Leg Compression Research Articles

Running Velocity Does Not Influence Lower Limb Mechanical Asymmetry.

We examined the effect of running velocity upon magnitude and range of asymmetry in the main kinetics and kinematics of treadmill running at constant, submaximal velocities. Nine well-trained, un-injured distance runners ran, in a random order, at seven running velocities (10, 12.5, 15, 17.5, 20, 22.5, and 25 km.h−1) for 60 s (separated by > 90 s of rest) on an instrumented treadmill (ADAL3D-WR, Medical Development, France). Continuous measurement (1,000 Hz) of spatio-temporal, horizontal force production, and spring-mass characteristics was performed and data over 10 consecutive steps (5 right and 5 leg foot contacts after ~50 s of running) were used for subsequent comparisons. Group mean and the range of asymmetry scores were assessed from the “symmetry angle” (SA) formulae where a score of 0%/100% indicates perfect symmetry/asymmetry. Mean SA scores for spatio-temporal variables were lower than 2%: contact time (0.6 ± 0.1%; range: 0.4–0.7%), aerial time (1.7 ± 0.2%; range: 1.3–2.1%) as well as step length and step frequency (0.7 ± 0.2%; range: 0.5–0.9%). Mean loading rate (5.3 ± 1.1%; range: 4.1–6.9%) and spring mass model [peak vertical force: 3.2 ± 1.6% (range: 2.9–3.4%); maximal downward vertical displacement: 11.2 ± 6.0% (range: 9.2–14.0%); leg compression: 3.6 ± 1.9% (range: 2.9–5.6%); vertical stiffness: 8.8 ± 1.9% (range: 7.1–11.6%); leg stiffness: 1.6 ± 0.6% (range: 1.2–2.9%)] presented larger mean SA values. Mean SA scores ranged 1–4% for duration of braking (1.3 ± 0.3%; range: 0.9–2.0%) and push-off (1.6 ± 0.9%; range: 1.2–2.4%) phases, peak braking (2.4 ± 1.1%; range: 1.6–3.6%), and push-off (1.7 ± 0.9%; range: 1.2–2.2%) forces as well as braking (3.7 ± 2.0%; range: 2.8–5.8%) and push-off (2.1 ± 0.8%; range: 1.3–2.6%) impulses. However, with the exception of braking impulse (P = 0.005), there was no influence of running velocity on asymmetry scores for any of the mechanical variables studied (0.118<P<0.920). Modifying treadmill belt velocity between 10 and 25 km.h−1 induced large adjustments in most running kinetics and kinematics. However, there was no noticeable difference in group mean and the range of asymmetry values across running velocities, with the magnitude of these scores being largely dependent on the biomechanical variable of interest. Finally, the relatively large range of asymmetry between participants for some variables reinforces the importance of assessing asymmetry on an individual basis.

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials.

Spinal anaesthesia for caesarean section commonly causes maternal hypotension. This systematic review and network meta-analysis compared methods to prevent hypotension in women receiving spinal anaesthesia for caesarean section. We selected randomised controlled trials that compared an intervention to prevent hypotension with another intervention or inactive control by searching MEDLINE and Embase, Web of Science to December 2018. There was no language restriction. Two reviewers extracted data on trial characteristics, methods and outcomes. We assessed risk of bias for individual trials (Cochrane tool) and quality of evidence (GRADE checklist). We assessed 109 trials (8561 women) and 12 different methods that resulted in 30 direct comparisons. Methods ranked by OR (95%CI) from most effective to least effective were: metaraminol 0.11 (0.04-0.26); norepinephrine 0.13 (0.06-0.28); phenylephrine 0.18 (0.11-0.29); leg compression 0.25 (0.14-0.43); ephedrine 0.28 (0.18-0.43); colloid given before induction of anaesthesia 0.38 (0.24-0.61); angiotensin 2, 0.12 (0.02-0.75); colloid given after induction of anaesthesia 0.52 (0.30-0.90); mephentermine 0.09 (0.01-1.30); crystalloid given after induction of anaesthesia 0.78 (0.46-1.31); and crystalloid given before induction of anaesthesia 1.16 (0.76-1.79). Phenylephrine caused maternal bradycardia compared with control, OR (95%CI) 0.23 (0.07-0.79). Ephedrine lowered umbilical artery pH more than phenylephrine, standardised mean difference (95%CI) 0.78 (0.47-1.49). We conclude that vasopressors should be given to healthy women to prevent hypotension during caesarean section with spinal anaesthesia.

