It’s been a couple of years since I last checked the research for the latest on compression clothing. When I first wrote about this topic back in October, 2007 there really wasn’t much available. By the time I followed up on it in March, 2009 there still wasn’t a great deal to report. But in the last two years there have been several studies added to the literature. I list and summarize each of them below including those that were reviewed in my 2009 post.
What is expected of compression clothing such as stockings, calf sleeves, thigh sleeves, briefs, tights and full-body suits? Why do athletes wear them? They are quite common now in triathlons and running races. Two primary reasons appear to have evolved. The first is that they may improve performance. The second is that they may speed recovery after difficult workouts and races.
When I ask athletes who wear them why, they seem to be certain there is a benefit in one or both of these areas. The problem with asking users is that they have invested money, time, reputation and self-perception in the product. They are unlikely to suggest that it doesn’t work. They may even be able to provide data to back up their use of the product. The placebo effect can be a powerful influencer of outcomes, especially when the changes are small. Nor can we trust the testimonials of elite athletes who are given the product or even paid to use it. Even non-elite athletes who are given a pair of $30 socks feel a need to “repay” the sponsor with glowing comments. That leaves us with science—and our own opinions. We’ll start with the science.
The following are summaries of the pertinent studies I could find with searches at PubMed.
Does Compression Clothing Improve Performance?
1. Ali, A., R.H. Creasy, J.A. Edge. 2011. The effect of graduated compression stockings on running performance. J Strength Cod Res Feb 2 (Epub ahead of print).
Summary: Nine male and three female competitive runners (VO2 max 68.7 +/-5.8 mLO2/kg/min) ran four 10km time trials on a track over a period of several days. They wore either standard stockings (CON), 12-15 mmHg compression stockings (LOW), 18-21 mmHg compression stockings (MED), or 23-32 mmHg compression stockings (HIGH). (The higher the mmHg number the greater the pressure placed on the tissues—lower legs and ankles, in this case.) There was no significant difference in 10km times, heart rate or blood lactate levels regardless of the type of stocking worn.
2. Ali, A., R.H. Creasy, J.A. Edge. 2010. Physiological effects of wearing graduated compression stockings during running. Eur J Appl Physiol 109(6):1017-25.
Summary: Nine male and one female competitive runners ran 3 x 40-minute treadmill runs at 80% of their VO2 max. They wore either 0 mmHg stockings (CON), 12-15 mmHg compression stockings (LOW) or 23-32 mmHg compression stockings (HIGH). There were no significant differences in oxygen uptake, heart rate or blood lactate during the runs. There were no benefits post-exercise.
3. Chatard, J.C., D. Atlaoui, J. Farjanel, F. Louisy, D. Rastel, C.Y. Guezennec. 2004. Elastic stockings, performance and leg pain recovery in 63-year-old sportsmen. Eur J Appl Physiol 93(3):347-52.
Summary: Twelve, trained older (average age 63) cyclists did 2 x 5-minute maximum efforts on a bicycle ergometer separated by an 80-minute recovery period on four occasions. During the recovery between the efforts they wore either compression stockings or no compression stockings. On the second max effort in each case their power decreased compared with the first effort in each pair. The decrease in max power was less when the compression stockings were worn during the preceding recovery and lactate was significantly decreased with the compression stockings also.
4. Duffield, R., J. Cannon, M. King. 2010. The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise. J Sci Med Sport 13(1):136-40.
Summary: Eleven subjects completed two exercise sessions separated by seven days. The sessions consisted of 20-meter sprints and 10 bounds every minute. For one session they wore compression stockings. For the other they did not wear compression stockings. Performance was measured for the sprints and bounds. Before each session, immediately after, 2 hours after and 24 hours after the researchers measured muscle twitch properties, knee extension strength, knee flexion strength, blood lactate, body fluid pH, creatine kinase, aspartate transaminase, C-reactive protein, heart rate, ratings of perceived exertion and muscle soreness. There were no differences in performance or other measures except for muscle soreness which was less after using the compression stockings.
5. Higgins, T., G.A. Naughton, D. Burgess. 2009. Effects of wearing compression garments on physiological and performance measures in a simulated game-specific circuit for netball. J Sci Med Sport 12(1):223-6.
Summary: Competitive netball players wore either 1) traditional netball clothing, 2) compression garments or 3) placebo garments. They were tested for sprints, countermovement jumps, blood lactate, heart rate, velocity and distance covered during a game (using GPS technology). With compression garments there was greater distances covered and faster velocities although the enhancements were minimal.
