Our research proved that pressotherapy essentially influences the resorption of liquids. It only minimally influences reabsorption of proteins, if at all. ( 2, 3, 11 )

Lymphoedema is characterised by the high concentration of proteins, caused by various physiopathological processes and especially by the lowering of the protein resorption.

As long as the proteins stagnate in the interstitial spaces, the oncotic pressure remains increased and the oedema continues. This is important because the protein concentration will favour fibrotic changes to the oedema and so acts as a stimulus causing a chronic inflammatory process. For this reason, pressotherapy should never be used alone and should only be used in conjunction with MLD.

It has been established that sequential intermittent pressotherapy (IPT) should not be used without MLT. The exerted pressure should never exceed 40 mmHg. Any higher pressure than this low figure causes collapse of the initial lvmphatics. Both manual and mechanic pressures
must be set in response to the physiological condition of the individual patient ( 10 ). The raise in pressure as a result of IPT drives the fluids forward via all the existing possibilities of the circulatory return.The absorption of the overfow.fluid is vervy slow. IPT has therefore to be
done in a slow cycle increasing and decreacing pressure.

It is clear that IPT should not be used alone, nor should it be the first treatment used. Examination of the proximal part of the limb by palpation is very important. It allows us to have a good idea of the tissue  infiltration and compare the affected limb with the unaffected limb. The trunk should also be examined with palvation of the skin of the abdominal wall, hip and buttock. It must be clearly understood that if there is any truncal or proximal oedema then the first goal of treatment will be to evacuate this oedema by manual stimulation of the lvmphangiomotoric activity of this area. We know that gentle tactile stimuli in combination with a greater filling of the lymhatics will increase the number of pulsations in the lymph vessels (4). IPT should therefore be preceded by MLT on the proximal part of the limb. We recommend that IPT should only be started after proximal oedema has been resorbed.