Compression stockings may help SMA patients with swelling, edema
After 3 years, patient has found them more comfortable to wear for longer
Michael Morale wears compression stockings to reduce edema in his lower extremities. (Courtesy of Michael Morale)
One of the first objectives we wanted to address when Michael, who has spinal muscular atrophy (SMA), began physical therapy in 2017, was swelling in his feet and ankles. There are many ways we have addressed the swelling and edema in his legs, including reducing his salt intake.
Although this helped slightly, the position Michael sustains all day, sitting in his wheelchair with no footrests, is one of the main causes of his edema. Also, his reduced ability to perform muscle contractions doesn’t allow him to use his natural muscular pump to reduce edema. Although Michael is going to have a wheelchair with footrests soon, he will still be sitting in his chair most of the day and will continue to struggle with edema in his feet. One way we have found to reduce this is to for Michael to wear compression stockings.
When we first began with the compression stockings, they were uncomfortable for Michael due to the increased swelling and he was only able to tolerate them for a few hours. He was unable to keep them on overnight or for consecutive days. In each session, we spend time using edema reduction techniques such as edema reduction massaging and lymphatic drainage of the feet and ankles.
Any pooling of fluid in the extremities will be uncomfortable. It is essential to try and rid the edema from the extremities and return the fluid to the lymphatic system; this is a common problem for people with SMA. Due to the lack of ability to perform muscle contractions and gain strength, they typically lead a sedentary lifestyle. Therefore, there is no natural muscular pump to return the fluid through the body and remove it from the feet and ankles.
If left in the feet and ankles for too long, increased swelling can lead to scarring of the tissues and reduced ability of the veins and arteries to work efficiently. Before using compression stockings, ensure the patient has no contraindications, such as congestive heart failure. Getting clearance from the patient’s primary care doctor is always considered best practice.
Now that Michael has been using the compression stocking for about three years, off and on, he is able to wear his compression stockings through the night and throughout multiple days. The increased amount of time he is able to tolerate these compression stockings leads to reduced edema for increased lengths of time.
Within the next few months, Michael will be in a wheelchair that has footrests which will allow for increased support of his feet and ankles to reduce edema. In this new chair, he will also be able to recline to bring his feet into an elevated position.
With these new options, there will be more ways to ensure reduced edema in Michael’s feet and ankles. Even with these new techniques and abilities, Michael will continue to wear compression stockings to continue to improve his comfort and reduce the edema in his lower extremities.
Patient perspective
For the first 13 years of my life, I had the ability to walk using braces and crutches. We also had a pool in our backyard, so I was able to exercise regularly. During junior high, I found it difficult to use my braces and crutches, because my classes were too far apart from each other, and it was also becoming increasingly difficult to walk due to the progression of my SMA.
At around the age of 14, I found it easier to use my wheelchair on a more permanent basis, and this was about the time when the swelling and edema became an issue. Doctors had already warned me about not using my footrests in my wheelchair, but with the footrests on, it made it very difficult for me to pull up under a desk or get close enough to reach up and open a door.
After beginning physical therapy in 2017, both of my therapists worked with me on trying to reduce the amount of swelling and edema that was occurring in my feet and ankles. As Emily stated, compression stockings were uncomfortable for long periods of time, but I have found that over time, the lymphatic and edema reduction massages that I go through each week have helped. I’m now able to tolerate wearing my compression stockings for multiple days.
I understand that this will not cure my problem with the swelling, but it has definitely shown to be beneficial, especially with the way my feet, ankles, toes, and legs feel throughout the day. The compression stocking on my left leg goes on quite easily, but it takes Emily considerably more time to put the compression stocking on my right leg, due to the swelling.
My physical therapists have been a blessing in my life, and if you’re a physical therapist working with a patient who has SMA, please know and understand the impact that you’re having on their lives. I may squawk and complain every once in a while, but I know that Emily has my best interests at heart. She has a beautiful son who just turned 2 last November, and when I start to complain or try to weasel my way out of doing something, all she has to do is look at me with her mom eyes. She’s very good at it.
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