Compression stocking

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Compression stockings ( orthopedic stockings or falsely rubber stockings , coll. Support stockings ) produce therapeutic effects by exerting pressure on the legs for thrombosis prophylaxis, for example . As travel items, to support sports and leisure activities or to relieve “heavy” legs, they are available in drugstores or in medical or sports shops. As medical compression stockings (MCS) , compression stockings are an essential part of compression therapy and are prescribed by the doctor as a medical aid if necessary . The following are treated with medical compression stockings: varicose veins (varices) , leg vein thrombosis and their consequences, chronic venous insufficiency (CVI) in all its forms and post-thrombotic syndrome (PTS), lymphedema and lipedema . Donning and doffing medical compression stockings of all compression classes is part of treatment care in Germany and is therefore prescribed by the doctor and the costs are reimbursed by health insurance companies .

Special ulcer stocking systems are used in the therapy of venous leg ulcers and use variable compression pressure to decongest the extremities, which ensures improved blood circulation and is the basis for wound healing. The stockings for thrombosis prophylaxis known as medical thrombosis prophylaxis stockings (MTPS) have a lower effect than foot-and-mouth disease or ulcer stocking systems. The widespread so-called support stockings offer only a very low and undefined compression and only have a non-specific therapeutic effect.

Medical compression stockings in different colors and shapes, etc. a. with attached rhinestones and in batik look

Working principle

Compression stockings generate external pressure on the tissue of the enclosed leg in order to relieve the damaged vein or lymphatic system . A compression stocking is manufactured in such a way that the pressure exerted increases from top to bottom in the same way as the tissue pressure in the direction of gravity.

Medical compression stockings (MKS)

The pressure that medical compression stockings produce is adapted to the patient's degree of illness and is divided into compression classes ("CCL", "Ccl" or "KKL") I-IV. Compression class I is the lightest compression class. The compression classes are divided as follows:

Compression classes
KKL intensity Pressure in mmHg in KPa
I. light 18-21 2.4-2.8
II medium 23-32 3.1-4.3
III strong 34-46 4.5-6.1
IV very strong 49 and larger at least 6.5

Medical compression stockings are intended to guarantee the decongestion success achieved in the context of compression therapy, for example, through compression bandages or adaptive compression bandages . Thus, in the so-called maintenance phase , these products are only used after the leg has been decongested, for example. Like the compression bandages, they serve as an abutment against the work of muscle movement , something like a muscle fascia . This means that they can only be effective if the wearer of the compression stocking moves sufficiently and only have a limited effect on immobile people.

Types of knitting and designs

A medical compression stocking consists of two-part material (longitudinal and transverse stretch). Today, the thread quality is rarely a natural fiber ( cotton ) mixed with an elastic chemical fiber (formerly rubber ). The currently mostly used fully synthetic fibers are much more durable. There are basically two different manufacturing processes: circular knitting and flat knitting.

Circular knitted medical compression stockings are knitted seamlessly. These are preferred for most venous disorders. They are available in different sizes. If the wearer of the stocking has body proportions that differ from the size of the stocking, a custom-made product is possible and sensible. An adjustment to the shape of the leg is only possible with circular knitting by changing the mesh size (tight or loose knitting) or the thread tension. Therefore, there are limits to the shaping of circular knitted MKS. Extremities with very small circumferences and extreme changes in circumference as well as with deepened tissue folds cannot be treated with circular knitted stockings.

A second variant are flat-knitted MCS, which are not made using a circular knitting process, but are sewn together with a seam like a tube. The appearance may suffer a little from this process (the seam runs forward, mostly visible, on the back of the leg along the entire length of the stocking; these seams can look very aesthetically pleasing nowadays), but the contours of the legs can be dressed much better. Flat-knitted stockings are usually used for lymphedema or lipedema or severe venous disorders with a tendency to edema and have compression classes II, III or even IV. In addition, flat-knit compression has a coarser mesh structure and thicker knit compared to circular-knitted stockings.

