Compression therapy

What is compression therapy, and how does it work?

Compression therapy is firm pressure applied to your leg and foot with bandages, stockings, tights or devices, to help blood and fluid move back up the leg¹. It's used for venous leg ulcers (slow-healing sores caused by weak leg veins), lymphoedema (long-term swelling from fluid build-up) and lower leg swelling¹.

The pressure is graduated: snug at the ankle, and less tight as it goes up the leg². That gently squeezes the calf muscles so they can push blood back towards your heart². Options include layered bandages, stockings, wraps with hook-and-loop fasteners, and pump devices (intermittent pneumatic compression)³.

What is it used for, and does it work?

Compression works best for venous leg ulcers. Bandages or stockings probably help ulcers heal sooner and more completely than no compression, and probably reduce pain⁴. Firmer pressure heals active ulcers better, but bandages are often applied too loosely: only about 10% reach the target pressure⁵⁶. After an ulcer heals, firm (class 3) stockings may reduce the chance it comes back over six months, although this is less certain⁷.

Other uses are less clear. In hospital patients, mostly after surgery, stockings are linked with fewer deep vein thromboses (DVT, blood clots in the leg)⁸. That doesn't show everyday stockings prevent clots in other people. For lymphoedema, compression is widely used and may reduce infections caused by swelling, though trial evidence is limited⁹. For long-term leg pain and swelling after a DVT (post-thrombotic syndrome), it isn't clear yet how much stockings help¹⁰.

Is compression therapy right for me?

It suits many people with venous problems such as varicose veins and leg swelling, and some people having surgery¹¹. It should be prescribed by a healthcare professional, who screens you for risks and checks the fit²⁹. They'll check the blood supply to your legs first (your pulses, and sometimes a test called ABPI), because poor blood flow can make compression dangerous⁹. With significant arterial disease or critical ischaemia (a severely reduced blood supply), compression must not be used without advice from your treating team¹.

It shouldn't be applied with an acute infection of the leg or foot, signs of sepsis, limb-threatening ischaemia, a suspected DVT, suspected skin cancer, bleeding varicose veins, or signs of worsening heart failure¹². Heart problems alone don't rule it out: it's possible with milder heart failure, but not recommended in severe heart failure⁹. Children need individual advice from a health professional.

What happens when I have compression therapy?

A clinician checks your legs and circulation, then chooses the type and strength for you. For venous leg ulcers, that's often firmer socks or wraps (class 2 to 3), a hosiery kit or a bandage system; a lighter class 1 sock may be offered for mild disease or a small wound¹. It's best to have bandages applied by a trained person.

Ask how long to wear it each day, how to put it on, what to expect over time and when you'll be reviewed. Wear it as advised, and keep your follow-up appointments so healing can be checked.

Check your skin and toes each day and whenever you take it off. Stockings lose their support, so replace them every 3 to 6 months¹¹.

What are the risks and side effects?

Compression is safer when risks are screened for first and the fit is checked⁷. The usual problems are skin irritation and itching. Rarely, serious problems happen, including heart failure getting worse, nerve damage, blood clots and skin damage⁷.

Bandages applied wrongly can cause pressure damage, pressure ulcers, skin death and nerve damage⁵. Stockings applied wrongly can cause discomfort, leg swelling, DVT and reduced blood supply to the leg⁸. Nerve damage usually shows as foot drop (a foot that drags) with numbness⁹. Regular skin care and daily checks help you catch trouble early.

How does it compare with other options?

For venous leg ulcers, compression is the first treatment usually tried⁴. Between types, no clear difference in healing has been found for bandages versus stockings, elastic versus inelastic material, or four-layer versus fewer-layer bandages¹³. A two-layer stocking system healed ulcers about as well as a four-component bandage⁵. A hosiery kit is often considered first, after a full leg ulcer assessment¹⁴.

It isn't clear yet how compression compares with treating varicose veins, exercise alone or other treatments. Ask whether they could be used alongside it, and if you can't tolerate compression, ask about alternatives rather than stopping on your own.