intermittent compression devices definitionsdefinitions edema - presence of abnormal amounts of...

Intermittent CompressionIntermittent CompressionDevicesDevices

Intermittent CompressionIntermittent CompressionDevicesDevices

DefinitionsDefinitionsDefinitionsDefinitions

• EdemaEdema - presence of abnormal amounts - presence of abnormal amounts of of fluid in extracellular tissue spaces fluid in extracellular tissue spaces

• Joint swellingJoint swelling-blood and joint fluid -blood and joint fluid accumulated immediately following injury accumulated immediately following injury appearance and feel of a water balloon appearance and feel of a water balloon

• Lymphedema-Lymphedema- swelling in subcutaneous swelling in subcutaneous tissues results from excessive tissues results from excessive accumulation of accumulation of lymph lymph occuring over occuring over several hours following injuryseveral hours following injury

• EdemaEdema - presence of abnormal amounts - presence of abnormal amounts of of fluid in extracellular tissue spaces fluid in extracellular tissue spaces

• Joint swellingJoint swelling-blood and joint fluid -blood and joint fluid accumulated immediately following injury accumulated immediately following injury appearance and feel of a water balloon appearance and feel of a water balloon

• Lymphedema-Lymphedema- swelling in subcutaneous swelling in subcutaneous tissues results from excessive tissues results from excessive accumulation of accumulation of lymph lymph occuring over occuring over several hours following injuryseveral hours following injury

Purposes Of The Lymphatic Purposes Of The Lymphatic SystemSystem


• As plasma and plasma proteins escape from As plasma and plasma proteins escape from small blood vessels they are picked up by small blood vessels they are picked up by lymphatic system and returned to blood lymphatic system and returned to blood circulationcirculation

• Lymphatic system acts as a safety valve for Lymphatic system acts as a safety valve for fluid overload thus a sudden local increase in fluid overload thus a sudden local increase in the interstitial fluid casues pitting edema the interstitial fluid casues pitting edema

• Maintains homeostasis of extracellular Maintains homeostasis of extracellular environment by removing excess protein environment by removing excess protein molecules and waste from the interstitial fluidmolecules and waste from the interstitial fluid

• As plasma and plasma proteins escape from As plasma and plasma proteins escape from small blood vessels they are picked up by small blood vessels they are picked up by lymphatic system and returned to blood lymphatic system and returned to blood circulationcirculation

• Lymphatic system acts as a safety valve for Lymphatic system acts as a safety valve for fluid overload thus a sudden local increase in fluid overload thus a sudden local increase in the interstitial fluid casues pitting edema the interstitial fluid casues pitting edema

• Maintains homeostasis of extracellular Maintains homeostasis of extracellular environment by removing excess protein environment by removing excess protein molecules and waste from the interstitial fluidmolecules and waste from the interstitial fluid



• Cleanses interstitial fluid and provides a Cleanses interstitial fluid and provides a blockade to spread of infection or blockade to spread of infection or malignant cells in lymph nodesmalignant cells in lymph nodes

• Cleanses interstitial fluid and provides a Cleanses interstitial fluid and provides a blockade to spread of infection or blockade to spread of infection or malignant cells in lymph nodesmalignant cells in lymph nodes

Structure of the Lymphatic Structure of the Lymphatic SystemSystem


• Closed vascular system Closed vascular system of of endothelial cellendothelial cell lined lined tubes that parallel tubes that parallel arterial and nervous arterial and nervous system system

• Lymphatic capillaries Lymphatic capillaries made of single made of single layered endothelial layered endothelial cells with cells with fibrilsfibrils radiating from junctions radiating from junctions of endothelial cellsof endothelial cells

• Closed vascular system Closed vascular system of of endothelial cellendothelial cell lined lined tubes that parallel tubes that parallel arterial and nervous arterial and nervous system system

• Lymphatic capillaries Lymphatic capillaries made of single made of single layered endothelial layered endothelial cells with cells with fibrilsfibrils radiating from junctions radiating from junctions of endothelial cellsof endothelial cells



• Fibrils support lymphatic Fibrils support lymphatic capillaries and anchor them capillaries and anchor them to surrounding connective to surrounding connective

tissuetissue• Capillary is surrounded Capillary is surrounded by by

interstitial fluid interstitial fluid • Lymphatic capillaries Lymphatic capillaries

called called terminal lymphaticsterminal lymphatics provide provide entry way into lymphatic system for excess entry way into lymphatic system for excess interstitial fluid and plasma proteinsinterstitial fluid and plasma proteins