Attachment with suspender belt

Medical compression stockings are available as calf stockings (AD), half-thigh stockings (AF), thigh stockings (AG) and also as tights for both sexes (AT). If necessary, models as maternity tights, as well as Capri, cycling shorts and leggings are available in medical supply stores , from orthopedic technicians and pharmacies . The versions beginning with "A" are optionally available with toe opening (open toe) or without toe opening (closed toe). With AF and AG compression stockings, the upper edge of the stocking is usually equipped with a silicone-coated strap (adhesive edge), alternatively you can also use suspender belts . Compression stockings are now available in many standard and trendy colors.

There are also medical compression stockings for arms and hands, as the upper limbs can also be affected by diseases that require compression.

application

Dressing / undressing aid: frame

Medical compression stockings are used for:

  • Chronic venous insufficiency: The most common area of ​​application for medical compression stockings, which after swelling of the edema through compression therapy, maintain decongestion, restore the functionality of the venous valves and support the work of the calf muscle pump . In patients with CVI, wearing medical compression stockings is an essential factor in preventing recurrences .
  • Post-thrombotic syndrome: Consistent and long-term compression with medical compression stockings prevents a number of long-term consequences after a thrombosis of the deep veins in the leg .
  • Lymphedema: Compression stockings are used in the treatment of lymphedema as part of the complex physical decongestion therapy . They guarantee the sustainability of the success of the manual lymphatic drainage congestion . In patients with lymphedema, the compression stocking is only used when the affected extremity has been decongested as much as possible.
  • Lipoedema: When lipoedema is not actually a edema, which is a collection of fluid in the tissue, but a plant-specific usually Fettverteilungs- and -Vermehrungsstörung. It occurs almost exclusively in women and is more common than it is known; According to studies, around 10% of women in Germany are moderately to significantly affected. As with lymphedema, compression stockings are only part of the complex physical decongestion therapy, and the compression garments are only adjusted when the extremities have been decongested by lymphatic drainage.

Aids to put on and take off make it easier to use medical compression stockings and protect the stocking material, which increases the service life of the products. Aids to put on and take off are also available from specialist retailers and can be prescribed by a doctor. A distinction is made between frames and gliders . The former are made of metal or plastic, the latter are made of slippery synthetic fibers such as balloon silk. Depending on the product, these products either only made it easier to put on or both put on and take off the stockings. There are also special rubber gloves and textile gloves with rubberized palms that make it easier to put on and take off the compression stockings and also protect the knitted fabric of the stockings.

Ulcer stocking systems

For some years now, special compression stocking sets have been available for the care of patients with leg ulcers , so-called ulcer stocking systems, which can also be used with an existing wound. A leg ulcer is a chronic wound that typically occurs on the inside of the lower leg. Prior to the development of ulcer stocking systems, compression fitting for patients with such an existing wound was therefore only possible with compression bandages because of the wound treatment that was used here . Most ulcer stocking systems consist of two stockings that are pulled over one another to achieve CCL III. The upper stocking can be taken off at night and is provided with a zipper on some models, which makes it easier for those affected to put it on themselves. The smooth and less firm liner stays permanently on the leg. It has a lower compression effect than in combination with the overstocking. The under stocking fixes the wound pad on the ulcer wound and its sliding structure makes it easier to pull the upper stocking over it. Ulcer stocking systems are usually available as a ready-made product. The selection of the size is based on a measurement of the circumference of the ankles and calves. Some manufacturers offer made-to-measure ulcer stocking systems.

Medical thrombosis prophylaxis stockings (MTPS)

Knitted fabric of an anti-thrombosis stocking (detail)

After a thrombosis , a permanently increased pressure is created in the veins in the ankle area, which is carried through the disturbed veins into the smallest skin vessels. A counter pressure must be built up against this pressure from the outside. The medical thrombosis prophylaxis stocking is used for this. At the beginning of the thrombosis treatment, it helps to quickly eliminate the discomfort and swelling. In the long term, the stocking prevents pathological skin changes and the development of open legs . It only has to be worn on the thrombotic leg during the day. The doctor prescribes the stocking again about every six months; it is individually adjusted in a specialist shop. Generally, a calf-length stocking is sufficient. Normally, compression class II is the right one for the treatment of deep vein thrombosis. Medical thrombosis prophylaxis stockings (MTPS, formerly MTS) have a targeted pressure curve that decreases towards the heart. There is no evidence of the effectiveness of medical thrombosis prophylaxis stockings. In 2013, at the 57th annual conference of the German Society for Thrombosis and Haemostasis Research , Marc Kraft presented that clinical efficacy for certain products can be demonstrated and that due to the heterogeneity of the products, their efficacy has so far been controversial.

