Medically correct compression for lymphatic patients means multi-level lymphoedema bandaging (MLLB) and should only ever be applied by a suitably qualified professional. Applied incorrectly, it can be dangerous.
There is an endemic misunderstanding of the term “medically correct compression” in the equine therapies and services industry. The most common issue is the assumption that garments for circulation and lymphatic support are suitable for horses with chronic lymphoedema. The second problem is not realising the importance of including the hoof in the bandaging process. Lets look at what is required, then we can see what is unsuitable about the majority of compression garments on the market.
This is medically correct compression on a CPL cob. Using short stretch bandages (absolutely no more than 10% stretch = 10cm per meter) and specific materials to pad out the indurations of the leg to make a cylinder. This shape allows for safe pressure and reduces the risk of bandages creeping into skin folds.
The bandaging must cover the top 50% of the hoof and tuck under the heel bulbs. Garments that stop at the pastern can cause the lymph to pool below or prevent it from draining upwards from the hoof.
There must always be a gradient of pressure from tightest over the hoof to looser towards the top. There should be a 50% bandage overlap which sometimes means two bandages need to be sewn together if the legs are fairly large in size due to the advanced stage of the CPL.
How to check whether a garment provides medically correct compression for the treatment of lymphoedema and CPL.
- Is it non-elastic (ie no more than 10% stretch, or 1m10cms on a 1 meter roll)?
- Is it graduated pressure? (ie slightly more pressure distally and lessening up the leg)
- Does it start on the hoof and end at a point above the pitting oedema?
- Does it creep, or move down the leg/into the CPL folds, creating pressure bands? If so, its no good.
- Are there any baggy bits, or bits that don’t connect to the limb? If so, no good
- Can it be over tensioned? It takes very little pressure to over-compress the leg so compare it to a human sock – if it’s tight enough to leave indentations at the top, it’s too tight.
- Does the pressure given correspond to the degree of tissue induration? So, very mild and soft oedema will need less pressure.
- If the tissue quality improves, is the garment able to be adapted to give less pressure?
It is important to realise that lymphoedema is a dynamic disease, therefore will always be changing. There is no “pop it in this compression garment for life” type situation. The affected limbs need constant monitoring and adapting.
Chronic Progressive Lymphoedema 