The importance of pressotherapy in different areas of medicine. The pressotherapy is very effective in treating ulcers, diabetic foot, elephantiasis, lymphoedema, edema and other diseases of the lymphatic system.

1. THE IMPORTANCE OF PRESSOTHERAPY
IN DIFFERENT AREAS OF MEDICINE
Lic. Sandra Fariña
Kinesiologist
Peripheral Vascular Rehabilitator
Coordinator and Spokesperson of ALCVA (American Association of Vascular Surgery and Angiology)
Teacher in the specialty: Vascular and Cardio-pulmonary (Universidad Simon Bolivar - Colombia)
Director of the unit of Peripheral Vascular Rehabilitation in the Instituto Vascular Internacional (Bolivia),
Instituto Terra (Argentina) Instituto Oxígeno (Colombia)

2. What is peripheral vascular rehabilitation?
The PVR is based on a series of methods and
therapeutic maneuvers to improve venous, arterial
and lymphatic return, through different techniques
we seek to improve the life quality of patients by
reducing the signs and symptoms of these diseases
as well as the own risks of complications such as
infections, ulcers, amputations, etc.

3. Tools of the PVR
Manual lymphatic drainage
Intermittent sequential pressure therapy
Multilayer bandage
Graded elastocompression
Miolinfokinetic excersices
Prevention Guidelines
Skin care and appendages
Tape neuromuscular
Special software

4. Stages of treatment
First Stage
Phase A
Manual lymphatic drainage (MLD)
Sequential pressotherapy
Specific exercises
Phase B
Manual lymphatic drainage (MLD)
Specific exercises
Sequential pressotherapy
Bandages (whichever required by each part)
Frequency of treatment: 5 sessions per week
Second Stage
Stabilization or maintenance
Manual lymphatic drainage (MLD)
Specific exercises
Pressotherapy
Containment: medium or sleeve
replacement of dressing used
Frequency: progressive reduction of the
quantity of sessions per week

5. Sequential Pressotherapy
The limb to be treated is introduced in an inflatable sleeve, it
produces an external force on the extremity when the sleeve
is filled with compressed air, regulated by the control unit,
through a hose system. Each sleeve
is composed of a number of separate
air chambers that inflate each other
in a predefined cycle according to
the patient’s needs.

6. Lymphastim is the closest to copying and giving
effectiveness to the Vodder technique. In this
type of preassure-therapies, the cameras are
arranged in the direction of the lymphatic
system, they will slowly insufflate in pants, legs
and arms in a gradual and progressive manner,
based on the Vodder
drainage technique.
Sequential Pressotherapy

7. Maximum number of chambers, allowing
greater accuracy in treatment
22 chambers’ pants
10 chambers’ legs
8 chambers’ arms

8. Benefits of Sequential Pressotherapy
• The effectiveness of pressotherapy is based on producing tissue relaxation and the
opening of initial lymphatic vessels due to the progressive decrease in pressure.
• Facilitates the evacuation of the water component of edema by generating a negative
pressure that sucks the interstitial fluid.
• Stimulates the secretion of parietal fibrinolytic substances, increasing the activity of
the plasminogen in the blood (Plasminogen is the central component of the fibrinolytic
system in the body), which reduces the risk of thrombosis.
• Mainly removes water causing a gradual concentration of protein edema.
• Promotes and increases venous return, which explains the decrease in the volume of
the limb being treated, after the session of kinesiology.

9. Possible side effects of Sequential
Pressotherapy due to misuse
Temporary increase in pain
Petechiae
Capillary rupture - if the pressure exceeds the
level recommended
Haematoma
Vegetative reaction - in patients with sensibly
vegetative system
Lymphatic Congestion - in not treated areas

10. In which fields of
medicine is our therapy
important?
Can I use
pressotherapy
on them?

11. Vascular
Diabetology
Traumatology
Sports medicine
Surgery

12. THE IMPORTANCE OF PRESSOTHERAPY
IN SPORTS

13. The PVR in traumatology and
sports medicine
When an injury occurs the most common is an
immediate response by a swelling (edema).
Inflammation is a complex
reaction of vascularized
connective tissue from
harmful stimuli.