6. Kemmler, W. S. Von Stengel, C. Kockritz, J. Mayhew, A. Wassermann, J. Zapf. 2009. Effect of compression stockings on running performance in men runners. J Strength Con Res 23(1):101-5.
Summary: Twenty-one moderately trained men ran a graded exercise test on a treadmill to a voluntary maximum output on two occasions separated by a week. One test was done with compression socks and the other with standard athletic socks. Running performance with the compression socks improved at anaerobic threshold 1.5% and at aerobic threshold 2.1%.
7. Scanlon, A.T., B.J. Dascombe, P.R. Reaburn, M. Osborne. 2008. The effects of wearing lower-body compression garments during endurance cycling. Int J Sports Physiol Perform 3(4):424-38.
Summary: Twelve well-trained (VO2 max 70.5 +/-4.9 mL/kg/min), young (20.5 +/- 3.6 years old), male cyclists did 2 graded exercise tests and 2 one-hour time trials wearing either full-length SportSkins Classic compression garment (LBCG) or standard underwear briefs (CON). In the graded exercise tests there was a 5% increase in anaerobic threshold power (245.9 +/- 55.7 to 259.8 +/- 44.6 watts) when wearing LBCG. There was no performance enhancement in the time trial (as measured by total work achieved in kilojoules).
8. Sperlich, B., M. Haegele, S. Achtzehn, J. Linville, H.C. Holmberg, J. Mester. 2010. Different types of compression clothing do not increase sub-maximal and maximal endurance performance in well-trained athletes. J Sports Sci 28(6):609-14.
Summary: Fifteen young (27 +/- 4.8 years old), well-trained (VO2 max 63.7 +/- 4.9) athletes did sub-maximal (70% VO2 max) and maximal tests wearing either compression stockings, standard tights or whole-body compression suits. There were no differences in performance, ratings of perceived exertion, muscle soreness, time to exhaustion and lactate concentrations.
Does Compression Clothing Improve Recovery?
9. Ali, A., M.P. Caine, B.G. Snow. 2007. Graduated compression stockings: Physiological and perceptual responses during and after exercise. J Sports Sci 25(4):413-419.
Summary: In this study Ali discovered that after 10km running trials, recreationally active men experienced a reduction in delayed-onset muscle soreness 24 hours after wearing compression stockings (18-22 mmHg) compared with traditional sports socks.
10. Berry, M.J., R.G. McMurray. 1987. Effects of graduated compression stockings on blood lactate following an exhaustive bout of exercise. J Phys Med 66(3):121-32.
Summary: Twelve highly fit males were subjects in 2 experiments. In the first experiment 6 of them did VO2 max tests on a treadmill with and without compression stockings. In the second 6 of them did 3 x 3-minute max efforts on a bicycle ergometer at 110% of their VO2 max. On the first of these 3-minute efforts they wore compression stockings during the test and during recovery. For the second 3-minute bout they wore compression stockings during the test but not during the recovery. On the third they did not use compression stockings for either the 3-minute effort or the recovery. For the first experiment (VO2 max tests) there was no difference in VO2 max with or without compression stockings. But blood lactate levels after the test were lower with compression stockings. For the second experiment (3-minute max efforts) post-exercise lactate was lower only when compression stockings were worn during recovery.
11. Davies, V., K.G. Thompson, S.M. Cooper. 2009. The effects of compression garments on recovery. J Strength Cod Res 23(6):1786-94.
Summary: Following exercises designed to cause soreness 11 trained subjects wore compression tights on one occasion and none on another. Self-reported muscle soreness was reduced by wearing the tights.
12. French D.N., K.G. Thompson, S.W. Garland, C.A. Barnes, M.D. Portas, P.E. Hood, G. Wilkes. 2008. The effects of contrast bathing and compression therapy on muscular performance. Med Sci Sports Exerc 40(7):1297-306.
Summary: Twenty-six young men did heavy-load squats to induce muscle soreness. 48 hours afterwards they were evaluated for strength performance. During the 48 hours they either 1) did hot-cold contrast baths, 2) wore compression stockings or 3) rested passively. Neither the contrast baths or compression stockings promoted recovery any more effectively than passive rest. However, the contrast baths had a brief but transient benefit for reduced soreness.
13. Miyamoto, N., K. Hirata, N. Mitsukawa, T. Yanai, Y. Kawkami. 2011. Effect of pressure intensity of graduated elastic compression stocking on muscle fatigue following calf-raise exercise. J Electromyogr Kinsiol 21(2):249-54.
