Patient Education · Hypermobility & EDS · Recovery

By Jacques Courseault, MD, CAQSM, FAAPMR · Founder, The Fascia Institute and Treatment Center^®

In our hypermobility and EDS clinic, one of the most common patterns we see is blood that doesn’t come back up. Patients stand, blood pools in the abdomen and legs, the heart races to compensate — and the day falls apart. That mechanism has a name (splanchnic venous pooling), it has a diagnosis (postural orthostatic tachycardia syndrome, or POTS), and it has surprisingly good evidence for a low-tech intervention: compression.

This is why we use, and recommend, sequential pneumatic compression devices like the NormaTec.

Roughly 60-70% of your total blood volume sits in the veins at any given moment. Veins are thin-walled and stretchy, which makes them efficient reservoirs — and inefficient pumps. In healthy adults, calf muscles, abdominal pressure, and tight connective tissue squeeze venous blood back toward the heart with every step. In patients with hypermobility, dysautonomia, lipedema, or chronic venous insufficiency, that return system underperforms. Blood accumulates below the diaphragm, cardiac filling drops, and the autonomic nervous system compensates by accelerating heart rate.

A Vanderbilt Autonomic Dysfunction Center study published in JAHA showed this directly: an abdominal binder targeting the splanchnic venous bed prevented the blood-pressure drop POTS patients experience on a beta-blocker, and the combination of compression plus low-dose propranolol improved symptoms more than either alone.^[3] The takeaway: venous pooling is treatable mechanically, not just pharmacologically.

Compression socks and abdominal binders apply constant pressure. NormaTec and similar sequential pneumatic compression devices apply dynamic pressure — chambers inflate in a wave from the foot upward, milking venous blood toward the heart, then release.

The mechanism isn’t marketing. A duplex-ultrasound study in the Journal of Vascular Surgery demonstrated that high-pressure, rapid-inflation pneumatic compression increases femoral and popliteal vein velocities significantly above baseline — even in patients with post-thrombotic damage to the venous system.^[5] In plain English: the device actively pushes blood back up to the heart, in a way that walking does, but on demand and without requiring the patient to be upright.

A 2025 Duke study added a useful nuance: when it comes to abdominal compression, surface area matters more than peak pressure. Circumferential compression covering more skin at moderate pressure (40 mmHg) blunted the standing heart-rate rise and supported standing blood pressure better than focal high-pressure binders.^[4] This is one reason a hip- or core-level pneumatic attachment is often more useful for POTS patients than a narrow waist belt.

The clinical evidence for compression in POTS — the conceptual cousin to pneumatic compression — is strong and getting stronger.

In a 30-patient randomized crossover tilt-table trial published in the Journal of the American College of Cardiology, a full waist-high compression garment dropped standing heart rate from 109 to 92 bpm and improved Vanderbilt Orthostatic Symptom Scores, in a dose-dependent fashion (no compression → legs only → abdomen/thigh → full lower body). The benefit was driven by better-maintained stroke volume.^[1]

A 2025 follow-up in the Canadian Journal of Cardiology tested the same concept in real-world conditions: commercially available abdominal-only garments lowered standing heart rate (103 vs 118 bpm) and improved symptoms both immediately and after several hours of wear. Heart rate and symptoms rebounded when patients took the garment off in the afternoon.^[2]

And in athletes with reliable post-exercise orthostatic intolerance, a small but elegant study found that simply wearing lower-limb compression after exercise reduced fainting episodes from 6/6 to 1/6.^[6]

Static garments work. Dynamic pneumatic compression amplifies that effect by actively moving the blood column, which is why we use it before patient sessions on rough days, and why many of our patients use it at home.

Venous congestion shows up in many of the patients we treat — chronic venous insufficiency, post-thrombotic syndrome, lipedema, lymphedema, and the lower-extremity heaviness that’s common in EDS. The Cochrane systematic review of intermittent pneumatic compression for venous leg ulcers (9 RCTs, 489 patients) found that IPC increased healing compared to no compression, with one study showing 62% healed vs. 28% — and that rapid-inflation IPC outperformed slow IPC (86% vs 61% healed).^[7]

NormaTec falls into the rapid-inflation, sequential category. The device class has decades of vascular-surgery evidence behind it.