14. A circle is produced
Edema by trauma
pathology
Muscular atrophy
Muscular atrophy
Pain from increasing
pressure in the tissue
More pain

15. Benefits of Lymphatic drainage through
Presotherapy in traumatologic injuries
Decrease the content
of extravasated fluids
(decreases tumor)
Decrease
tissue tension
Facilitating the removal
of bacteria, necrotic tissue,
degradation residues of RBC
Facilitate
cellular nutrition
Decrease
pain
Balancing
intra and extravascular
pressures
Bring closer the edges
of the wound
(speed healing)
Reabsorb low molecular
weight plasma proteins
Allow early mobilization,
having less fluid
in the joints

16. Considering the psychological aspect, the fact
of feeling less pain, of having less swelling in the
injured area and the possibility of making movements
in a precocious way, stimulates the patient to a more
rapid improvement and better convalescence.

17. Management of Edema in athletes from PVR
The treatment goals are:
• Immediate control of the inflammatory reaction
• Decrease the pain
• Decrese the edema
• Reduce muscle spasm
If we meet the stated goals, timing of
rehabilitation will be significantly reduced
and the occurrence of unintended
consequences will be avoided, such as
the residual inflammation.

18. Pressotherapy in sports practice
Due to intense physical activity, muscles increase their volume to the point of reaching
inflammation. This inflammation can block or interrupt the smooth flow of lymph.
Besides muscle soreness, fatigue symptoms appear.
That’s when with a session of just 30 minutes of pressotherapy we can accomplish
restoring lymph and blood circulation, reduce inflammation and eliminate fatigue.
The recovery of muscles and tissue is noted immediately, the athlete is safe and well.
Similarly, all people who regularly practice some intense sport, should also recover the
muscles with the help of pressotherapy.

19. When the body is subjected to high energy expenditure induced by physical training
with heavy loads, it is essential to get the muscular system to obtain rapid
rehabilitation, so that once recovered, it can again be stimulated and generate a
new adaptation process in order to gain greater training load. By placing an athlete
in pressotherapy after training or competition, we can achieve a quicker recovery
and thereby accelerate the processes of adaptation and with it an improvement in
physical capacity.

20. How can
pressotherapy achieve
an improvement in
athletic performance?

21. Pressotherapy in sports
The swelling of the chambers produces a sedative effect, relaxing, derived from the
rhythmic and synchronized massage while providing an anti-inflammatory effect.
Pressotherapy promotes lymphatic and venous circulation, a satisfactory drainage and
filtering toxic substances act revitalizing the area treated, significantly diminishes the
recovery time after sports body burden and be able to undergo re-training in a shorter
period of time.
The effect of pressotherapy helps us to make work sessions more continuous and
demanding of a shorter period of adaptation to the effort made, it is understandable
that this will impact very positively on the success of sports performances.

22. We must remember that in order for the massaging
sensation to be effective, it must be always pleasant.
not in a single case more is better, thus we wish to
emphasize that increasing the air pressure when it
produces unpleasant sensations is harmful.

23. Therefore
When using PRESSOTHERAPY we produce a
mechanical stimulus aimed at accelerating the
reabsorption of toxins that accumulate in the muscle
and in the interstitial space, improving circulation,
promoting the diffusion of lactic acid into the lymph
collectors and from them to the lymphatics
(authentic ducts washout), resulting in getting
more rest and avoiding injury.

24. Patient 22 years, playing rugby dislocates
the humerus-radial joint

25. It is applied pressotherapy for 7 days to the patient,
half an hour per session accompanied by massage
therapy, ultrasound and magnetic therapy. In the first
session, it is managed to decrease the edema and
increased joint range previously presented the patient,
breaking adhesions proper of immobilization.

26. Skater, sprinter of the Atlantic, suffers a fall leading to breaking
multiple tables with his leg, which produces multiple trauma.
It can be seen: edema, broken capillaries, bruising, pain and
functional limitation.