• Fibrils support lymphatic Fibrils support lymphatic capillaries and anchor them capillaries and anchor them to surrounding connective to surrounding connective

tissuetissue• Capillary is surrounded Capillary is surrounded by by

interstitial fluid interstitial fluid • Lymphatic capillaries Lymphatic capillaries

called called terminal lymphaticsterminal lymphatics provide provide entry way into lymphatic system for excess entry way into lymphatic system for excess interstitial fluid and plasma proteinsinterstitial fluid and plasma proteins



• These lymphatic capillaries join together in network of

lymphatic vessels that eventually lead to

larger collecting vessels in extremities

• Collecting vessels connect with thoracic duct or right lymphatic

duct which join the venous system in the left and right cervical area

• These lymphatic capillaries join together in network of

lymphatic vessels that eventually lead to

larger collecting vessels in extremities

• Collecting vessels connect with thoracic duct or right lymphatic

duct which join the venous system in the left and right cervical area

Peripheral Lymphatic Structure Peripheral Lymphatic Structure and Functionand Function


• Fluid moving into interstitial Fluid moving into interstitial spaces pushes or pulls on spaces pushes or pulls on

fibrils supporting terminal fibrils supporting terminal lymphatics forcing endothelial lymphatics forcing endothelial

cells to gap apart creating cells to gap apart creating anan opening in terminal opening in terminal lymphaticslymphatics for entry of for entry of interstitial fluid, cellular waste, large protein interstitial fluid, cellular waste, large protein molecules, plasma proteins, extracellular molecules, plasma proteins, extracellular particles, and cells into lymphatic channelsparticles, and cells into lymphatic channels

• Fluid moving into interstitial Fluid moving into interstitial spaces pushes or pulls on spaces pushes or pulls on

fibrils supporting terminal fibrils supporting terminal lymphatics forcing endothelial lymphatics forcing endothelial

cells to gap apart creating cells to gap apart creating anan opening in terminal opening in terminal lymphaticslymphatics for entry of for entry of interstitial fluid, cellular waste, large protein interstitial fluid, cellular waste, large protein molecules, plasma proteins, extracellular molecules, plasma proteins, extracellular particles, and cells into lymphatic channelsparticles, and cells into lymphatic channels



• Once the interstitial fluid and proteins enter these channels they become lymph

• If no tissue activity or interstitial volume increase takes place endothelial junctions remain closed

• Muscle activity, active and passive movements, elevated positions, respiration and blood

vessel pulsation, all aid in the movement of lymph

• Once the interstitial fluid and proteins enter these channels they become lymph

• If no tissue activity or interstitial volume increase takes place endothelial junctions remain closed

• Muscle activity, active and passive movements, elevated positions, respiration and blood

vessel pulsation, all aid in the movement of lymph

Formation of Pitting EdemaFormation of Pitting EdemaFormation of Pitting EdemaFormation of Pitting Edema

• Local edema formed by plasma, plasma proteins and cell debris from damaged cells all move into interstitial spaces

• Hormones released by injured cells stimulate small anterioles, capillaries and venules to vasodialate separating endothelial cells in vessel wall

• Local edema formed by plasma, plasma proteins and cell debris from damaged cells all move into interstitial spaces

• Hormones released by injured cells stimulate small anterioles, capillaries and venules to vasodialate separating endothelial cells in vessel wall

Formation of Pitting EdemaFormation of Pitting EdemaFormation of Pitting EdemaFormation of Pitting Edema

• Increased permeability allows more plasma,

plasma proteins, and leucocytes to escape into

local area• Fluid in the form of a gel is

trapped by collagen fibers and proteoglycan molecules

• Gel prevents the free flow of fluid and is referred to as pitting edema

• Increased permeability allows more plasma,

plasma proteins, and leucocytes to escape into

local area• Fluid in the form of a gel is

trapped by collagen fibers and proteoglycan molecules

• Gel prevents the free flow of fluid and is referred to as pitting edema

Formation of LymphedemaFormation of LymphedemaFormation of LymphedemaFormation of Lymphedema

• If edema causes an overdistention of If edema causes an overdistention of lymph capillaries, entry pores become lymph capillaries, entry pores become ineffective and ineffective and lymphedemalymphedema results results

• Constriction of lymph capillaries or Constriction of lymph capillaries or larger lymphatic vessels from larger lymphatic vessels from increased pressure will also increased pressure will also discourage lymph flow and cause discourage lymph flow and cause intercellular fluid to increaseintercellular fluid to increase

• If edema causes an overdistention of If edema causes an overdistention of lymph capillaries, entry pores become lymph capillaries, entry pores become ineffective and ineffective and lymphedemalymphedema results results