The athlete-recovery literature, while less directly clinical, validates the device design. A randomized trial at the US Olympic Training Center showed that 15 minutes of NormaTec-style sequential compression raised pressure-to-pain thresholds in the lower extremity, and the effect persisted through the training day.^[8]

From a fascia standpoint, sequential compression also creates rhythmic mechanical loading of the superficial fascia and the lower-limb lymphatic chains. We see this clinically as reduced lower-extremity heaviness, less next-day swelling after Hydrofascia Release™, and better tolerance to upright activity the following day.

In the clinic, we use sequential pneumatic compression in three settings:

Before evaluation, for POTS-spectrum patients who are too symptomatic standing to give a good history.

After Hydrofascia Release™, particularly in the lower extremity, to move fluid through the treated tissue planes and reduce post-treatment heaviness.

As part of the FLIP program (FIT Lipedema and Inflammation Program), where chronic lower-extremity congestion is part of the diagnostic picture.

For at-home use, most of our POTS and hypermobility patients run 20-30 minutes once or twice daily — typically mid-day and again before bed. Settings are individualized; start low and build up.

Pneumatic compression is generally safe but it is not for everyone. Talk to your physician first if you have any of the following: known or suspected deep vein thrombosis (DVT), severe peripheral arterial disease, decompensated heart failure, acute skin infection or open wound at the compression site, severe peripheral neuropathy, or recent lower-extremity fracture or surgery. If you develop new calf pain, redness, or swelling, stop using the device and seek evaluation.

The device we recommend. The NormaTec leg system is the one we point patients toward most often — it’s the model with the longest peer-reviewed track record in the sequential-compression category and the one we use in clinic.

Disclosure: The Fascia Institute and Treatment Center^® is a participant in the Amazon Services LLC Associates Program. As an Amazon Associate, FIT earns from qualifying purchases. This does not affect the price you pay and does not influence our clinical recommendations.

Curious whether compression therapy belongs in your care plan?
Our Hypermobility & EDS Clinic and FLIP program both build pneumatic compression into the protocol when indicated. Request an appointment →

1. Bourne KM, Sheldon RS, Hall J, et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. J Am Coll Cardiol. 2021;77(3):285-296. pubmed.ncbi.nlm.nih.gov/33478652
2. Bourne KM, Karalasingham K, Siddiqui T, et al. Abdominal-only Compression Garments Reduce Orthostatic Tachycardia and Improve Symptoms in Patients With POTS. Can J Cardiol. 2025 (online ahead of print). pubmed.ncbi.nlm.nih.gov/41338488
3. Smith EC, Diedrich A, Raj SR, et al. Splanchnic Venous Compression Enhances the Effects of Beta-Blockade in the Treatment of Postural Tachycardia Syndrome. J Am Heart Assoc. 2020;9(14):e016196. pubmed.ncbi.nlm.nih.gov/32673517
4. Mitra K, Kunte SA, Taube SE, et al. Standing under pressure: hemodynamic effects of abdominal compression type and intensity in healthy adults. Front Physiol. 2025;16:1621617. pubmed.ncbi.nlm.nih.gov/40909328
5. Malone MD, Cisek PL, Comerota AJ Jr, et al. High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics in healthy volunteers and patients who are post-thrombotic. J Vasc Surg. 1999;29(4):593-599. pubmed.ncbi.nlm.nih.gov/10194485
6. Privett SE, George KP, Whyte GP, Cable NT. The effectiveness of compression garments and lower limb exercise on post-exercise blood pressure regulation in orthostatically intolerant athletes. Clin J Sport Med. 2010;20(5):362-367. pubmed.ncbi.nlm.nih.gov/20818194
7. Nelson EA, Hillman A, Thomas K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2014;(5):CD001899. pubmed.ncbi.nlm.nih.gov/24820100
8. Sands WA, McNeal JR, Murray SR, Stone MH. Dynamic Compression Enhances Pressure-to-Pain Threshold in Elite Athlete Recovery: Exploratory Study. J Strength Cond Res. 2015;29(5):1263-1272. pubmed.ncbi.nlm.nih.gov/24531439

This article is for educational purposes and is not a substitute for individualized medical advice. If you have POTS, EDS, lipedema, venous disease, or any cardiovascular condition, please consult your physician before starting compression therapy.