27. Sequential pressotherapy
Comprehensive elastic bandages
Multilayer bandages with exercises
TENS
Neuromuscular taping
Magnetotherapy
Ultrasound
Rehabilitation of walking
Marco in Peripheral Vascular Rehabilitation

28. Back to the competition...

29. Guillermo Celis
He is a player that performs as defensive midfielder in
the team Atlético Junior de Barranquilla, in the
Colombian first division: it is a great pleasure to be
able to help him improve his physical performance
from kinesiology as a Peripheral Vascular Rehabilitator
and devoted to sports, serving both fields.
Thank you very much, Guillermo, for trusting in
my team.

30. José Luis Chunga
José Luis Chunga, goalkeeper of the Atlético Junior of Barranquilla, Colombia.
As a kinesiologist, it is a pleasure to be able to care for the physical performance, by
means of the Peripheral Vascular Rehabilitation, of an excellent football goalkeeper,
great person with a great heart, of one of the most important clubs in Colombia, the
“Atlético Junior de Barranquilla”. We are working in the injury prevention area, which
tends to transform in the enormous ghost of most of professional players and also
work on their agility, flexibility and joint mobility.

31. Cases
The goalkeeper of a professional football club playing in the
national tournament B of Argentina, suffered a subluxation of
the ring finger of his left hand. The edema prevents him to wear
a glove, even without bandages. He was treated with manual
lymphatic drainage, pressotherapy and adhesive bands for
three sessions. Neuromuscular taping was performed, managing
to place the glove and play regularly.
Lymphatic drainage in addition to facilitating the evacuation of
extravasated fluid promotes the elimination of waste products,
such as degraded red blood cells that form the hematoma.
In skater children, I have observed the impact velocity of the drainage on their
recovery. In the case of Esteban Duarte, skater of the Atlantic, after recovering with
this method, he accomplished, after a few days, several medals at the National
Championship in the children’s category of 9-11 years.

32. Esteban Duarte Rubio
The young barranquillero skater, Esteban Duarte Rubio, is a diamond in the Rough for
this sport: shinning with his own light he follows the steps of the triple world champion,
Alex Cujavante.
Written by Francisco Figueroa Turcios

33. Esteban Duarte in PVR

34. THE IMPORTANCE OF PRESSOTHERAPY
IN DIABETIC PATIENTS

35. Definition
The diabetic foot is a result of chronic complications
of diabetes and at the same time it is an acute
complication that requires immediate treatment
and for which there are existing prevention
measures of great importance.

36. Peripheral vascular disease in
diabetic patients
Diabetes also damages the blood vessels, reducing blood flow
to the feet. Poor circulation weakens the bone and can cause
disintegration of the bones and joints in the foot and ankle.
As a result, people with diabetes are at increased risk of bone
fractures of the foot.

37. Chronic Limb Ischemia
It appears as a result of the slow and progressive decrease in
blood flow, and therefore oxygen supply to the muscle groups
of the lower limbs during exercise.
Intermittent Claudication

38. Peripheral Neuropathy
Peripheral nerves carry information to and from
the brain. They also carry signals to and from the
spinal cord to the body.
Peripheral Neuropathy means that nerves do not
function properly. This neuropathy may damage a
single nerve or a nerve group. It can also affect the
nerves throughout the body.

39. Treatment
Don't forget that good control of the disease
with non-pharmacological measures (proper diet,
exercise, peripheral vascular rehabilitation) and
drug therapy (oral hypoglycemic agents, insulin)
can prevent many of the serious complications
that occur in these patients.

40. Peripheral Vascular Rehabilitation
in diabetic patients

41. Fisiokinesic treatment
Objectives
Increasing transport capacity
of the lymphatic and venous
vascular system
Decrease the volume
of the affected limb
Prevent the patient’s
progress toward
a elephantiasis
Rehabilitate muscle pump
Improve joint mobility
Correct posture
of the patient
Reduce pain

42. Physiotherapy
The agents most used in the treatment of diseases
of the circulatory system.
Sequential pressotherapy
Magneto therapy
Laser
Ultrasound

43. Sequential Pressotherapy
The Lymphastim works on the principle of
intermittent pneumatic compression, using a
pressure wave progresses to facilitate
lymphatic drainage.
Stimulates the activity of the lymphatic
channels, increases the flow of lymph hot-
spots, improving blood flow and accelerates
the exchange of body fluids.

44. Lymphatic system
The lymphatic system is in charge of
draining the plasma of the processes of
cellular exchange. In the same manner, this
system works as a true filter
for catching bacteria’s and
residues from the organism.

