, patients with early lymphoedema should be fitted with a class 1 or 2 garment, while patients with a more severe lymphoedema would need a class 2 or 3.

Who should receive compression therapy?

A randomised controlled trial, completed in 2021, researched the effect on prophylactic use of compression garments after an axillary node dissection (removal of lymph nodes) in breast cancer. The study found that wearing a lightweight compression garment for the first three months post-operatively and thereafter when exercising, significantly reduced the incidence of lymphoedema in the first two years.

According to the National Institute of Health, any person with swelling that persists for three months is considered to have lymphoedema and should be wearing compression to prevent oedema worsening.

Generally, in South Africa, opinions differ depending on the background and training of the health professional. As a certified lymphoedema therapist, my patients are encouraged to wear compression for at least eight hours a day if they are experiencing swelling that can’t be controlled by only massage and exercise.

The Lymphoedema Association of South Africa (LAOSA) advocates for the use of a compression garment on an at-risk limb when travelling as part of their risk-reduction strategies.

Where do I get a compression garment?

Compression therapy is covered by most medical aids for patients who are on an oncology plan. Within the state sector, these garments are available on tender in most provinces, usually from the occupational therapy or nursing departments.

It’s important that the compression garment you receive is measured for you, as an incorrectly sized garment can cause swelling to worsen instead of getting better.

It’s advised to visit an orthotist (a specifically trained healthcare professional who works with medical supportive devices) with compression experience or a certified lymphoedema therapist to ensure you get the combination of size, class, and type of knit that is suited to your specific swelling. LAOSA provides a list of certified therapists from across the country.

It’s important to remember that compression garments are made to last for six months when used regularly and should be replaced twice a year to ensure that they remain effective.

Things to consider

Compression therapy is something that most people will shy away from, but it can do wonders to prevent unnecessary swelling and related loss of function and pain.

New advances in the field mean that compression is available in attractive colours and patterns, as well as softer and gentler fabrics.  Devices to help apply your garment are available and are often simpler than you might think to use. Compression shouldn’t be considered a life sentence, but rather a tool to a more functional, less uncomfortable you.

Jennifer Dunn is an occupational and lymphoedema therapist who also has certification in cancer rehabilitation. Her practice, based in Cape Town, focuses on adult physical rehabilitation, especially in the field of oncology.

MEET THE EXPERT – Jennifer Dunn

Jennifer Dunn is an occupational and lymphoedema therapist who also has certification in cancer rehabilitation. Her practice, based in Cape Town, focuses on adult physical rehabilitation, especially in the field of oncology.

Header image by Adobe Stock

This article is sponsored by Essity in the interest of education, awareness and support. The content and opinions expressed are entirely of the healthcare professional and not influenced by Essity in any way.