A Long-Standing History: How Compression Socks and Therapy Have Evolved Over Time
Compression therapy has been around for thousands of years, but modern compression stockings as we think of them only emerged in the 1940s and 1950s, making them a relatively recent development. From ancient bandages to advanced compression technology, we are going to investigate how compression therapy has evolved over time before diving into compression therapy today. We also want to explain everything you need to know about popular compression garments and break down the five main levels of compression.
History of Compression Therapy
Like many medical devices, compression garments have their roots in ancient history. Physicians in ancient Rome and Egypt used bandages to wrap patients’ legs to bind and treat injuries. However, compression garments as we know them today didn’t arise until thousands of years later, in the late 1930s just before World War II.
Many companies, including Jobst, Juzo and Mediven, began manufacturing compression stockings in Europe around the same time and quickly innovated on the design. While we can’t know for sure, it seems that Conrad Jobst, founder of the eponymous company, was probably the first to invent compression garments.
A medical engineer and inventor originally born in Germany, Jobst suffered from severe chronic venous insufficiency (CVI). According to Johns Hopkins Medicine, chronic venous insufficiency is a condition that occurs when veins in your legs don’t function properly. Instead of allowing blood to flow back to your heart, the valves malfunction, which can cause blood to flow backwards and/or pool in your lower legs.
Jobst noticed how swimming in the pool helped with his swelling and poor circulation. Reasoning that the relief came from the gentle pressure of the water, he sought to make a product that could emulate the same effect that the liquid had on his legs. Thus, the medical compression stocking was born.
Jobst worked with professionals in phlebology and lymphology to further refine his compression stocking design. Alongside other brands, Jobst compression stockings spread all over Europe. In the wake of WWII, the use of medical compression stockings made its way across the pond, becoming popular in the United States as well.
These medical compression stockings were a boon to people like Jobst who suffered from chronic venous insufficiency and other potentially debilitating venous conditions. However, the design hadn’t quite reached its peak form yet. Original compression stocking designs provided the exact same pressure all up and down the garment. However, you need more pressure at the bottom of the limb than at the top because the bottom of the limb is where gravity’s effect is the strongest. In the 1980s, graduated compression stockings were invented and soon became the standard in compression garment design. Compression therapy has come a long way from ancient leg binding techniques!
Compression Therapy Today
Today, compression therapy is used to prevent or manage a wide variety of venous issues, including chronic venous insufficiency, deep vein thrombosis and other blood clots, spider veins and varicose veins. Compression socks may also help alleviate swelling, pain and/or achiness in the legs.
To be exact, compression therapy is often used to address venous issues, especially in the elderly, who experience these health problems more often. But don’t knock compression therapy because you think you’re too young or healthy to need it. Compression garments may be used by people of all ages for all kinds of reasons. For example, many young athletes in their physical prime swear by compression gear to help them reach peak performance and recover faster from workouts and competitions. Other people might wear compression gear in order to cope with the symptoms of DVT. Frequent travelers turn to compression socks to help reduce their risk of blood clots and help keep their legs limber during long flights and driving. Meanwhile, expecting moms use maternity compression tights to help them manage swelling and leg pain during pregnancies.
Compression garments come in many different styles. Perhaps the most popular are those for the lower body, including compression socks, compression thigh highs, compression tights and maternity pantyhose. Compression therapy is also available for the upper body in the form of an arm sleeve or gauntlet. While much less common, compression products can also be found for other areas of the body such as the torso and groin. (More on popular compression products in the next section.)
Compression wraps are also available for people who find one continuous tube of fabric hard to don. Compression wraps are made of sturdy fabric with hook and loop tabs so you can adjust the level of compression as needed. If you struggle to put on traditional compression stockings, compression wraps are a great alternative.
Popular Styles of Compression Products
If you’re new to the world of compression therapy or haven’t worn the garments in a while, all the options can feel overwhelming. Here’s a quick primer on some of the most popular styles of compression products:
Compression Socks
The most common type of compression garment is the compression sock. While there are ankle/crew compression socks available, most people opt for a knee-high sock that extends up the calf so they can get the benefits of compression in their lower legs as well as their feet. Of course, the socks come in basic, solid neutrals like nude, grey, black and navy, perfect for blending in with your office wardrobe. However, there are also plenty of eye-catching designs available if you like to make a statement with your socks. In particular, SockWell makes really fun (and uber comfortable) compression socks that look like the hippest designs you’d find in a sporting goods store.
Thigh High Stockings
For those who’d like to get compression benefits in their thighs as well as their calves, we recommend thigh high stockings. The stockings come in closed toe and open toe designs, and most brands feature a silicone band at the top to keep the stockings from rolling downward as you move around. If you only need compression for one leg (say, you only suffer from lymphedema on one side of your body), chap-style stockings with a waist belt will get you set up perfectly. If you prefer the look of a stocking over a sock but don’t need a garment that covers your thighs, check out knee-high stockings instead. As for brands that we like, we recommend Sigvaris compression stockings and, of course, Jobst compression stockings as well.