Summary: Fourteen subjects did 15 sets of 10 reps each of calf raises on different occasions. They wore either standard stockings (CON), compression stockings of 21-25 mmHg at the calf and 30 at the ankle (EC30), or compression stockings of 12-14 mmHg at the calf and 18 at the ankle (EC18). The EC30 stockings produced the lowest levels of fatigue.
14. Montgomery, P.G., D.B. Pyne, W.G. Hopkins, J.C. Dorman, K. Cook, C.L. Minhan. 2008. The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball. J Sports Sci 26(11):1135-45.
Summary: 29 male basketball players competed in a 3-day tournament. After each game they recovered by either 1) taking in extra carbohydrate and stretching, 2) doing cold-water immersion (11C degrees) or 3) wearing full-leg compression garments (18 mmHg for 18 hours). Measures of recovery were sprint speed, agility, vertical jump height and flexibility. Cold-water produced better recovery results than carbs + stretching or the compression garments.
15. Riman, D., L. Messonier, J. Castells, X. Devillard, P. Calmels. 2010. Effects of compression stockings during exercise and recovery on blood lactate kinetics. Eur J Appl Physiol 110(2):425-33.
Summary: Eight healthy, trained males did 2 maximum-effort tests on bikes with and without compression stockings. Post-exercise lactate removal was significantly faster with compression stockings.
16. Jakeman, J.R., C. Byrne, R.G. Eston. 2010. Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. Eur J Appl Physiol 109(6):1137-44.
Summary: Seventeen females did 100 plyometric drop jumps from a high box to induce muscle soreness and damage. Eight of them wore compression stockings for 12 hours post-exercise. Nine did not wear compression stockings after the session. Recovery was measured using self-reported muscle soreness, creatine kinase levels, knee extensor strength and vertical jump height. Compression stockings improved all markers of recovery except for creatine kinase (a marker of muscle cell damage).
17. Kraemer, W.J., S.D. Flanagan, B.A. Comstock, et al. 2010. Effects of a whole body compression garment on markers of recovery after a heavy resistance workout in men and women. J Strength Cond Res 24(3):804-14.
Wearing a full-body compression garment for 24 hours after a challenging, heavy-resistance strength workout enhanced psychological, physiological and performance markers of recovery when compared with non-compressive garments.
SUMMARY
So where does all of this leave us? Unfortunately, when it comes to performance and recovery from using compression garments there are no clear-cut answers. Part of the problem is defining “performance” (Is an increase in aerobic threshold equal in value to a faster time trial? Does improving a netballer’s velocity translate to faster 10km times?) and “recovery” (Does quickly removing lactate after exercise mean a speedier recovery for the following day’s workout?). Using a rather loose definition of “performance” the study yeas and nays for performance are close to even (4 yes: 3, 5, 6, 7 and 6 no: 1, 2, 4, 7, 8, 10). (Note that some studies reported on both performance and recovery.) With an equally liberal definition of “recovery” there is a slight advantage for the yeas (8 yes: 4, 9, 10, 11, 13, 15, 16, 17 and 4 no: 2, 8, 12, 14). Of course, research is really not intended to be simply a way of “voting” or “polling.” There are significant differences in what is studied, who is studied and how the research was designed. Taken as a whole this muddies up the interpretation of such a review.
So there really isn’t an overwhelmingly obvious answer to the questions regarding the benefits of compression clothing for performance and recovery. It still comes down to what each of us thinks and personally experiences (placebo or not). Here are my thoughts.
My sense is that the performance benefits of compression garments are at best very small and probably non-existent. If you’re a triathlete I suspect the time it takes to put the garment on in transition is probably greater than the amount of time gained by wearing it, if there is any time gain at all. Missing one less workout in the build-up to your race or improving your other gear such as bikes and shoes would probably have a greater impact on performance than compression clothing.
When it comes to recovery, however, I believe there really may be a significant benefit. The research somewhat suggests this also. I’ve tried many different types of compression garments both during workouts and in recovery. There were no obvious benefits during the workouts but I could sense some positive post-workout sensations when using the garments to recover. Could this have been a placebo effect? Possibly.
It seems to me, however, that the greatest benefit would come from helping the return of body fluids from the feet, ankles and lower legs where they tend to accumulate in the recovery time after a challenging session. For me that means using compression stockings. I really don’t see much value in shin or thigh sleeves, or hip and thigh tights. They have little or no benefit for helping move fluids out of the lower extremities. In fact, it would seem to me that wearing a shin sleeve would tend to force fluids down into the feet and ankles. But then I’ve seen no research on this at all.
