Innovations in Lymphedema Management: STRIDE 2.0 and the Paradigm Shift in Compression Therapy

This Research Roundtable opened with a powerful reframing of compression therapy, challenging the long-held belief that compression is simply a sleeve, stocking, or pressure number. While compression does influence the vascular system, the discussion highlighted that its most meaningful effects may occur at the cellular level. Rather than merely moving fluid, compression—particularly stiff and textured textiles—creates mechanical deformation of the extracellular matrix, triggering cellular responses that affect inflammation, fibrosis, microcirculation, and lymphatic flow. This represents a paradigm shift, positioning compression as a biologically active intervention, not just a fluid-management tool. Moderator Dr. Karen Herbst was joined by Suzie Ehmann, DPT, PhD, CWS, CLT-LANA, CLWT, and Brandy McKeown, OTR/L, CLT-LANA, CLWT, who introduced STRIDE (https://www.ilwti.com/pages/strideguide), a clinically grounded framework designed to guide compression garment selection beyond dosage alone. STRIDE incorporates six interdependent factors: Shape (where and how swelling presents), Texture (fatty, watery, or fibrotic tissue), Refill (how quickly edema returns), Issues (patient-specific functional, cognitive, cosmetic, and lifestyle considerations), Dosage, and Etiology (the underlying cause and stage of lymphatic impairment). This approach enables clinicians to match textile behavior, not just pressure, to each patient’s unique presentation. The second iteration of STRIDE expands its application to the upper extremity, breast, and trunk—areas historically under-addressed despite significant clinical burden. The panel emphasized that truncal and breast lymphedema are increasingly common, often painful, and frequently mismanaged with inadequate solutions such as sports bras or generic compression garments. Through a detailed case study, the speakers demonstrated how applying STRIDE led to a tailored plan combining stiff daytime compression with focal textured padding and lighter nighttime options, resulting in rapid improvements in pain, tissue texture, and swelling. A recurring theme throughout the discussion was that stiffness often matters more than dosage. Layering lighter garments can increase stiffness and therapeutic effectiveness without overwhelming patients. The panel also clarified that flat-knit compression is not a single category; stiffness, weave, and texture vary widely and must be carefully matched to tissue type and anatomy. The conversation also emphasized the importance of patient choice and flexibility, noting that adherence improves when patients are given options rather than rigid prescriptions. The panel also addressed documentation and insurance coverage, particularly for truncal edema and non-oncologic lymphedema. Clinicians were encouraged to document edema location, tissue texture, circumferential measurements, skin changes, and contributing conditions such as obesity, venous insufficiency, immobility, metabolic disease, or prior surgery. Coding should reflect not only lymphedema staging but also conditions that exacerbate lymphatic dysfunction. STRIDE offers a shared language and structure to strengthen documentation and support medical necessity. The session concluded with a call for ongoing learning and innovation. Compression therapy has evolved far beyond static pressure, and clinicians were encouraged to remain curious, collaborate with manufacturers, explore emerging textiles, and challenge outdated assumptions. The closing message was clear: compression is not about squeezing harder—it’s about applying pressure intelligently, respecting biology, and matching the right textile to the right patient at the right time. Lympha Press sponsors the monthly Research Roundtable to support both patients and clinicians and is proud to offer pneumatic compression therapy that’s easy to live with. Find out more at www.lymphapress.com. ---------- This Roundtable was originally recorded live on January 5, 2026. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of Lympha Press. The content is for educational purposes only and not intended as medical advice. Thank you to ‪‪‪@brendaviolamedia2024‬ for moderating! 📚 MORE INFORMATION: This Roundtable is presented by ‪‪@Lympha_Press‬. Learn more about #LymphaPress and our advanced pneumatic #compressiontherapy here: https://lymphapress.com/ Read STRIDE™ Lower Extremity Guide: https://cdn.shopify.com/s/files/1/221... Read STRIDE™ Upper Extremity Guide: https://cdn.shopify.com/s/files/1/221... Register for our upcoming virtual events here: https://linktr.ee/LymphaPress