Venous thromboembolism in epithelial ovarian cancer. A prospective cohort study

ObjectiveTo determine the incidence of symptomatic and incidental venous thromboembolism (VTE) at time of diagnosis and throughout the first year, in patients with suspected epithelial ovarian cancer (EOC). MethodsPatients were recruited consecutively in the gynecological outpatient clinic at Aalborg University Hospital, Denmark from December 2014 to May 2017. All patients underwent a whole leg compression ultrasound scan (CUS), Computed Tomography (CT) of the thorax in arterial phase at time of inclusion, to be able to diagnose deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively. Patients were followed and systematically screened for VTE throughout 12 months. ResultsNinety-seven patients with suspected EOC were enrolled in the study and followed up. Within the group of EOC patients (N = 53) eleven were diagnosed with VTE during the first year from EOC diagnosis, the incidence of VTE at time of diagnosis was low (2/53–3.8%). No patients with borderline or benign ovarian neoplasms were diagnosed with VTE. One EOC patient had a VTE during the postoperative period and further eight EOC patients were diagnosed with VTE within the first year, during periods undergoing non-surgical cancer treatment. Median time to VTE was 87 days. ConclusionsThe one year cumulative incidence of VTE in EOC patients was 20.8% with a low incidence at time of diagnosis. A substantial number of VTE cases (73%) appeared during periods of non-surgical oncologic treatment. Future research should focus on risk factors and timing of VTE in EOC patients, as this could have important implications for future prophylaxis guidelines.

Effects of compression stockings and leg positions on the caliber of the reticular veins

Effects of compression stockings and leg positions on the caliber of the reticular veins

Superficial femoral artery blood flow with intermittent pneumatic compression of the lower leg applied during walking exercise and recovery.

The purpose of this study was to determine if muscle blood flow during walking exercise and postexercise recovery can be augmented through the application of intermittent compression of the lower legs applied during the diastolic phase of the cardiac cycle. Results from four conditions were assessed: no compression (NoComp), compression during walking (ExComp), compression during postexercise recovery (RecComp), and compression applied throughout (AllComp). Superficial femoral artery (SFA) blood flow was measured (Doppler ultrasound) during rest and postexercise recovery. Mean arterial blood pressure (MAP, finger photoplethysmography) was used to calculate vascular conductance as VC = SFA flow/MAP. Near infrared spectroscopy measured changes in oxygenated (O2Hb) and deoxygenated hemoglobin concentration throughout the test. Compression during exercise increased SFA blood flow measured over the first 15 s of postexercise recovery (AllComp: 532.2 ± 123.1 mL/min; ExComp: 529.8 ± 99.2 mL/min) compared with NoComp (462.3 ± 87.3 mL/min P < 0.05) and corresponded to increased VC (NoComp: 4.7 ± 0.9 mL·min-1·mmHg-1 versus ExComp: 5.5 ± 1.0 mL·min-1·mmHg-1, P < 0.05). Similarly, compression throughout postexercise recovery also resulted in increased SFA flow (AllComp: 190.5 ± 57.1 mL/min; RecComp: 158.7 ± 49.1 mL/min versus NoComp: 108.8 ± 28.5 mL/min, P < 0.05) and vascular conductance. Muscle contractions during exercise reduced total hemoglobin with O2Hb comprising ~57% of the observed reduction. Compression during exercise augmented this reduction (P < 0.05) with O2HB again comprising ~55% of the reduction. Total hemoglobin was reduced with compression during postexercise recovery (P < 0.05) with O2Hb accounting for ~40% of this reduction. Results from this study indicate that intermittent compression applied during walking and during postexercise recovery enhanced vascular conductance during exercise and elevated postexercise SFA blood flow and tissue oxygenation during recovery.NEW & NOTEWORTHY Intermittent compression mimics the mechanical actions of voluntary muscle contraction on venous volume. This study demonstrates that compression applied during the diastolic phase of the cardiac cycle while walking accentuates the actions of the muscle pump resulting in increased immediate postexercise muscle blood flow and vascular conductance. Similarly, compression applied during the recovery period independently increased arterial flow and tissue oxygenation, potentially providing conditions conducive to faster recovery.

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism.

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism.

Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial

ObjectivesThis study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters. MethodsThis study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute, Damanhour, Egypt. The sample included 120 parturients (60 intervention and 60 control). The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule, electronic monitoring of maternal hemodynamic parameters, and neonatal hemodynamic assessment sheet. All parturients received ordinary pre-operative care. For the intervention group, a long elastic stocking (ordinary pressure 20–30 mmHg, 1 mmHg = 0.133 kPa) was applied on both legs during cesarean section. The control group received the same care without the elastic stocking. ResultsSystolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5–15 min. Heart rate was significantly lower in the intervention group. Only 13.3% of the intervention group took ephedrine compared with 45% of the control group. Apgar score was higher among neonates of intervention group compared with the control group at 1 min. Neonatal acidosis was significantly higher in the control group than in the contral group. ConclusionLower leg compression technique can effectively reduce PSH and neonatal acidosis.

High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients

Postural hypotension (PH) is a very common and often symptomatic disorder among elderly hospitalized patients. Little is known about measures for preventing previously unknown PH in this population. We evaluated the effectiveness of high compression leg bandaging in preventing seated PH during the initial phase of ambulation, among elderly inpatients without a history of PH. We compared the occurrence of seated PH between patients who were bandaged (n = 100) and unbandaged (n = 100). The rate of seated PH was significantly lower in the bandaged than the unbandaged group (27% vs. 51%, p < 0.001, relative risk reduction 47%, and the number of patients needed to treat 4.2). On multivariate analysis, not wearing leg bandaging was one of the variables most significantly associated with eventual occurrence of PH (p = 0.002, odds ratio 2.65, and 95% confidence interval 1.42−4.97). We conclude that during ambulation of elderly inpatients, high compression leg bandaging is beneficial to prevent seated PH.

Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury.

Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury. Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9% saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K]T390 - serum [K]T0. There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27-4.42] and 1.15 [0.62-1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K] was reduced by 25% (24.9%-27.8%) across the cartridges. The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments. Translational science study, level I.

Anti-slip anchoring system for leg compression bandaging in phlebological practice

The bandage remains a very important instrument in daily phlebological practice, but making a good bandage is not always easy, especially in the presence of an unfavorable anatomy of the leg (inverted conical shape). One of the most common problems is the downward sliding of the bandages, which can also fold and create a lace effect. An anti-slip anchor, consisting of two turns of an acrylic glue bandage (this glue being practically hypoallergenic) or a cohesive bandage, placed below the knee, can help solving this inconvenience. This solution is very simple and effective according to the Authors' long-lasting experience. A clinical study on 50 patients confirms this efficacy.

Leg stiffness in unilateral transfemoral amputees across a range of running speeds

Carbon fiber running-specific prostheses have allowed lower extremity amputees to participate in running activity by providing spring-like properties in their affected limb. It has been established that as running speed increases, stiffness of the leg spring (leg stiffness; kleg) remains constant in non-amputees. Although a better understanding of kleg regulation may be helpful for the development of spring-based prostheses, little is known about stiffness regulation in unilateral transfemoral amputees. The aim of this study was to investigate stiffness regulation at different running speeds in unilateral transfemoral amputees wearing a running-specific prosthesis. Nine unilateral transfemoral amputees performed running on an instrumented treadmill across a range of speeds (30, 40, 50, 60, and 70% of their maximum running speed). Using a spring-mass model, kleg was calculated as the ratio of maximal vertical ground reaction force to maximum leg compression during the stance phase in both affected and unaffected limbs. We found a decrease in kleg from the slower speed to 70% speed for the affected limb, whereas no change was present in the unaffected limb. Specifically, there was a significant differences in the kleg between 30% and 70%, 40% and 70%, and 50% and 70%, and the magnitude of the kleg difference between affected and unaffected limbs varied with variations in running speeds in unilateral TFAs with an RSP. These results suggest the kleg regulation strategy of unilateral transfemoral amputees is not the same in the affected and unaffected limbs across a range of running speeds.

Reliable self-application of short stretch leg compression: Pressure measurements under self-applied, adjustable compression wraps.