Compression stockings for diabetics

Compression stockings for diabetics

The large number of damage that can occur to the lower extremities as a result of diabetes is summarized under the term diabetic foot syndrome . Triggered by injuries that are noticed late or not at all due to reduced pain perception in the context of neuropathy and which heal with difficulty in view of the worsened blood circulation in the legs due to diabetes, stubborn skin damage often occurs, which can develop into a chronic wound .

Special compression stockings for diabetics are designed to counteract these risks. It is a ready-made product with a low compression effect, for example a pressure range of 18-15 mmHg. The stockings have a particularly heavily padded foot area, which is intended to protect the person concerned from minor injuries. Since those affected cannot rely on their pain perception in view of the reduced sensation, these special compression stockings are made of white textile so that injuries can be more easily noticed visually.

prophylaxis

Around 90 percent of the average adult population in Germany have at least minor changes in the leg veins, but only 23 percent are receiving appropriate medical treatment. In a weaker version (KKL <I), compression stockings are also used as a prophylactic agent against travel thrombosis or as support for members of permanent professions (e.g. salespeople).

Compression stockings are regularly prescribed after operations or for wearers of plaster casts or the like. Support stockings (except MTPS) do not have a controlled pressure curve and are therefore not suitable for people with venous diseases.

Compression stockings in sport and leisure

Joanne Pavey with compression stockings
Hiking socks with a slight compression effect

Compression stockings are also increasingly used in sports (e.g. Nordic walking , marathon running ) and are offered by many sports equipment manufacturers. Usually it but these are not to medical compression stockings; so there are B. no division into compression classes. The increased use in professional sports is seen as the trigger for the increased need for materials with a compression effect. However, such products only produce very little compression. Both recreational and professional athletes hope that these stockings will increase the speed of blood flow and thus improve the supply of oxygen and nutrients to the muscles. The available product range extends from robust hiking socks for trekking and mountain sports to sports socks for professional long-distance running or similar endurance-demanding competitive sports.

In 2003, the British long-distance runner Paula Radcliffe ran the London Marathon in rubber stockings with compression effect and won. Since then, professional endurance athletes have increasingly been using compression materials to support the work of certain muscle parts, whose regeneration is accelerated by the compression effect. Above all, knee-length compression stockings are used here, which can be observed at international sporting events, but are now also used by many semi-professional and amateur athletes. Around a quarter of the participants in the big city marathons run in compression stockings. In the triathlon , on the other hand, so-called “sleeves” are used, which cover the ankle and calf, but have no foot part.

A performance-enhancing effect of compression stockings in achieving athletic results is difficult to judge in meters or seconds for top athletes. In 2009, under laboratory conditions, an increase in performance was determined in a step test on a treadmill . Another study from 2012 recorded an increase in performance during time trials on the bicycle ergometer . However, these findings are contrasted by numerous studies that have not been able to prove any performance-enhancing effects of compression materials. More recent studies focus on research into the biological mechanisms of action of compression stockings in sport.

In addition to their role in promoting regenerative processes , compression stockings also seem to be justified in reducing muscle soreness and avoiding over- acidification during anaerobic exercise.

Web links

Commons : Compression stockings  - collection of images, videos and audio files

literature

  • Stefanie Reich-Schupke, Markus Stücker: Modern Compression Therapy - A Practical Guide. Viavital Verlag, Cologne 2013, ISBN 978-3-934371-50-7 .
  • Kerstin Protz, Joachim Dissemond, Knut Kröger: Compression therapy An overview for the practice. Springer Verlag, Berlin a. a. 2016, ISBN 978-3-662-49743-2 .

