Compression vs Decompression

by Mitch Hauschildt, MA, ATC, CSCS

Dealing with fluid is always a challenge for a lot of us in the therapy world.  It is one of, if not the first items that we put on our “to-do” list to jump start the healing process and returning our patients and clients to their activities.

To say that swelling and fluid can be problematic is an understatement.  It will limit range of motion, alter proprioceptive feedback, increase pain, and slow the overall healing process.  And if it isn’t dealt with in a timely manner, pitting edema and/or myositis ossificans can set in which is a mess.

The traditional approach to dealing with excess and unwanted fluid is with compression.  Using Ace Wraps, elastic tape and pneumatic constriction devices have long been the gold standard for moving fluid out of a joint or area of the body and back into the body.

With the rise in popularity of kinesiology tape in recent years, we are now seeing a different approach take hold in many medical circles in the form of decompressing tissue with tape.  Obviously, as most of you know, I work closely with Rocktape and I am a big fan of their products and methodology, so I might be a little bit biased in some ways when it comes to using tape.  In the case of moving fluid, I actually use both compression and decompression at different times for a variety of reasons.  Before we get to when I use which strategy, lets first look at the advantages and disadvantages of each:

• Compression

  • Mechanism:  Compressing tissue by wrapping a limb or body part with either an elastic product or mechanical device to physically push fluid out of an area and/or prevent fluid from entering the area
  • Advantages: Ease of use
    • Inexpensive
    • It is very effective for a specific population
    • Can be used to limit fluid build up initially after an injury
  • Disadvantages:
    • Many times it is uncomfortable to provide compression acutely after an injury
    • Wraps can be bulky
    • Mechanical compression devices are often expensive and require power, proper cuffs, etc.
    • The potential for tissue damage exists when compressing tissue for extended periods of time

• Decompression:

  • Mechanism:  Utilizing the decompression effects of kinesiology tape, oftentimes cut into thin strips and fanned out over an area to decrease the pressure gradient, open up space within the tissue and allow fluid to move more freely
  • Advantages:
    • Ease of use – tape can be applied and left and/or changed out for several days at a time, even with showering
    • Easily fits in a shoe or under a brace
    • Very comfortable to wear
    • It is very effective for a specific population
    • The risk of tissue damage is small
  • Disadvantages:
    • Depending on the size of the area, sometimes it can be more expensive than a wrap
    • It may irritate some people’s skin
    • A small population doesn’t tolerate the neurological input that the tape provides after an acute injury

Which is best?

The answer is, it depends.  My experience tells me that most people prefer to wear tape instead of a compression wrap due to it’s slim fit, colorful design, and ease of access and use.  Objectively, I have observed that using decompression is at least as good as compression for most people if I compare something like an Ace wrap with kinesiology tape that are worn around the clock after an injury or surgery.  Because of this, I prefer to start with tape to decompress an injured area and see how they do with it.

With that being said, there are some people don’t respond well to decompression.  As an example, I am currently treating an offensive lineman who has just had his ACL reconstructed for the second time.  He has had a lot of damage in that knee and he is a large framed individual.  I taped him the day after surgery and changed it out every day or two for close to a week.  What I found with him was that his effusion steadily increased over that time.  The tape was not helping him.  As much as I love to tape, I had to try something else.  So, we switched to an Ace wrap to provide compression with his activities of daily living and he saw significant improvements within a couple of days.  His body prefers compression to deal with fluid build up.

It appears that, as with most treatments, there isn’t just one intervention that is right for everyone.  That’s why it’s important to have plenty of tools in our toolbox.  I use tape most of the time, but when it doesn’t work, I go with a wrap.

One thing that I don’t suggest that you do is combine tape with a wrap.  While it can be tempting to throw the entire “kitchen sink” at the issue when it is bad or you are under a tight timeframe, using compression and decompression at the same time essentially cancels each therapy out and won’t do much to make improvements.

With that being said, I do like to combine compression with decompression in a different way.  What I find works very well is to use tape as they move throughout their day to decompress the area and keep fluid flowing freely.  When they are in my clinic, however, I like to use manual massage, IASTM (fluid capture stroke), and short term, aggressive compression such as a vaso-neumatic device or mobility bands to provide aggressive compression for a short period of time.

A simple and very cost effective approach is to use a 4 inch wide (or 2 inch for smaller areas) floss band to wrap the area very tightly while elevating the area for a relatively short period of time.  This can have a significant impact on the area and then maintained with less aggressive interventions (i.e. tape).

While I haven’t (and likely can’t) provide much in the way of research to support these strategies, conceptually they make a lot of sense and clinically have worked very well for me.  It is rare that just one strategy will work for everyone so combining approaches at the right time and in the right sequence seems to be the most effective approach seems to lead to the best outcome for most patients and clients.