All About: Compression Garments

Compression garments come in many forms to address swelling in different body areas, levels of severity and functional needs. The choice depends on the location of swelling, limb shape, severity of oedema, mobility and the person’s ability to apply and tolerate compression. Some of the main differentiating factors when choosing a compression garment are discussed below.

Ready-to-Wear (RTW) vs. Made-to-Measure (MTM) vs. Custom-Made (Bespoke) Garments

• Ready-to-wear garments are manufactured in standard sizes and shapes, similar to clothing items available at a retail store. Because of this, RTW garments are relatively easy to obtain and are generally the most affordable garment to purchase. However, they are only suitable when the affected body region fits within the standard size chart and has minimal shape distortion which is most common with early stage presentations
  
  
• Made-to-measure garments are based on a predefined garment pattern that is adjusted using the individual’s limb measurements. They offer a better fit than RTW whilst still following standard design parameters. MTM garments are more suitable if there is mild to moderate shape variation and are often used when RTW garments are not appropriate but full customisation is not yet required
  
  
• Custom-made garments are individually designed and constructed from scratch using detailed limb measurements, allowing for precise accommodation of complex or distorted limb shapes, skin folds, lobules or large size discrepancies. They provide the most accurate fit and best containment, particularly for moderate to severe lymphoedema or later stage lipoedema, but are more expensive and take longer to manufacture
  
  

Circular Knit vs. Flat Knit Garments

Circular knit garments:

• Produced on circular knitting machines that create a continuous tubular fabric. This process results in a seamless garment with a fine, smooth texture and high elasticity in multiple directions. Because the fabric is uniform and thin, it closely resembles standard hosiery
• Have high elasticity and low stiffness meaning they exert higher resting pressure (pressure when the limb is at rest) but lower working pressure (pressure generated during muscle contraction and movement). This means they may feel more comfortable to wear but offer limited resistance to tissue expansion during activity
• Provide limited containment and are prone to rolling, cutting in or creating a tourniquet effect, particularly when used in limbs with skin folds or irregular contours
• Best suited to mild, stable conditions such as early-stage lymphoedema, early-stage lipoedema, chronic venous insufficiency or maintenance therapy after significant fluid volume reduction. They are often chosen when cosmesis, comfort and ease of donning are priorities
• Circular knit garments are lighter, cooler and less visible under clothing, making them more appealing for some users
  
  

Flat knit garments:

• Knitted as a flat panel and then sewn together, creating a visible seam. This allows the manufacturer to vary stitch density across the garment, enabling precise shaping and contouring to match complex limb anatomy. The fabric is thicker, more textured and inherently stiffer than circular knit
• Have lower elasticity and higher stiffness meaning they provide lower resting pressure but significantly higher working pressure, making them much more effective at counteracting oedema and supporting lymphatic flow during movement. This stiffness is a key factor in their superior containment capability, allowing them to bridge skin creases, accommodate lobules and maintain even pressure distribution across irregular limbs
• Considered the gold standard for moderate to severe lymphoedema, lipoedema (stage 2-4) and mixed oedema, particularly when limb shape is altered
• Flat knit garments are bulkier, warmer and more noticeable but many patients report improved comfort over time due to better oedema control and reduced tissue pressure points