If you use compression clothing I’m sure you have an opinion on the topic also. Feel free to post it in the Comments section below. And if you come across other research in this area please send it my way. Thanks for your comments.
Hey Joe-
Tim Waggoner here (formerly Luchinske), not sure if you remember me? I was sponsored by Skins 2 years ago and found that for traveling long distances to/ from races the socks were solid. The full tights are supposed to increase proprioception and awareness of your leg movement and increase economy due to improved form. Also muscle stability and the prevention of muscle damage due to impact. I think there is a significant placebo effect and I would probably rather spend the money for all the compression gear instead on a good vegetable juicer. And then just elevate my legs as I drank a fresh veg juice.
Tim
Posted by: Lucho | 03/01/2011 at 06:50 PM
Madeleine--That's an interesting idea. If true it would be the same thing for runners.
Posted by: Joe Friel | 03/02/2011 at 06:51 AM
every time I go for a run without comp socks I get calf strains
Posted by: kmbgolf | 03/02/2011 at 01:19 PM
Swelling: I use calf-compression sleeves or knee-length stockings for recovery after very hard or long runs because I find they reduce soreness. Subjectively, it’s also comforting to have that squeeze. But if I leave the sleeves (not the stockings) on for more than a few hours, my ankles will swell a bit that day if I’m on my feet. More interesting, my ankles will swell again late in the afternoon the next day or two if I’ve worn either stockings or sleeves the day of the hard workout. I have no such swelling when I skip the compression altogether. I’ve looked for research on this and have found none.
To be clear, I’m not talking about swelling from injury, but from fluid pooling in the ankles and feet due to gravity – all physical indications are that this is lymphatic fluid, and not blood as another reader suggested.
Concerning performance, I don’t find any benefit from calf sleeves and stockings. However, compression shorts on my quads definitely help me to run better, in addition to minimizing soreness. My guess is that the compression keeps the thigh mass from moving around too much, making movements and muscle contractions more efficient. With calves having less mass and less jiggle than thighs, there’s less inertia to control. I suspect that compression gives more benefits for more muscular or heavier athletes than for the elite ectomorphs, and that runners would benefit more than cyclists.
Posted by: DS | 03/02/2011 at 02:37 PM
Joe and Madeleine:
I may be a perfect example of Madeleine's hypothesis since I have Chronic Venous Insufficiency (CVI) in one leg only. I'm 55, have serious CVI in right leg only (from a 1981 femur fracture while skiing that did a lot of damage to my inner veins)and absolutely none in my left leg. Been wearing a compression stocking except when sleeping (30-40mm Hg) on right leg since 1993. If I don't wear the stocking, after about 4-6 hours my lower leg has noticable swelling, and over a few days a lot of swelling. I've never tried to measure bicycling performance after not wearing the stocking, but I can tell you that running performance deteriorates (mainly an increase in RPE, not otherwise measured). I can also say that the left leg never experiences any observable increase in fluid buildup, even after a long biking or running session (that is, if you have CVI you can detect swelling due to "pocking" or indentations that stay on the skin surface after you push in with your finger - but on the good let there is never even a hint of "pocking"). (Also, I generally wear a compression stocking on my left leg, just because, but I can observe absolutely no difference in RPE whether I wear a stocking on that leg or not). So, with my N=1 test individual, I think one must have CVI to some degree to benefit from a compression stocking while exercising. Additionally, I just can't imagine the low compression stockings cited in the studies helping anyway, even for someone with CVI.
Thanks,
Jeff
Posted by: Jeff | 03/03/2011 at 08:34 AM
I wear compression socks after long runs to aid in recovery. I broke my ankle ( fibula and talar dome) last spring.) To prevent swelling while in the air cast I wore a compression sock instead of a regular sock, since they are similar to the socks given to patients before surgery my orthopedic surgeon approved of the idea.
For my last two half marathon's I wore the socks after to aid in recovery and had no stiffness even while sitting in the car for 4 hours.
I live in Maine so I wear compression tights as a first layer to run outside in the winter, they are warmer probably because they don't let the frigid wind get under them like traditional tights do.
Posted by: Cindy | 03/04/2011 at 06:07 AM
Hi Joe
Excellent summary. I was going to do something similar so I was wondering what search terms you used on PubMed?