• Constriction of lymph capillaries or Constriction of lymph capillaries or larger lymphatic vessels from larger lymphatic vessels from increased pressure will also increased pressure will also discourage lymph flow and cause discourage lymph flow and cause intercellular fluid to increaseintercellular fluid to increase

Negative Effects of EdemaNegative Effects of EdemaNegative Effects of EdemaNegative Effects of Edema

• Edema compounds extent of injury by causing secondary hypoxic cellular death in surrounding tissues

• Other ill effects of edema include – Physical separation of torn tissue ends – Pain– Restricted joint range of motion. – Prolonged recovery times – Interstitial fibrosis– Reflex sympathetic dystrophy

• Edema compounds extent of injury by causing secondary hypoxic cellular death in surrounding tissues

• Other ill effects of edema include – Physical separation of torn tissue ends – Pain– Restricted joint range of motion. – Prolonged recovery times – Interstitial fibrosis– Reflex sympathetic dystrophy

Treatment of EdemaTreatment of EdemaTreatment of EdemaTreatment of Edema

• Immediate first aid following injury can minimize edema

• Use of ice, compression, electricity, elevation and early gentle motion retards accumulation of fluid and keeps lymphatic system functioning at an optimum level

• Any treatment that encourages lymph flow will decrease plasma protein content in intercellular spaces and decrease edema

• Immediate first aid following injury can minimize edema

• Use of ice, compression, electricity, elevation and early gentle motion retards accumulation of fluid and keeps lymphatic system functioning at an optimum level

• Any treatment that encourages lymph flow will decrease plasma protein content in intercellular spaces and decrease edema

Initial Control of EdemaInitial Control of EdemaInitial Control of EdemaInitial Control of Edema

• Elevation• Compression• Weight bearing

exercise• Cryotherapy

• Elevation• Compression• Weight bearing

exercise• Cryotherapy

ElevationElevationElevationElevation

• Gravity can be used to augment normal lymph flow by encouraging its movement

• The higher the elevation, the greater the effect on the lymph flow

• Gravity can be used to augment normal lymph flow by encouraging its movement

• The higher the elevation, the greater the effect on the lymph flow

CompressionCompressionCompressionCompression

• Rhythmic internal compression Rhythmic internal compression provided by muscle contraction will provided by muscle contraction will squeeze lymph through lymph vessels squeeze lymph through lymph vessels improving its flow back to the vascular improving its flow back to the vascular system Msystem M

• Muscle contraction can be Muscle contraction can be accomplished through isometric or accomplished through isometric or active exercise or through electrically active exercise or through electrically induced muscle contractioninduced muscle contraction

• Rhythmic internal compression Rhythmic internal compression provided by muscle contraction will provided by muscle contraction will squeeze lymph through lymph vessels squeeze lymph through lymph vessels improving its flow back to the vascular improving its flow back to the vascular system Msystem M

• Muscle contraction can be Muscle contraction can be accomplished through isometric or accomplished through isometric or active exercise or through electrically active exercise or through electrically induced muscle contractioninduced muscle contraction

CompressionCompressionCompressionCompression

• External pressure can be used to increase External pressure can be used to increase lymph flow. Massage, elastic compression, lymph flow. Massage, elastic compression, and intermittent pressure devices are most and intermittent pressure devices are most often used external pressure devices often used external pressure devices

• External compression not only moves External compression not only moves lymph along but also may spread lymph along but also may spread intercellular edema over a larger area, intercellular edema over a larger area, enabling more lymph capillaries to become enabling more lymph capillaries to become involved in removing plasma proteinsinvolved in removing plasma proteins

• External pressure can be used to increase External pressure can be used to increase lymph flow. Massage, elastic compression, lymph flow. Massage, elastic compression, and intermittent pressure devices are most and intermittent pressure devices are most often used external pressure devices often used external pressure devices

• External compression not only moves External compression not only moves lymph along but also may spread lymph along but also may spread intercellular edema over a larger area, intercellular edema over a larger area, enabling more lymph capillaries to become enabling more lymph capillaries to become involved in removing plasma proteinsinvolved in removing plasma proteins

Weight Bearing ExerciseWeight Bearing ExerciseWeight Bearing ExerciseWeight Bearing Exercise

• Weight bearing activities activate a Weight bearing activities activate a venous pump venous pump – Mediated by release of an Mediated by release of an endothelial-endothelial-

derived relaxing factor (EDRF)derived relaxing factor (EDRF) and is not and is not related to muscular activity of the limb. related to muscular activity of the limb. • EDRF is liberated by sudden pressure EDRF is liberated by sudden pressure

changes and it diffuses locallychanges and it diffuses locally• Major action is to relax the smooth muscle Major action is to relax the smooth muscle

and stimulate blood flow rates in the veinsand stimulate blood flow rates in the veins

