Intermittent compression review
- 1. Intermittent Compression ReviewCasey Christy, MA, ATC, CSCS
- 2. How It WorksMechanical pressure produced by the intermittent compression forces fluids within the venous system back towards the heart.
- 3. How It WorksIntermittent compression reduces the pressure gradient between the tissue hydrostatic pressure and the capillary filtration pressure (see cap. filt. pressure powerpointto learn more), which encourages the reabsorption of interstitial fluids.
- 4. How It WorksA second pressure gradient is created between the distal portion (high pressure) and the proximal portion (low pressure) of the extremity, resulting in fluid movement.
- 5. How It WorksSpreading the edema proximally over a larger area allows more lymphatic ducts to absorb the solid matter within the edema.
- 6. How It WorksWhen treating lower leg edema with a pressure of 35-55 mm Hg, venous flow velocity increases 175 percent. When using pressures between 90 and 100 mm Hg, venous flow accelerates 336 percent!
- 7. IC TypesThere are two basic types of intermittent compression units, circumferential and sequential. Both can significantly reduce edema in an injured extremity.
- 8. IC TypesCircumferential units apply an equal amount of pressure to all parts of the treated extremity at the same time.
- 9. IC TypesSequential units have pressure chambers within the sleeve (called a garment) placed around the extremity, and these chambers fill sequentially from distal to proximal. For example, the most distal chamber fills first, then the next compartment and so on. This results in a distal to proximal pressure gradient.
- 10. IndicationIntermittent compression is used to reduce edema. Combine with elevation for optimal benefit.
- 11. ApplicationThe pressure used should not exceed the patient’s diastolic blood pressure. Maximum pressure ranges used for treating the upper extremity are 40-60 mm Hg; 60-100 for the lower extremity.
- 12. ApplicationSome manufacturers recommend a pressure setting 10% below the patient’s diastolic blood pressure.
- 13. ApplicationFor sanitary precautions, cover the area to be treated with stockinette. Make sure there are no wrinkles as this can cause high pressure areas and subsequent bruising.
- 14. ApplicationFor sanitary precautions, cover the area to be treated with stockinette. Make sure there are no wrinkles as this can cause high pressure areas and subsequent bruising.
- 15. ApplicationStarkey recommends a 3:1 on/off time cycle (45 seconds on, 15 seconds off) for a 20-30 minute treatment time (Denegar recommends 30-40 seconds on, 20-30 seconds off).
- 16. ApplicationStarkey recommends a 3:1 on/off time cycle (45 seconds on, 15 seconds off) for a 20-30 minute treatment time (Denegar recommends 30-40 seconds on, 20-30 seconds off).
- 17. ApplicationEncourage the patient to perform gentle ROM exercises (wiggle fingers or toes) during the off time. Instruct the patient to notify you if pain or a “tingling” feeling occurs.
- 18. ApplicationEncourage the patient to perform gentle ROM exercises (wiggle fingers or toes) during the off time. Instruct the patient to notify you if pain or a “tingling” feeling occurs.
- 19. ContraindicationsContraindications include but are not limited to:Deep Vein ThrombosisCompartment syndromesVenous and other vascular insufficienciesFracture Pulmonary edemaCongestive hear failure and other circulatory diseases (ie: arteriosclerosis)
- 20. ReferencesDenegar et al, Therapeutic Modalities for Musculoskeletal Injuries, 3rd editionKnight and Draper, Therapeutic Modalities: The Art and ScienceStarkey, Therapeutic Modalities, 3rd edition