Intermittent
Compression
Devices
Jennifer Doherty-Restrepo, ATC, LAT
Entry-Level Athletic Training Education Program
PET 4995: Therapeutic Modalities
Definitions

Edema
 Abnormal
amounts of fluid in extracellular tissue
spaces

Joint swelling
 Blood
and/or fluid accumulation
 Appears and feels like a water balloon

Lymphedema
 Accumulation
of lymph in subcutaneous tissues
 Occurs over several hours following injury
The Lymphatic System


Pick up plasma and plasma proteins that escape
from small blood vessels and return them to
blood circulation
Acts as a safety valve for fluid overload
 Prevents

edema formation
Maintains homeostasis of extracellular
environment
 Removes
excess protein molecules and waste from
the interstitial fluid

Cleanses interstitial fluid
 Blocks
thes spread of infection or malignant cells
The Lymphatic System



Closed vascular
system
Parallels arterial
system
Lymphatic capillaries
made of single
layered endothelial
cells
The Lymphatic System


Lymphatic capillaries
are surrounded by
interstitial fluid
Terminal lymphatics
provide entry way into
lymphatic system for
excess interstitial fluid
and plasma proteins
The Lymphatic System



Lymphatic capillaries
form a network of
lymphatic vessels
Lead to larger Collecting
Vessels in extremities
Collecting vessels
connect with thoracic duct
or right lymphatic duct,
which join the venous
system
The Lymphatic System

Fluid moving into interstitial spaces pushes or pulls on
fibrils



Fibrils = connective tissue fibers supporting lymphatic capillaries
Endothelial cell junctions in lymphatic capillary wall open
Allows entry of interstitial fluid,
cellular waste, large protein
molecules, plasma proteins,
extracellular particles, and
cells into terminal lymphatics
The Lymphatic System


Once in the terminal lymphatics, the interstitial
fluid, cellular waste, large protein molecules,
plasma proteins, extracellular particles, and cells
become lymph
Endothelial cell junctions in lymphatic capillaries
remain closed when there is …
 No
 No

increase in interstitial volume
tissue activity
Movement of lymph is accomplished via muscle
activity, active and passive motion, elevation,
respiration, and blood vessel contraction
Injury Edema: Pitting Edema
Local edema
 Formed by plasma, plasma proteins, and
cellular debris moving into interstitial
spaces
 Hormones released by injured cells
stimulate small anterioles, capillaries and
venules to vasodialate separating
endothelial cells in vessel wall

 Increases
permeability
Injury Edema: Pitting Edema



Increased permeability
allows more plasma,
plasma proteins, and
cellular debris to escape
into local area
Results in gel-like fluid
that is trapped by
collagen fibers
Gel-like fluid referred to
as pitting edema
Injury Edema: Lymphedema

Accumulation of edema causing
overdistention of lymph capillaries
 Entry
pores become ineffective and interstitial
fluid increases
Lymphedema results
 Constriction of lymph capillaries due to
increased pressure will also discourage
lymph flow and cause lymphedema
formation

Negative Effects of Edema


Edema compounds injury by causing secondary
hypoxic cellular death in surrounding tissues
Other negative effects include:
 Physical
separation of torn tissue ends
 Pain
 Restricted
joint range of motion
 Prolonged recovery times
 Interstitial fibrosis
 Reflex sympathetic dystrophy
Treatment of Edema

P.R.I.C.E.
 Minimize
edema
formation

E-stim or AROM
exercises
 Retard
edema
accumulation

Any treatment that assists lymph flow will
decrease plasma protein content in
interstitial spaces and decrease edema
Treatment of Edema: Elevation


Gravity used to assist
lymph flow
The higher the
elevation, the greater
the effect on the
lymph flow
Treatment of Edema: Compression

Muscle contractions provide rhythmic internal
compression of lymph vessels to assist lymph
flow
 Isometrics, AROM

exercise, or E-stim
External compression assists lymph flow
 Massage,
elastic compression, or intermittent
pressure devices