• Weight bearing activities activate a Weight bearing activities activate a venous pump venous pump – Mediated by release of an Mediated by release of an endothelial-endothelial-

derived relaxing factor (EDRF)derived relaxing factor (EDRF) and is not and is not related to muscular activity of the limb. related to muscular activity of the limb. • EDRF is liberated by sudden pressure EDRF is liberated by sudden pressure

changes and it diffuses locallychanges and it diffuses locally• Major action is to relax the smooth muscle Major action is to relax the smooth muscle

and stimulate blood flow rates in the veinsand stimulate blood flow rates in the veins

CryotherapyCryotherapyCryotherapyCryotherapy

• Addition of cryotherapy to intermittent compression has shown the best results in the reduction of post acute injury edema

• Addition of cryotherapy to intermittent compression has shown the best results in the reduction of post acute injury edema

Intermittent Compression Intermittent Compression Treatment ParametersTreatment Parameters

Intermittent Compression Intermittent Compression Treatment ParametersTreatment Parameters

• Inflation PressureInflation Pressure

• On/Off Time SequenceOn/Off Time Sequence

• Total Treatment TimeTotal Treatment Time

• Inflation PressureInflation Pressure

• On/Off Time SequenceOn/Off Time Sequence

• Total Treatment TimeTotal Treatment Time

Inflation PressureInflation PressureInflation PressureInflation Pressure

• Therapeutic pressure settings loosely correlated with blood pressure

• A pressure approximating diastolic blood pressure used in most treatment protocols

• Therapeutic pressure settings loosely correlated with blood pressure

• A pressure approximating diastolic blood pressure used in most treatment protocols


• Arterial capillary pressures are 30 mm Hg

• Any pressure that exceeds this should encourage reabsorption of the edema and movement of lymph

• Arterial capillary pressures are 30 mm Hg

• Any pressure that exceeds this should encourage reabsorption of the edema and movement of lymph


• Maximum pressure should correspond to diastolic blood pressure

• More may not necessarily be better

• Enough pressure is needed to squeeze lymphatic vessels and force lymph to move

• Maximum pressure should correspond to diastolic blood pressure

• More may not necessarily be better

• Enough pressure is needed to squeeze lymphatic vessels and force lymph to move

On/Off SequenceOn/Off SequenceOn/Off SequenceOn/Off Sequence

• On and off time sequences are variable

• In lymphatic massage shorter on-off time sequences may have an advantage

• Athlete comfort should be a primary deciding factor

• On and off time sequences are variable

• In lymphatic massage shorter on-off time sequences may have an advantage

• Athlete comfort should be a primary deciding factor

Total Treatment TimeTotal Treatment TimeTotal Treatment TimeTotal Treatment Time

• Clinical studies show significant gains in limb volume reduction after 30

minutes of compression• A 10- to 30-minute treatment seems

adequate unless edema is overwhelming in volume or is resistant to treatment

• More treatment times per day may also be an advantage in controlling and reducing edema

• Clinical studies show significant gains in limb volume reduction after 30

minutes of compression• A 10- to 30-minute treatment seems

adequate unless edema is overwhelming in volume or is resistant to treatment

• More treatment times per day may also be an advantage in controlling and reducing edema

Equipment Set-Up and Equipment Set-Up and InstructionsInstructions


• Compression sleeves come as either half-leg, full-leg, full-arm, or half-arm

• Deflated compression sleeve is connected to compression unit via a rubber hose and connecting valve

• On time should be adjusted between 30 to 120 seconds

• Compression sleeves come as either half-leg, full-leg, full-arm, or half-arm

• Deflated compression sleeve is connected to compression unit via a rubber hose and connecting valve

• On time should be adjusted between 30 to 120 seconds



• Off time is left at 0 until the sleeve is inflated and treatment pressure is reached then adjusted between 0 and 120 seconds

• When unit cycles off patient instructed to move extremity

• 30-seconds-on/ 30-seconds-off setting is effective and comfortable

• Treatment should last between 20 and 30 min

• Off time is left at 0 until the sleeve is inflated and treatment pressure is reached then adjusted between 0 and 120 seconds

