Dr. Zatrok's blog
Dr. Zatrok's blog

Dr. Zatrok's blog

Questions about compression therapy

by Dr. Zsolt Zatrok

In this article, you will find frequently asked questions related to compression therapy and lymphatic massage related.

I have an old, one-air chamber compression device, can I use it to treat my lymphoedema?

The first-generation compression devices aimed to treat the oedema of the arm, and leg, or the leg. They inflated then deflated the cuffs (compartments of the cuff) simultaneously. For a time, they also included the device among the basic lymphoedema treatment modules. However, in a short time, they reached the conclusion that simultaneous, full inflation of the cuffs (or its chambers) creates too strong pressure. This can result in damage to the lymphatic vessels, and lymph nodes over the years in congenital lymphoedema, in some cases. Thus, the lymphatic therapists expressly forbid the use of old types of pumps. Today’s latest generation compression therapy units no longer inflate all the compartments of the cuff at the same time, rather sequentially and intermittently. We can adjust the cuff pressure very precisely and thus the treatment pressure is adaptable to the patient’s condition. Use a modern, up-to-date device!

My therapist says that it is prohibited to use mechanical lymphatic massage. Is this true?

There is no single drug, machine, treatment method that works in the same way for every patient! There have always been clinicians, therapists and patients who have not received good results with the machines and do not recommend their use. However, there is only one treatment failure in hundreds of success stories giving great results. Machine therapies are not for everyone and the treatment success depends on how precise equipment you use and what settings you apply. Improper settings can cause damage (too high pressure) or yield no results (too simple device, short operating time, etc.) THE KEY IS TO BUY A GOOD QUALITY DEVICE AND PROPERLY SET THE TREATMENT PROGRAM/UNIT!

Lymphatic massage aka Compression Therapy

[message title=”Power Q-1000 Premium compression therapy unit” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • 4 compression chamber cuffsPower Q-1000 Premium compression therapy unit
  • Use it equally in oedema affecting the arms or legs.
  • Optimal for arm swelling, developing after breast removal surgery (mastectomy)
  • Eliminate the feeling of heaviness of legs, and tension pains caused by varicosity.
  • Relieve swelling of your feet associated with varicosity in pregnancy.


[message title=”Power Q-1000 Plus compression therapy unit” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • Home treatment of mild to moderate lymphoedema without complicationsPower Q-1000 Plus compression therapy unit
  • For cardiac swelling after mastectomy, this device is usually sufficient
  • It is effective in relieving the heavy legs and tightness caused by varicose veins
  • You can also use it to reduce leg swelling in pregnancy varicose veins


My therapist says that the machine doesn’t help initiate lymph flow and even exacerbates the oedema.

That’s actually not correct! As I mentioned above, a poorly adjusted treatment can cause complications, while treating with settings appropriate to the patient’s condition can cause no harm.I reviewed the medical literature. There is no scientifically proven data or case report that would support the fact that mechanical lymphatic drainage would exacerbate the oedema. While, on the other hand, a series of studies demonstrate the effectiveness of these machines.

There is a growing perception that we should use pneumatic compression as an alternative to bandaging and compression stockings. While, in contrast, opening of the lymphatic drainage pathways should be performed from time to time with manual lymphatic drainage. I don’t consider it appropriate, if a therapist prohibits – on the basis of false, partial information, “presumption”-, a treatment from the patient that could actually help. If your lymphoedema does not receive adequate treatment, you are the one who “pay the price” (i.e., the patient is the one who pays for the consequences).

Facts prove that an intermittent compression therapy unit provides effective assistance in reducing the symptoms. The false, incorrect information can confuse patients about treatment. Despite the contradictions, there is clinical evidence that good quality and properly adjusted mechanical lymphatic massage can help hundreds of thousands of people.

It is important to make sure that your device has proper functions and pay attention to use it correctly! It’s not complicated. In my blog, you’ll find more articles, videos on the subject.

Can we apply mechanical lymphatic drainage in children?

Experts do not recommend the use of compression therapy units for infants and children under 6 years of age. For them, general decongestive therapy is advisable (a combination of bandaging, wearing compression stockings, and manual lymphatic drainage).

How important is the pressure gradient?

Devices with adjustable pressure gradients prove to be the most suitable for reducing lymphoedema. Your device is not ineffective just because it does not provide a pressure gradient, but it is less efficient than those that have that feature.

What is compression therapy and treatment like?

Unlike the vascular system, the lymphatic system has no “built-in engine”. The heart pumps blood into the blood vessels. The lymphatic system “leans on” the muscles, their contraction keeps the lymph moving. When a muscle contracts, it presses on also the lymphatic vessels and the lymph fluid, which flows upwards. The alternating compression “mimics” this natural way of the lymphatic circulation, that is, the function of the muscle pump.

I don’t move at night. How can the lymphatic circulation still work?

Your muscles are under the control of your brain. A few percent of your muscle fibers is still active and perform delicate contractions even during your deep sleep. You don’t even feel this muscle twitching (fasciculations), it’s not visible, but it’s enough to maintain the lymph circulation and, in part, the blood circulation. Therefore, the flow does not stop even during sleep.

How do I set the correct treatment pressure?