Self-application of properly performed compression bandages is generally considered as problematic. Therefore, the aim of this study was to measure the pressure of self-applied short stretch adjustable compression wrap compression systems (Juxta fit™) and to compare the results with the pressure achieved by bandaging other legs using the same material. In the two training courses for nurses, specifically interested in leg ulcer treatment, the new bandage type of adjustable compression wrap was explained and workshops were organized, in which the interface pressure achieved by Juxta fit™ was measured. In the first course, the nurses applied the compression system to each other, and in the second course, another group did it on their own legs. Bandagers were instructed to apply the system strongly, with a target range of more than 50-60 mmHg. In the first course with mutual application ( n = 34), the median pressure at the medial lower leg was 58.5 mmHg (minimal 31, maximal value 137 mmHg), in the second course in which self-application was tested ( n = 36), the corresponding values were 61.5 mmHg (minimum 35, maximum 102 mmHg). No pressures less than 30 mmHg were seen on the distal calf in either group. In contrast to short stretch bandages that are frequently applied by bandagers with too low pressure, the adjustable compression wrap devices handled by the patients themselves produce more appropriate and more consistent pressure.

Invited commentary

We thoroughly enjoyed reading this study by Dr Labropolous and colleagues, in which they clearly demonstrate that the use of intermittent pneumatic compression (IPC) devices is fraught with difficulties, even after implementation of strategies to improve compliance. The physiologic effects of IPC can be grouped into hemodynamic, hematologic, flow-induced alterations of the endothelium of the veins and an increase in lymphatic drainage. IPC devices prevent venous thromboembolism (VTE) by reducing venous stasis and increasing endogenous fibrinolytic potential. It remains unknown which of these effects is most important for the prevention of VTE. Nonetheless, for the hemodynamic effects, correct calf application of IPC and continuous use are required to be effective. Several large meta-analyses have demonstrated that IPC use alone can reduce the incidence of deep venous thrombosis (DVT) by >60%, with even greater reduction by the combination of pharmacologic and mechanical prophylaxis. 1 Delos Reyes A.P. Partsch H. Mosti G. Obi A. Lurie F. Report from the 2013 meeting of the International Compression Club on advances and challenges of compression therapy. J Vasc Surg Venous Lymphat Disord. 2014; 2: 469-476 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar A recent Cochrane review concluded that on the basis of moderate-quality evidence, combining IPC with pharmacologic prophylaxis, compared with IPC or pharmacologic prophylaxis alone, decreased DVT compared with compression and decreased pulmonary embolism compared with anticoagulation. The addition of pharmacologic prophylaxis to IPC increased the risk of bleeding compared with IPC alone, but not the other way around. 2 Kakkos S.K. Caprini J.A. Geroulakos G. Nicolaides A.N. Stansby G.P. Reddy D.J. et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016; 9: CD005258 PubMed Google Scholar The proper use of IPC is unequivocally an important preventive strategy. The staff and patient perspectives on compliance with mechanical prophylaxis for venous thromboembolismJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 6Issue 4PreviewThis study evaluated the accuracy of assessment and compliance with proper use of intermittent pneumatic compression (IPC) devices before and after implementation of education, accountability, and oversight measures for health care providers. Full-Text PDF

Effects of wearing lower leg compression sleeves on locomotion economy

ABSTRACTThe purpose of this investigation was to assess the effect of compression sleeves on muscle activation cost during locomotion. Twenty-two recreationally active men (age: 25 ± 3 years) ran on a treadmill at four different speeds (ordered sequence of 2.8, 3.3, 2.2, and 3.9 m/s). The tests were performed without (control situation, CON) and while wearing specially designed lower leg compression sleeves (SL). Myoelectric activity of five lower leg muscles (tibialis anterior, fibularis longus, lateral and medial head of gastrocnemius, and soleus) was captured using Surface EMG. To assess muscle activation cost, the cumulative muscle activity per distance travelled (CMAPD) of the CON and SL situations was determined. Repeated measures analyses of variance were performed separately for each muscle. The analyses revealed a reduced lower leg muscle activation cost with respect to test situation for SL for all muscles (p < 0.05, ηp2 > 0.18). The respective significant reductions of CMAPD values during SL ranged between 4% and 16% and were largest at 2.8 m/s. The findings presented point towards an improved muscle activation cost while wearing lower leg compression sleeves during locomotion that have potential to postpone muscle fatigue.

