Custom-made vs standard sized products

Functionality of compression and pressure garments

There are several characteristics affecting the functionality of compression and pressure garments, all the way from its quality to its proper use. In order to ensure functioning pressure treatment, the most important characteristics of the product is how the indicated compression or pressure level is realized on the patient, the strength of compression or pressure, and the intended time of use. When comparing different products and their functionalities, one must first become familiar with how pressure is formed and the factors that influence it, and with the differences between a pressure garment vs. a compression garment. There is lots of literature and information available in information portals used by medical personnel. Pressure therapy has been used for various purposes since the 1950s and one of its first uses was scar treatment. Pressure products can be made either with a steady pressure (for example, scar treatment) or progressively decreasing level of pressure, otherwise known as compression.

The correct level of pressure

The effects of compression and pressure garments are based on a correct level of pressure. In compression garments it is progressively declining – it’s the strongest in the distal areas of the body and eases towards the center of the body. The more body the product covers, the more powerful the compression effect is. In garments with a steady, even pressure, the pressure is manufactured uniformly throughout the entire product.

Compression socks are manufactured in various compression classes. Compression socks are available in preventive compression class A and medical compression classes I-IV (the most popular classification in Europe is the EU’s pre-standards, although others do exist). Official compression products in classes I-IV are known in Finland as medical compression stockings. Abroad the terms “medical compression socks/stockings” or “therapeutic compression socks” are in use. Medical products are suitable for the treatment of diseases and conditions, and the millimeter of mercury levels in products (mmHg) is always determined. Preventive compression products have a number of nicknames. Preventive Compression stockings (Class A) are often referred to with terms “support stockings” or “flight socks”. The terms have stuck in general use, but they originate from some old trade titles. The term “compression stocking” best describes the purpose of use of the products and is the official name for these products.

The most important starting point, when comparing garments, is whether a product is custom-made or standard size. This determines how the levels of compression or pressure is realized when wearing the garment. There are several ranges of compression and pressure garments available in the market:

– Standard sized products (these may need some measuring to determine the correct size, but it does not mean that the product is made to the customer’s dimensions)
– Semi-finished products (product is partially standard sized, but some customizations can be made based on couple of measurements)
– Fully made-to-measure products (which are made completely according to customer’s unique body measurements and shape, eg. Lymed products).

Standard sized products are chosen based on a couple of personal measurements. The size is based on a range of a few centimeters. The pressure is realized differently with customers that are situated in the opposite ends of the same size range. Customers with larger dimensions will have a greater pressure or compression, because the material reached greater elongation. The actual pressure level is also affected by tissue’s texture, firmness and many other characteristics. This is the reason that many medical compression garments are made by prescription only. It is very important that the garment works properly.

The pressure in standard size items (eg. a sock) is formed based on what type of a foot is inside it in relation to the sizing, which is predetermined by the manufacturer. There’s no common standard or guideline in use for every manufacturer to follow. It is also impossible to verify, if a non-medical compression manufacturer has information on how compression behaves or how it is really formed. There are risks involved when a high compression class, standard size product is in use. If the fit and functionality is not monitored, the risks might include embolism, infection or varicose veins. The risk is high in products that are available for consumers without any service. According to studies, only custom-made compression product functions properly and gives the desired result (source: Born et al.).

Every medical compression product manufacturer, that uses one of the existing official classification systems, mentions the compression level of their product as millimetres mercury (mmHg). Different levels of classification are mainly used to help discussing about compression in general, or as an assistive system to define which level should be used to a certain indication. In medical compression products, medical aids, compression level is defined in millimetres mercury (mmHg), which makes it very easy to compare them to different compression classifications.

Product testing

Many medical compression manufacturers are official aid manufacturers and their products are tested annually in independent Research Institutes (eg. Hochenstein Institute, Germany), that are specialized in testing compression products. This guarantees that the products have the compression indicated by the manufacturers, and that the products also keep their notified compression and pressure. These products are often covered by public health care (eg. reimbursement), and can therefore be concluded as certified, working therapeutic aids.

In sports, there are no quality requirements for the realization of pressure. This means that most of the sports compression products have not been controlled by external testing. There’s a lot of information on the web pages of Research Institutes, for example about the performance tests and standards for compression stockings. In addition, a variety of pressure gauges can also be used to verify the pressure at different points in the product, when the product is in use. Studies have shown that compression products work and produces the desired results only when its made-to-measure (source: Born et al). In the light of recent studies it can also be noted that compression has most impact when its used for recovery after sports. Studies do not show that they enhance the performance itself.