Measuring your blood pressure can be a good guiding factor. For example, if the value is 120/80 mmHg, 120 mmHg represents the occurring pressure when your heart is just contracting, squeezing blood into your arteries. And the value of 80 mmHg represents when your heart rests between two contractions.

Thus, you SHOULD NEVER SET the treatment pressure higher than this lower value! Moreover, you should set this value at least 20-30% below that. Therefore, in case of a 120/80 mmHg blood pressure, the maximum pressure in the lower compartment should be 55-65 mmHg. The pressure values should gradually decrease with each compartment in the direction of the thigh and the upper arm.

There are therapists who consider even lower (maximum 40 mmHg) pressure on the arm to be the best.

High pressure would suddenly trigger the movement of a lot of fluids, which would overload the tissues above. So if you apply high pressure regularly, it can worsen your condition over time. So a higher pressure is not a better option.

Although, there are cases, such as fibrosis, where we may need to use higher pressures to soften the solid tissues. In the event of a severe fibrotic condition, pressure treatment (pressotherapy) should be performed exclusively under the guidance of a competent therapist.

How long should I use the machine a day?

If you only have time for one treatment a day, do it before going to bed in the evening. You may have noticed that you have significantly less oedema in the morning (during sleep, it “flows out” from your limb).

If you can, divide the treatment into two parts. Do a treatment session in the early afternoon and the other in the evening.

The duration of a treatment can range from twenty minutes to up to an hour, depending on the outcome. The lower pressure will yield a result in a longer period of time. For most of the affected people, half a day, up to two hours of treatment is usually enough. Take longer treatment sessions only when the therapist recommends that.

It is better to divide the treatment procedure to several treatment sessions, because there will be less fluctuation in swelling. If you wait too long before you treat, and you have much oedema, it could be harder to reduce it. With more frequent treatment sessions, you can achieve a state when the swelling (the fluid refill) is not so pronounced.

Each case is different and requires appropriate treatment! Change your therapy only if your lymph therapist recommends it.

Can I use the lymphatic massage machine in case of ulcers and open wounds?

The lymphatic massage machine can also be used for venous ulcers or open skin wounds if there is no infection nor signs of cellulitis. Cellulitis is the superficial inflammation of the skin. (Though a person with cellulitis can also develop fever and/or swollen lymph nodes in the area of the infection) You should treat the wound or ulcer as follows: cover it with wound dressing. You need to clean and disinfect the treatment cuff after treatment.

In case of an active skin infection, inflammation (e.g., erysipelas), you should not carry out compression massage. That is because pressure waves may carry pathogens further on the skin surface, or can cause generalised sepsis, when pumping them into the blood stream.

Signs of an active infection: local swelling, pain, redness, purulence, red streaks on the skin. If you have any of these symptoms, do not use the pump! See a doctor immediately! The infection requires antibiotic treatment.

I have lymphoedema and also leg ulcer and my doctor prohibits the use of a lymphatic massage machine. Why?

Probably, this doctor didn’t think through the conditions of this medical prohibition, or didn’t know what a compression machine is for.

Lymphoedema causes tension in the leg, which causes a severe circulatory condition. The consequence of slow circulation is that the injuries to the leg showing signs of lymphoedema are easily infected and heal very badly.

If you do not get help to reduce your tense oedema – this is what the machine would do-, you cannot expect recovery. The reason for this is that it is exactly the poor circulation, which causes your oedema.

Thus, in case of an ulcer, healing can be achieved by supporting the circulation and reducing tension – that is, by applying mechanical massage.

I have visited my beautician for lymphoedema treatment, after which my legs hardened and I feel pain. What causes that?

Beauticians are not authorized to treat lymphatic diseases, but this is only a minor part of the “spree”. The bigger problem is that if they don’t even have the proper knowledge in the field, they don’t know what they are doing. Post-treatment pain and induration indicate that they have treated you with inadequate (too high) pressure.

Although a single badly done treatment probably doesn’t cause any lasting damage. However, if you receive such “treatments” regularly, your condition may worsen rapidly and may render your oedema unmanageable in a few months.

Please, find a competent, skilled specialist!

I was at my beautician for lymphoedema treatment, after which my varicose veins became inflamed and I feel pain. What causes that?

Pain and “inflammation” of the vessels indicate that the treatment was carried out with too high pressure, and with inadequate attention. The machine thoroughly “kneads” your dilated, crooked veins (they were thoroughly worked on). Put ice on it for 2-3 days and load your leg (put weight on your injured leg) only carefully (do not go to training, but you can go for a walk). No further mechanical or manual massage can be carried out until the superficial venous inflammation heals properly.

Contact a lymphatic therapist, also known as (lymph)oedema therapist, instead of an incompetent beautician.

I got a headache during the machine treatment! What caused that?

This is due to the treatment pressure being too high or too large an area being treated at the same time (e.g., both legs and the trunk). Thus, they squeezed out the blood from your legs and even your trunk. This raised your blood pressure.

Look for a treatment centre where experts pay more attention to proper settings and handling of treatment. If you experience a headache during treatment, discontinue the session and notify the therapist immediately.

High blood pressure does not exclude mechanical treatment, but even a lower than usual pressure is needed, and the treated area should be reduced. That is, it treats only one leg at a time, then the other, and finally the trunk. This is, of course, three separate treatments, three times as much time, but in this way, it will not cause complaints.

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