Integration of ayurveda and conventional medicine for chronic wound healing

Background: Chronic wounds affect around 2.4 – 4.5 million patients in the United States. The burden of wound management is growing rapidly. Objective: Management of chronic wounds with integrated conventional medicine and Ayurveda treatment. Clinical Features: A 52-year-old female patient, presented with non-healing chronic wound on the right leg with pain persisting for 5 years. Initial measurement of the wound was 48 cm length × 13 cm width × 0.4 cm depth. Intervention and Outcomes: Wound depth was measured during different stages of healing along with photographic images. Patient was given Ciprofloxacin 500mg twice daily for 10 days, compression leg wraps and diuretics along with washing of the wound with Triphala decoction daily and application of wound dressing with Turmeric powder, neem bark powder and Medihoney daily were done. Marma therapy was performed once a week. Patient was also suggested kapha pacifying diet and lifestyle. Results: The wound was completely healed with normal skin coloration by the sixth week. Conclusions: This case study discusses the use of integration of ayurvedic herbs with conventional medicine for the management of wound healing. Interventional studies should be conducted to better understand the effectiveness of this integrative approach for the treatment of chronic wounds.

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?

Responses of low and high compression during recovery after repeated sprint training in well-trained handball players

The aim of the study was to investigate the effects of wearing various levels of compression following repeated and exhausting sprint exercise on variables related to recovery. Twelve well-trained handball players performed three sessions of repeated and exhausting sprint exercise (30 × 30m). Directly after each session the participants wore tights extending from below the hip to the foot with either 0, 10, or 25 mm Hg of compression onto the thigh and calf muscles. 48 h after the training session all participants performed 5 × 30m sprints and counter movement jumps. Before, directly after, 24 h, and 48 h after the training session venous blood samples were drawn for the determination of creatine kinase (CK), urea, C-reactive protein (CRP). At the same time points, subjective ratings of the Acute Recovery and Stress Scale (ARSS) questionnaires were obtained. The results for plasma concentrations of CK and urea showed ‘likely’ to ‘very, very likely’ beneficial effects for compression garments exerting 10 mm Hg of compression (p = 0.06–1.0). With regard to sprint and jump performance no differences were evident between 0, 10, and 25 mm Hg (p = 0.07–1.0). In addition, subjective scores from the ARSS did not differ between conditions over time (p > 0.05). We conclude that the application of 10 mm Hg leg compression compared to 0 and 25 mm Hg of compression during 48 h of recovery from repeated and exhausting sprints lowered the plasma concentrations of CK and urea with no improvements in recovery for performance.

Impact of Leg Elevation and Compression Bandaging on Skin Microcirculation in Healthy Adults.

Impact of Leg Elevation and Compression Bandaging on Skin Microcirculation in Healthy Adults.

A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy

BackgroundInadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). Our hypothesis is that a prototype thermal compression device that heats the popliteal fossa and soles of the feet, with lower leg compression, increases perioperative temperatures and reduces IPH compared to the current standard of care.MethodsThirty six female breast surgery patients, at a tertiary academic hospital, were randomized to the device or intraoperative FAW (stage I) with a further 18 patients randomized to the device with a single heating area only (stage II, popliteal fossa or sole of the feet). Stage I: 37 patients recruited (final 36). Stage II: 18 patients recruited (final 18). Inclusion criteria: general anesthesia with esophageal monitoring for over 30 min, legs available and able to fit the device and no contraindications to leg heating or compression. The intervention was: Stage I: Investigational prototype thermal compression device (full device group) or intraoperative FAW. Stage II: Device with only a single heating location. Primary outcomes were perioperative temperatures and incidence of IPH. Secondary outcomes were local skin temperature, general and thermal comfort scores and presence of perioperative complications, including blood loss.ResultsMean temperatures in the full device group were significantly higher than the FAW group in the pre-operative (36.7 vs 36.4 °C, p < 0.001), early intraoperative (36.3 vs 35.9 °C, p < 0.001), intraoperative (36.6 vs 36.2 °C, p < 0.001) and postoperative periods (36.8 vs 36.5 °C, p < 0.001). The incidence of IPH in the device group was also significantly lower (16.7% vs 72.0%, p = 0.001). Thermal comfort scores were significantly higher in the full device group and hypothermia associated wound complications were higher in the FAW group.ConclusionsThe thermal compression device is feasible and has efficacy over the FAW. Further studies are recommended to investigate clinically significant outcomes.Trial registrationclinicaltrials.gov (NCT02155400)

Techniques for preventing hypotension during spinal anaesthesia for caesarean section.

Techniques for preventing hypotension during spinal anaesthesia for caesarean section.