45. Maximum number of chambers, allowing a more accurate
treatment. Through these pressure waves, the circulatory
system is stimulated.
22 chambers pants
10 chamber legs

46. Diabetic patient with amputation
of 4th
and 5th
toe

50. Diabetic patient 18 years of age

51. With the use of Pressotherapy
in diabetic patients we accomplish:
Improve circulation
Reduce edema
Improve mobility
Improve flexion and extension (twin pump)
Improve gait
Reduce infection risks
Improved healing (in the case of ulcer)
Improve the trophism of the skin

52. Contraindicaciones
Malignant tumors
Skin conditions
Acute bronchial asthma
and asthmatic bronchitis
Phlebitis, thrombosis,
thrombophlebitis
Decompensated
heart failure
Hypotension
Acute
infections

53. Therefore, diabetic patients
If not properly controlled, high blood glucose level,
typical of diabetes, can cause progressive damage
to the nerves and blood vessels of the lower limbs
which can lead to severe health complications,
such as diabetic foot.

54. BENEFITS OF PRESSOTHERAPY
IN PRE AND POST SURGICAL

55. Surgery and Sequential Pressotherapy
Any surgical intervention, due to the trauma it causes (ruptured
blood and lymph vessels, cell injury, etc.), produces a local
inflammatory reaction with swelling and edema in many of the
affected and surrounding tissues.
The application of Lymphatic Drainage
before and after surgery, helps always
get better results than if we let the
body to respond alone to the
surgical aggression.

56. Benefits of pre-surgical application
of Pressotherapy
When we activate the lymphatic circulation in the area to be operated, the positive
impact of the intervention is higher, results especially useful in patients with previous
alteration of your lymphatic circulation.
By acting the LD on regional lymph nodes in the area where the surgery will be
performed, the conditions of repair and response to surgical aggression improve.
It is important for a better surgical procedure that the interstitial medium and the
fundamental substance of connective tissue are not waste loaded.
If the area where the surgery will be performed presents edema, lymphatic drainage
can reduce it and it is possible to anticipate surgery.
Stimulates the immune system.

57. Drainage benefits in
Traumatic Inflammatory Joint diseases
Considering the psychological aspect, the fact of feeling less pain, of having less swelling in
the injured area and the possibility of making movements in a precocious way, stimulates
the patient to a more rapid improvement and better convalescence.
Decrease the content
of extravasated fluids
(decreases tumor)
Decrease
tissue tension
Facilitate the removal
of bacteria, necrotic tissue,
degradation residues of RBC
Facilitate
cellular nutrition
Decrease pain
Balancing intra and
extravascular pressures
Brings together the
edges of the wound
(speed healing)
Reabsorb high
molecular weight
plasma proteins
Allow early mobility,
by having less fluid
in the joints

58. Goals of postsurgical drainage
Goals
Reduce
edemas
Decrease
pain
Decrease
fibrosis
Ameliorate
ecchymosis
Ameliorate
ecchymosis
Obtain
good wound
healing
Reduce
retractions
Improve
mobility
Undermine
alterations in the
sensitivity
Eliminate
toxins

59. Decrease edema: main goal
Manual Lymphatic Drainage and Pressotherapy
are indicated from the start. Its effectiveness
percentage is above 80%.
Evacuation
Reabsorption
Return

60. The Peripheral Vascular Rehabilitation is important after a surgical procedure. When
producing an incision in the tissue, damage is done to the lymphatic system, there is
rupture of blood vessels, etc. An accumulation of fluid in the interstitial space is
produced, which delays the recovery of the patient and can present some
complications such as thrombosis, adhesions, etc.
In a patient being able to move is very important to reestablish the circulatory pumps
in charge of returning the blood to the heart; with PVR, we help to significantly shorten
rehabilitation time.