• When unit cycles off patient instructed to move extremity

• 30-seconds-on/ 30-seconds-off setting is effective and comfortable

• Treatment should last between 20 and 30 min

Cold and Compression Cold and Compression CombinationCombination


• Combination of cold and compression has been

shown to be clinically effective in treating some edema conditions

– Jobst Cryotemp - controlled cold/compression unit

• Temperature adjustment ranges between 10 - 25oC• Cooling accomplished by circulating cold water

through sleeve

• Combination of cold and compression has been

shown to be clinically effective in treating some edema conditions

– Jobst Cryotemp - controlled cold/compression unit

• Temperature adjustment ranges between 10 - 25oC• Cooling accomplished by circulating cold water

through sleeve



• Cryo-Cuff is anotherdevice which makes use of a combination of cold and compression which provides an inexpensive means of treating edema

• Cryo-Cuff is anotherdevice which makes use of a combination of cold and compression which provides an inexpensive means of treating edema

Compression and Electrical Compression and Electrical Stimulating CurrentsStimulating Currents

Compression and Electrical Compression and Electrical Stimulating CurrentsStimulating Currents

• Intermittent compression Intermittent compression may also be used in may also be used in conjunction with a low-conjunction with a low-

frequency pulsed or frequency pulsed or surging electrical surging electrical stimulating current to stimulating current to produce muscle pumping produce muscle pumping contractions contractions

• Facilitates resorption of injury byproducts Facilitates resorption of injury byproducts by lymphatic system by lymphatic system

• Intermittent compression Intermittent compression may also be used in may also be used in conjunction with a low-conjunction with a low-

frequency pulsed or frequency pulsed or surging electrical surging electrical stimulating current to stimulating current to produce muscle pumping produce muscle pumping contractions contractions

• Facilitates resorption of injury byproducts Facilitates resorption of injury byproducts by lymphatic system by lymphatic system

Linear Compression PumpsLinear Compression PumpsLinear Compression PumpsLinear Compression Pumps

• Incorporate sequentially Incorporate sequentially inflated multiple inflated multiple compartment designs compartment designs

• Designs have included a Designs have included a programmable gradient designprogrammable gradient design

• Linear pumps incorporate Linear pumps incorporate massage effects of a distal massage effects of a distal

to proximal pressure with a to proximal pressure with a gradual decrease in gradual decrease in pressure gradient pressure gradient

• Incorporate sequentially Incorporate sequentially inflated multiple inflated multiple compartment designs compartment designs

• Designs have included a Designs have included a programmable gradient designprogrammable gradient design

• Linear pumps incorporate Linear pumps incorporate massage effects of a distal massage effects of a distal

to proximal pressure with a to proximal pressure with a gradual decrease in gradual decrease in pressure gradient pressure gradient


• Highest pressure in distal sleeve and is determined by

mean value of systolic to diastolic pressure

• Middle cell is set at 20 mm lower than the distal cell,

proximal cell pressure is reduced an additional 20 mm

• Highest pressure in distal sleeve and is determined by

mean value of systolic to diastolic pressure

• Middle cell is set at 20 mm lower than the distal cell,

proximal cell pressure is reduced an additional 20 mm


• Length of each pressure cycle is 120 seconds

• Distal cell is pressurized initially and continues pressurization for 90 sec.

• 20 seconds later middle cell inflates and after another 20 seconds the proximal cell inflates

• A final 30-second period allows pressure in all three cells to return to 0 after which the

cycle repeats

• Length of each pressure cycle is 120 seconds

• Distal cell is pressurized initially and continues pressurization for 90 sec.

• 20 seconds later middle cell inflates and after another 20 seconds the proximal cell inflates

• A final 30-second period allows pressure in all three cells to return to 0 after which the

cycle repeats

Clinical ApplicationsClinical ApplicationsClinical ApplicationsClinical Applications• Intermittent compression has been Intermittent compression has been

recommended for recommended for – LymphedemaLymphedema– Traumatic edema Traumatic edema – Chronic edema Chronic edema – Swelling Swelling – Intermittent claudications Intermittent claudications – Postoperatively to reduce the possibility of Postoperatively to reduce the possibility of

developing adeveloping a deep vein thrombosis deep vein thrombosis – Facilitate wound healing following surgery by Facilitate wound healing following surgery by

reducingreducing swelling swelling

• Intermittent compression has been Intermittent compression has been recommended for recommended for – LymphedemaLymphedema– Traumatic edema Traumatic edema – Chronic edema Chronic edema – Swelling Swelling – Intermittent claudications Intermittent claudications – Postoperatively to reduce the possibility of Postoperatively to reduce the possibility of

developing adeveloping a deep vein thrombosis deep vein thrombosis – Facilitate wound healing following surgery by Facilitate wound healing following surgery by

reducingreducing swelling swelling

intermittent compression devices definitionsdefinitions edema - presence of abnormal amounts of...

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