External compression spread interstitial edema
over a larger area, enabling more lymph
capillaries to become involved in removing
plasma proteins
Treatment of Edema:
Weight-Bearing Exercise

Activates a venous pump
 Not

related to muscle activity
Mediated by release of an endothelialderived relaxing factor (EDRF)
 EDRF
is liberated by sudden pressure
changes and it diffuses locally
 Functions to relax smooth muscle and
stimulate blood flow in the veins
Treatment of Edema: Cryotherapy

Cryotherapy used in conjunction with
intermittent compression has shown the
best results in the reduction of post-acute
injury edema
Intermittent Compression
Treatment Parameters
Inflation Pressure
 On/Off Time Sequence
 Total Treatment Time

Inflation Pressure


Loosely correlated
with BP
Most treatment
protocols utilize a
pressure
approximating
diastolic BP
Inflation Pressure


Arterial capillary
pressures ~ 30
mmHg
Any pressure that
exceeds this should
encourage
 Edema
absorption,
and
 Lymph flow
Inflation Pressure



Maximum pressure
should correspond to
diastolic BP
More pressure is not
necessarily better
Enough pressure is
needed to squeeze
lymphatic vessels and
encourage lymph flow
On/Off Time Sequence




On/Off time sequences
are variable
Patient comfort should be
a primary deciding factor
30s on, 30s off is
effective and comfortable
Lymphatic massage

Shorter on/off time
sequences may have an
advantage
Total Treatment Time
Clinical studies show significant limb
volume reduction after 30 minutes of
compression
 A treatment of 10 - 30 minutes may be
adequate unless edema is overwhelming
in volume or is resistant to treatment
 Multiple treatment times per day may also
be an advantage in controlling and
reducing edema

Equipment Setup and Instructions

Compression sleeves
 Half-leg,
full-leg,
half-arm, or full-arm

Connect compression
sleeve (deflated) to
unit via a rubber hose
and connecting valve
Equipment Setup and Instructions



Assess BP and set inflation pressure
Set On-time (between 30 to 120 seconds)
Off-time is left at 0 until the compression sleeve
is inflated and treatment pressure is reached
 Then


adjust off-time between 0 and 120 seconds
During the off-time, instruct patient to move
extremity
Treatment should last between 20 - 30 minutes
Cold and Compression
Combination


Combination of cold and
compression is effective
in treating edema
Cold/compression unit


Temperature adjustment
o
ranges between 10 - 25 C
Cooling accomplished by
circulating cold water
through compression
sleeve
Compression and Electrical
Stimulating Currents


Combination of
compression and
e-stim induced
muscle pumping is
effective in treating
edema
Facilitates
reabsorption of injury
byproducts by
lymphatic system
Sequential Compression Pumps




Sequentially inflate
compression sleeves
with multiple
compartments
Massage effect
Applies pressure from
distal to proximal
Gradual decrease in
pressure gradient
Sequential Compression Pumps

Highest pressure in distal
compartment sleeve



Determined by mean value
of systolic to diastolic BP
Middle compartment is
set at 20 mm lower than
the distal cell
Proximal compartment
pressure is reduced an
additional 20 mm
Sequential Compression Pumps






Each pressure cycle is 120s
Distal compartment is
pressurized initially and
continues pressurization for
90s
20s later, the middle
compartment inflates
After another 20s, the proximal
compartment inflates
A final 30s period allows
pressure in all three
compartments to return to 0
Entire cycle is then repeated
Indications
Lymphedema
 Traumatic edema
 Chronic edema
 Stasis ulcers
 Intermittent claudications
 Postoperatively to reduce the possibility of
developing a deep vein thrombosis
 Facilitate wound healing following surgery

Contraindications
Deep vein thrombosis
 Local superficial infection
 Congestive heart failure
 Acute pulmonary edema
 Displaced fractures
 Cancer