61. Hallux Valgus
Postsurgical

62. The importance of Pressotherapy
as a tool of Peripheral Vascular
diseases in PVR

63. The PVR in peripheral vascular diseases
Lymphedema Elephantiasis Lymphedema mmss
EdemaLymphedemaLymphedemaUlcers

64. Kinesiology in patients with
vascular diseases
Goals:
• Activate venous and lymphatic return
• Reduce edema
• Prevent/correct ankyloses or unnormal articular position
capable of obstructing the venous return
• Help closing the ulcer as second intention through
desbrindantes maneuvers and approximation of the borders

65. Chronic Venous Insufficiency
Valves in
normal veins
This healthy valve
prevents the
return of the flow
There is a return of
the flow due to a
damaged valve
Blood flows
to the heart
Blood flows
to the heart
Valves in
varicose veins

66. Varicose Veins
Permanent dilations of the veins associated with elongation,
functional or organic avalvulación and irreversible damage to
the parietal endothelium.
Morphology:
• Telangiectasia
• Reticular Varicose Veins
• Truncal Varicose Veins

67. Edemas
In a flooded area,
communications are
hindered, resulting in an
adverse swamping to the
health of the person.
Accumulation of fluid in the interstitial space

68. Lymphedema
It is a protein rich edema
It can be:
Primary (hereditary)
It’s divided in 3:
• Congenital lymphedema
• Early Lymphedema: before the age of 35
• Late Lymphedema occurs after the age of 35
Secondary
It’s divided in:
• Benign: acquired
• Malignant: tumor

69. A patient after traveling from Canada to Colombia presents an
acute lymphedema. After three therapies a great improvement
in signs and symptoms was shown – The patient had to return
to Canada so two therapies were done on the same day and
the other on the day.
It was recommended
compression stockings,
lymphokinetic exercises
and following therapy
when arriving the
country of residence.

70. Lymphedema
Female patient
Age: 84
Weight: 25 kilos

71. Elephantiasis

72. Secondary lymphedema
by gait disturbances

73. Patient with left arm lymphedema,
Chronic Venous Insufficiency in mmii

74. THE IMPORTANCE OF PRESSOTHERAPY
AS A TOOL OF PVR IN ULCERS

75. Ulcers
Consists in the loss of substance,
chronic, of extension and variable
depth, located preferentially in
the distal third of the leg.
Mixed ulcers
(arterial and venous)
Vascular Ulcers
(most frequent)
Arterial ulcers

79. Complications of Peripheral Vascular Pathologies
due to negligence, carelessness
and/or misinformation
• Fungal infections of the skin
• Erysipelas (staphylococcus and
streptococcus bacteria)
• Papillomatosis: warts and
skin protrusions
• Elephantiasis
• Thrombosis
• Cellulite

80. PRESSOTHERAPY IN
ONCOLOGY PATIENTS

81. Inguinal-iliac lymphadenectomy
Part of the treatment in oncology
patients (retroperitoneal cancer, ovary,
endometrium, prostate, etc.)
This lymphatic
decompensatio
produces lower limb
lymphedema occurs
in a large percentage.

83. Axillary lymphadenectomy

84. Lymphedema with 30 years of evolution,
secondary to breast cancer

85. Is it allowed the use
of pressotherapy in
oncology patients?

86. After the various treatments to which are subject
oncology patients, they suffer some sequels,
product of the lack of full or partial lymph nodes
in different lymphatic node stations where the
filtering of surpluses in the organism occurs.
When a blockage of the lymphatic system occurs,
blocking proper evacuation of lymph, it begins to
produce what is known as Secondary Lymphedema.

87. Previously, the use of Pressotherapy in oncology
patients was discouraged because the sleeves had
a single chamber that when insufflated performed
a tissue pressure around the affected limb, creating
dangerous areas of hydric pressure and tissues with
little possibility of draining of liquids proximally.

88. However
When increasing the number of chambers and while making
a more fragmented sequential pressure, a gradient of more
fragmented sequential pressure is created, it is subsequently
also created a gradient of tissue and water pressure similar to
“tile roof”, with partial overlapping of the chambers- one above
the other- which avoiding coetaneous pressure.

89. What are we looking for in the
treatment of the oncologic patient?
• Decrease the volume of the affected limb
• Improving quality of life
• Reduce risk of complications
• Improve joint range
• Improve the psychological state of the patient
• Improve skin trophism

90. THE IMPORTANCE OF PRESSOTHERAPY
IN DIFFERENT AREAS OF MEDICINE
Lic. Sandra Fariña
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