Compression Garments for Different Body Parts

• Limb sleeves and stockings – sleeves (arm or leg) and stockings (knee-high, thigh-high) are the most commonly prescribed compression garments. They provide graduated compression to a single limb and are used for lymphoedema, lipoedema, venous disease and post-operative swelling. Knee-high garments are often sufficient for swelling limited below the knee, while thigh-high sleeves are used when swelling extends to the thigh. These garments can be RTW, MTM or custom-made and may be circular knit or flat knit depending on the level of containment required
• Pantyhose and tights – provide continuous compression from the foot or ankle up to the waist. They are particularly useful when swelling involves both legs, the thighs, hips or lower abdomen, or when thigh-high stockings slip down. Tights offer more even pressure distribution and improved stability but can be harder to put on and may feel warmer or more restrictive, especially for those with limited mobility.
• Adjustable compression wraps – use overlapping bands secured with Velcro fastenings, allowing the level of compression to be adjusted throughout the day. They are especially helpful for people with fluctuating swelling, limited hand strength or difficulty donning traditional garments. Wraps are commonly used during the intensive swelling reduction phase or as an alternative to daily bandaging, and while they are bulkier, they offer flexibility and ease of use
• Hand, foot and toe garments – swelling in the hands, feet or toes often requires specialised garments such as gloves, gauntlets, toe caps or foot pieces. These can be worn alone for isolated swelling or combined with sleeves or stockings to ensure complete coverage and prevent fluid accumulation at garment edges
• Trunk and body garments – include abdominal binders, vests, boleros and bodysuits. These are used when swelling affects the chest, back, abdomen or pelvis, or when limb compression causes fluid to shift into the trunk. In lipoedema and lymphoedema, trunk garments are sometimes combined with limb compression for comprehensive management
• Post-operative garments – designed to support tissues after procedures such as liposuction or reconstructive surgery and to prevent formation of blood clots
  
  

Levels of Compression

Compression garments are classified according to the amount of pressure they apply, usually measured in millimetres of mercury (mmHg) at the ankle or wrist. Higher classes provide stronger compression but the most appropriate class depends on the condition being treated, symptom severity, limb tolerance and individual needs. Compression class systems vary slightly by country and manufacturer (e.g. UK, European RAL and US systems) but the functional principles are the same

• Class 1 (mild compression – approx. 15-20mmHg) – provides light support and is commonly used for mild lymphoedema or lipoedema, dependent oedema or early venous disease. It may also be used preventatively for early intervention (sub-clinical stage), during travel or prolonged standing. This class is generally well tolerated and easier to apply but offers limited containment for more advanced swelling
• Class 2 (moderate compression – approx. 20-30mmHg) – the most frequently prescribed level for medical conditions. It is used for established venous insufficiency, moderate lymphoedema and lipoedema, as well as after deep vein thrombosis or surgery. This class provides a balance between effective oedema control and tolerability for daily wear
• Class 3 (strong compression – approx. 30-40mmHg) – delivers firm support and is typically used for more severe or longstanding lymphoedema, significant limb distortion or persistent swelling that does not respond to lower classes. These garments require good application technique and patient education, as they are more difficult to put on and may not be suitable for everyone
• Class 4 (very strong compression/custom levels – >40mmHg) – reserved for severe, complex cases of lymphoedema and is usually custom-made. It is prescribed and monitored by specialist clinicians due to the increased risk of intolerance or complications. This level is not commonly used in routine practice.
  
  

Medical-Grade Compression vs. Sports Compression

Medical-grade compression garments and sports (athletic) compression wear may look similar but they are designed for very different purposes.

Medical-grade compression

• Medical-grade compression garments deliver measured, graduated compression, meaning the pressure is strongest at the ankle or wrist and gradually decreases as it moves up the limb
• This compression is precisely defined in millimetres of mercury (mmHg) and is intended to actively influence blood and lymphatic circulation
• The purpose of medical-grade compression is clinical – these garments are used to help manage medical conditions. Their effectiveness is supported by medical evidence, as they help reduce swelling by improving lymphatic and venous return
• Medical-grade compression garments require precise limb measurements and are available in standard sizing or custom-made options to ensure the correct fit – an incorrect fit can make them ineffective or even harmful
• They are regulated as medical devices in many countries and must meet specific clinical and quality standards
  
  

Sports compression

• Sports compression wear does not provide medically calibrated or graduated compression
• The pressure varies by brand and style and is not designed to influence circulation in a therapeutic way
• Sports compression wear is designed primarily for comfort and performance. Their use is aimed at assisting muscle recovery by reducing muscular soreness and fatigue but they do not treat medical conditions
• Sports compression is sized like regular clothing and designed for general use rather than anatomical precision
• They are considered sports apparel and are not subject to medical regulation or required to meet therapeutic standards