Pantyhose and Tights
If you need the benefits of compression from your waist to your toes, then compression pantyhose are what you want. This garment looks like a regular pair of tights but provides compression for your entire lower body. With tights, you don’t have to worry about the garment rolling down since the waistband keeps everything in place. Compression pantyhose are available in both sheer and opaque fabrics, and they also come in closed toe, open toe, footless designs just like thigh high stockings. Expectant mothers will want to look at maternity pantyhose, which are meant to accommodate a growing belly and help manage swelling in the tummy area as well as the legs.
Armsleeves
Most people struggle with circulation and swelling in their lower bodies, hence why many best-selling compression products are designed for the legs. However, the legs don’t have a monopoly on venous issues, and some people struggle with poor blood flow and swelling in their upper body–especially their arms. Armsleeves offer graduated compression for your arms, and they can also be paired with a gauntlet to provide compression benefits to the hands as well. Armsleeves come in standard neutral colors and Juzo also makes a really fun line of printed armsleeves as well if you’d like to add a pop of color to your compression gear.
Understanding Compression Levels
There are five main levels of compression garments: 8-15 mmHg, 15-20 mmHg, 20-30 mmHg, 30-40 mmHg and 40-50 mmHg. Most people can wear the first two levels without any major issues, which is why they’re available over the counter. However, you should talk to your doctor before wearing compression hosiery if you have any of the following conditions: ischemia, untreated septic thrombophlebitis, uncontrolled congestive heart failure, phlegmasia coerulea dolens, concomitant dermatoses, advanced peripheral neuropathy and arthritis.
8-15 mmHg (mild)
The lightest level of compression available, 8-15 mmHg garments help maintain already healthy circulation and alleviate mild symptoms and swelling. If you don’t have venous issues but spend a lot of time sitting or standing (and experience heavy, aching legs as a result), mild compression can help your lower body stay energized and fight fatigue. Early on in pregnancy, these compression stockings can also help the symptoms of varicose and spider veins to be manageable, though you’ll likely want to increase the compression level as your pregnancy progresses.
15-20 mmHg (medium)
If you’ve never worn compression socks before, most doctors will recommend that you start with 15-20 mmHg, which is one of the many reasons why it’s the most common entry level of compression socks. Like mild compression, medium compression garments will help fight swelling and tired, aching limbs. They can also help relieve pain from other venous issues such as varicose and spider veins and deep vein thrombosis (DVT), a condition that occurs when a blood clot forms in the veins deep in the body, often in the legs. If a DVT clot breaks loose and travels to the lungs, it can result in a pulmonary embolism, which can be life-threatening. People who sit or stand all day—from nurses to frequent flyers to seniors with mobility issues—are at greater risk for developing DVT, which is why doctors often recommend this level of compression to them.
20-30 mmHg (firm)
You’ll want a recommendation from your doctor before you upgrade beyond 20 mmHg compression wear, as these compression garments are meant to be used for more serious venous issues, including: moderate to severe edema or lymphatic edema (aka swelling); orthostatic hypotension, a sudden fall in blood pressure that occurs when you stand up; the management of active ulcers and manifestations of post-thrombotic syndrome (PTS), a long-term condition that results from DVT; and superficial thrombophlebitis, an inflammatory condition caused by a blood clot just below the skin. Of course, this level of compression offers the same benefits as the first two levels as well, and will help address more minor complaints such as swelling and varicose or spider veins.
30-40 mmHg (extra firm)
Same as the 20-30 mmHg products, you shouldn’t wear this higher level of compression unless your doctor has instructed you to. This level of compression helps to better manage symptoms of lymphedema and more severe versions of the same conditions as the 20-30 mmHg product.
40-50 mmHg
This is the highest level of compression and it is only used to manage the most serious venous issues. Compression products with this level of compression should only be used if recommended by a doctor.
Compression socks help manage pain, swelling and symptoms for many patients who had no other treatment options before compression therapy was invented. While they can’t cure venous issues, compression garments can significantly improve your quality of life and help you better manage your conditions. We’re certainly thankful that compression socks were invented, and we know many of our customers are, too.
Kaki Zell - Vice President of Sales, Marketing, eCommerce at Legs-4-Life LLC Kaki holds a Bachelor of Science degree in Business Administration and Management from Virginia Polytechnic Institute and State University. She’s been working in the medical device industry for over 11 years and currently serves on the Board of Directors for the Greensboro Science Center.
Written April 2019 | Page last updated November 2021
Sources:
National Center for Biotechnology Information. “Wound Healing Through the Ages” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495363/
JOBST. “History” https://www.jobst-usa.com/about-us/history.html
John Hopkins Medicine. “Chronic Venous Insufficiency” https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-venous-insufficiency
Palm Vein Center. “History of Compression Stockings” https://www.palmveincenter.com/education/history-of-compression-stockings
Vein Clinic of North Carolina. “Who Shouldn’t Wear Compression Stockings?” https://veinclinicnc.com/who-shouldnt-wear-compression-stockings/
MedlinePlus. “Deep Vein Thrombosis | DVT” https://medlineplus.gov/deepveinthrombosis.html