Yu-Li SUNG, Physiotherapist and Director, Medical Device Center,
Sunshine Social Welfare Foundation
Is it OK wearing pressure garments during rehabilitation exercises? Many therapists often ask us this question. On one hand, we want to make sure that the patient wears pressure garments for as many hours possible during the day to achieve better scar control. This is especially crucial when hypertrophic scar growth is in its most active phase. On the other hand, garments can feel uncomfortable or the patient may feel that they impede movements. In this article, we will explain when garments should be removed or kept on, but more importantly, we will also explain key points that therapists should pay attention to.
When to remove garments? When to keep garments on?
Removing or keeping the garments on will depend on the type of rehabilitation activity that is being carried out.
During the active hypertrophic scar growth phase, continuous pressure should be applied to counteract scar growth. Generally speaking, we want to avoid interrupting wear time as much as possible, except when necessary, like bathing or showering. That is why patients should keep their pressure garments on when doing rehabilitation activities like active or passive exercises, stretching or functional training. Some activities like exercises with therapeutic putty or with Velcro-covered tools (like the E-Z Exer-board) risk soiling or damaging the fabric of the pressure garment glove. Instead of removing the pressure garment gloves to perform exercises, disposable clear plastic gloves can be used over them.
We remove pressure garments if the rehabilitation intervention requires direct contact with the skin, like ultrasound, massage with lotion or desensitization activities. We will also remove the garment if the rehabilitation intervention will cause friction from the fabric of the garments on scars that are still fragile or unstable, such as during manual therapy.
Precautions to reduce risk of problems
The therapist can take the following precautions to reduce the risk of friction or discomfort caused by pressure garments during rehabilitation interventions. The guiding principle is that we want to avoid causing any wounds or blisters.
1. Protect specific joints
Some interventions involve repetitive movements that will naturally cause the fabric of the garment to rub against the skin. This friction over joints or surrounding areas (ex: elbow olecranon or antecubital fossa) can cause discomfort, irritation and eventually result in wounds or blisters. A protective layer of non-woven gauze can be placed between the skin and the garment to reduce friction.
2. Observe skin condition after rehabilitation intervention
It’s important that the therapist observes the patient’s skin condition after rehabilitation interventions, and also educate the patient to be on the lookout for signs of wounds or blisters. If wounds appear after the rehabilitation intervention, it is necessary to adjust the intensity, frequency or even method of intervention.
3. Make sure the pressure garments fit
Garments that are too tight will not only affect ease of movement during rehabilitation, but they will also increase the risk of wounds due to friction on the skin. The therapist needs to make sure that garments provide adequate pressure without being too tight, which would otherwise cause other complications.