Individual evidence

  1. ↑ Compression stockings have not contained any rubber for a long time
  2. ↑ a b Finally improved data on medical thrombosis prophylaxis stockings . ( Memento of December 3, 2013 in the Internet Archive ) Retrieved June 18, 2016.
  3. ↑ a b Guideline: Medical compression therapy of the extremities with medical compression stocking (MKS) ... (PDF) German Society for Phlebology , December 31, 2018, accessed on June 16, 2019 .
  4. ↑ Kerstin Protz, Joachim Dissemond, Knut Kröger: Compression therapy An overview for the practice. Springer Verlag, Heidelberg 2016, ISBN 978-3-662-49743-2 , pp. 37-39.
  5. ↑ Joachim Dissemond : Ulcus cruris - Genesis, diagnosis and therapy. Uni-Med Verlag, Bremen 2007, ISBN 978-3-89599-298-8 , p. 103.
  6. ↑ Ulrich Herpertz: Edema and Lymph Drainage Diagnosis and Therapy Textbook of Edematology. 5th edition. Schattauer, Stuttgart 2014, ISBN 978-3-7945-2912-4 , pp. 307-310.
  7. ↑ Kerstin Protz, Knut Kröger, Joachim Dissemond: Compression therapy An overview for the practice. Springer Verlag, Heidelberg 2016, ISBN 978-3-662-49743-2 , pp. 94-95.
  8. ↑ a b Stefanie Reich-Schupke, Markus Stücker: Modern Compression Therapy - A Practical Guide . Viavital Verlag, Cologne 2013.
  9. ↑ C. Schwahn-Schreiber, M. Marshall: Prevalence of lipedema in working women in Germany . In: Phlebology . tape 40 , no. 03 , 2011, ISSN  0939-978X , p. 127-134 ( thieme-connect.com [accessed June 25, 2019]).
  10. ↑ Kerstin Protz, Knut Kröger, Joachim Dissemond: Compression therapy An overview for the practice. Springer Verlag, Heidelberg 2016, ISBN 978-3-662-49743-2 , pp. 35–36.
  11. ↑ Thrombosis - Prevent and Treat. German Society for Angiology - Society for Vascular Medicine e. V., Berlin 2009, p. 12.
  12. ↑ Guideline for Medical Thrombosis Prophylaxis Stocking (MTS). German Society for Phlebology online, accessed on June 24, 2016 .
  13. ↑ K. Kröger et al.: Medical thrombosis prophylaxis stockings - is there any evidence? In: Dtsch Med Wochenschr. 136, 2011, pp. 276-279. doi: 10.1055 / s-0031-1272524 , full text ( Memento from December 3, 2013 in the Internet Archive ) (PDF; 159 kB).
  14. ↑ Bonn vein study of the German Society for Phlebology, 2003. (PDF; 717 kB) Retrieved on June 18, 2016 .
  15. ↑ a b c Helmut Lötzerich : Compression and sport - what can be proven? In: vasomed specialist journal for vascular diseases. 29th year, Viavital Verlag, Cologne, January 2017, ISSN  0942-1181
  16. ↑ Knut Kröger: Nine indications for compression therapy. In: Heilberufe Das Pflegemagazin . 69th year. Edition 2, Springer Medizin Verlag, Berlin 2017.
  17. ^ W. Kemmler, S. Von Stengel, C. Köckritz et al .: Effect of compression stockings on running performance in men runners. In: Journal of Strength & Conditioning Research. Volume 23, January 2009. PMID 19057400 .
  18. ↑ JR Jakeman, C. Byrne, RG Eston: Efficacy of lower limb compression and compression treatment of manual massage and lower limb compression on symptoms of exercise-induced muscle damage in women. In: J Strength Cond Res. 24 (11), 2010, pp. 3157-3165.
  19. ↑ Arnd Krüger : Technical Aids. In: competitive sport. 42 (1), 2012, p. 21.