Treatments

Compression Therapy

The least invasive tool in vein care, and usually the first — supportive, evidence-based, and often a prerequisite for insurance authorisation.

Medically reviewed by Satish Tadepalli, MD, MPH, DABVLM · Last reviewed 18 August 2026

A Clinical Overview

Graduated compression garments apply external pressure that is strongest at the ankle and decreases up the leg. That gradient works with the calf muscle pump to help move blood upward, narrowing distended veins so their valves meet more effectively and reducing the pressure that forces fluid into surrounding tissue.

The word "graduated" matters. A garment that squeezes evenly, or more tightly higher up, does not produce the same effect and can act as a tourniquet. Properly specified medical compression is a different product from generic support hosiery.

Compression is honest about what it does: it manages the condition while it is worn. It does not repair a failed valve, and it does not remove a vein that is already enlarged. Symptoms typically return when it is stopped — which is precisely why it is a treatment rather than a cure.

Who May Benefit

Anyone with aching, heaviness or fatigue from chronic venous insufficiency.
Patients with venous leg swelling.
Patients with symptomatic varicose veins who are not ready for, or not suited to, a procedure.
Patients completing the conservative-therapy period their insurer requires before authorising treatment.
Patients after a vein procedure, as part of the recovery protocol.
People whose work involves prolonged standing or sitting, or who are pregnant, where compression is used supportively.

How It Is Used Here

Assessment first

Before compression is recommended, circulation is assessed. Compression is not appropriate for everyone — significant peripheral arterial disease is a genuine contraindication, and advanced neuropathy, certain skin conditions and uncontrolled heart failure all require caution. A duplex ultrasound also clarifies what is being managed.

Specification and fitting

Strength (measured in mmHg at the ankle), length, and garment style are chosen for your diagnosis and your circulation, then the leg is measured for fit. A garment that is the wrong size is the most common reason patients abandon compression.

Practical guidance

Stockings go on in the morning before swelling has accumulated and come off at bedtime. Donning aids, rubber gloves and open-toe or zip styles all make daily use more realistic. Garments lose elasticity with washing and wear and need replacing periodically.

What to Expect

Many patients notice aching and heaviness ease within days to weeks of consistent daily wear, and swelling is often better controlled through the day. Correctly fitted compression should feel firm and supportive — not painful, and it should not roll, dig in or leave deep grooves.

Where skin changes are already established, compression is used to reduce the risk of progression and to support healing; those changes may improve slowly or only partially.

Limitations

Compression is a management strategy, not a correction. It requires daily commitment, which some people find difficult in hot weather or with limited hand strength or mobility. It does not eliminate visible varicose veins. And where a duplex study shows significant reflux in a specific vein, compression alone leaves that underlying source untreated.

When symptoms persist despite consistent use, or when reflux is documented and appropriate, the options are radiofrequency ablation, endovenous laser ablation, Varithena®, VenaSeal™, ultrasound-guided sclerotherapy or microphlebectomy. Compression frequently continues alongside these.

"Compression gets dismissed as the thing you do before the real treatment. Worn properly and fitted correctly, it does a great deal of work — and it tells me a lot about how the leg behaves."— Dr. Satish Tadepalli, MD, MPH, DABVLM

Frequently Asked Questions

01Do compression stockings cure varicose veins?

No. Compression manages symptoms and supports venous return while it is being worn; it does not repair a failed valve or remove an existing varicose vein. It is a genuinely useful treatment, but it controls the problem rather than correcting it.

02What compression strength do I need?

Strength is measured in mmHg at the ankle, and the appropriate level depends on your diagnosis, the severity of your symptoms and your arterial circulation. This is a clinical decision rather than a shopping one — the wrong strength can be ineffective or, in someone with arterial disease, unsafe.

03How long each day should they be worn?

Generally they are put on in the morning before swelling accumulates and removed at bedtime. Compression works against gravity during the hours you are upright, so daytime wear is where the benefit lies. Your own regimen will be specified at your visit.

04Is anyone advised not to wear compression?

Yes. Significant peripheral arterial disease is the main contraindication, because compression can further reduce already limited arterial inflow. Certain skin conditions, advanced neuropathy and some cases of uncontrolled heart failure also require caution. Circulation is assessed before compression is recommended.

05Why does my insurer want me to try compression first?

Most plans require documentation of a trial of conservative therapy — commonly around three months — before authorising a vein procedure. Wearing the stockings and recording that period is often a practical prerequisite for coverage as well as a reasonable clinical step. See our insurance page.

06Mine are uncomfortable and hard to put on. Is that normal?

Correctly fitted compression should feel firm and supportive, not painful, and should not cut in or roll down. Difficulty is often a sizing or technique problem rather than an inevitability. Bring them to your visit — sizing, garment style and donning aids can usually be adjusted.