On a note of sports specificity, this paper http://www.ncbi.nlm.nih.gov/pubmed/16505085 looked at recovery in Rugby players and their Creatine Kinase (CK) clearance rates using compression, water contrast therapy, low intensity exercise and passive recovery and concludes that anything is better than doing nothing recovery wise. Here CK is an indicator of muscle damage and rugby players suffer a high level of damage due to the contact nature of the sport.
Perhaps the difference compression gear makes on muscular recovery is intimately linked to the level of muscle damage and the bodies inherent ability to recover. Thus they would be of most use to those who suffer most damage during exercise - either those exercising at high intensities, playing contact sports, or those with underlying comorbidities/poor technique/existing injury.
In relation to venous problems (as opposed to muscular, although they are obviously linked), for elderly people suffering from venous insufficiency leading to lower limb oedema the standard management is to use graduated compression stockings, elevate the lower limbs and increase mobility. These are all things that will work in a healthy adult too, but the difference is obviously that the healthy adult can compensate physiologically (which is why venous stasis and leg ulcers are more prevalent in the elderly). This may be why there are such small benefits noted in studies on compression garments, and why perhaps as noted previously just sitting with your legs elevated is the cheapest option.
Posted by: Phil | 03/16/2011 at 02:18 AM
Phil--Thanks for your input. Good comments. It's been a while since I did that search on PubMed but I believe the terms were 'compression exercise.'
Posted by: Joe Friel | 03/16/2011 at 01:50 PM
Great Review. I am a vascular surgeon who has dealt with compression stockings for venous disease for many years. One concern I have is that not all compression garments are truly graduated in nature. If you have a constant pressure on your legs then you may get more of a tourniquet effect. I would recommend making sure that stockings have graduated compression. My second concern is that our bodies cool by perspiration. Blood is shunted to the skin surface to be cooled. If compression prevents these small vessels to fill, is there some risk for overheating faster? All this being said, I wear the stockings for events and I feel that may calf muscles are less fatigued during long events such as a half ironman.
Posted by: Jeff Martinez | 04/23/2011 at 04:13 PM
My personal theory is that your body responds to hard exercise that causes muscle injury with swelling - the same way it responds to most injuries. Most of the damage from an ankle sprain or such is caused by excessive swelling, avoid the swelling and you avoid alot of the long term effects of the injury. If would follow that if you treat your muscles with RICE post-exertion, they wouldn't swell as much, and you wouldn't get DOMS... I've used ice baths ever since my first half marathon ended next to a glacial fed lake - I went up to my shorts, but refused to get them wet and my TFLs & Glutes sure paid the price!
Posted by: Kristina | 04/29/2011 at 02:20 PM
I'm a masters cyclist (60+) with a history of lower leg circulation issues evidenced by sometimes painful vericose vains. The relief afforded by compressions socks simply cannot be ignored. All the vascular websites support the use of compression hosiery for pain management. As a long time user, 30+ years, I have learned to stay with what works and reject what doesn't. Regardless of what is marketed, listen to what your body is telling you and make an informed decision.
Posted by: ralph e. schmook | 08/30/2011 at 07:13 AM
Joe, Thanks for the update. Although, personal preference matter when we train or race (quirky beasts that we are), I like the fact that there is some science. I have had repeated calf strains in the past. I've been fortunate to work through them over the past three months with strength training, massage and cross training. However, I'm doing a road relay in which I'l be running six segments of 5-6 miles through the Blue Ridge Mountains. I am scared to death that my calves won't hold up. So, I invested in some calf sleeves. In your opinion, based on this literature. Would you not wear them during the run segments and slip them on between, or wear them continuously during the 30 hour event?
Thanks,
Mike Fronsoe
Posted by: Mike Fronsoe | 08/31/2011 at 12:23 PM
Mike Fronsoe - The literature is not conclusive on dealing with what you are describing. But I doubt if there is any downside either to wearing them while running. Good luck!
Posted by: Joe Friel | 08/31/2011 at 02:14 PM
Nice Article. Well me personally,I have been wearing compression gear for quite some time and it helps to some extent.During my plyometric workouts it stabilizes my muscles to support against any micro tears caused by the impact.I found out also when wearing it I can perform at longer intervals during my training.As a professional powerlifter
it gives better support to hold the weight because it compresses much better for better lifts for me.So yeah its not going to give you super results but it will give you a helping hand.The only compression suit out now that will increase performance I think is the Generator.We use it in the Marine Corps for our PT and it does give resistance plus compression.
Posted by: Kelvin | 10/03/2011 at 10:12 AM
From personal experience I would say your summary is fair.
One additional point is that, for me, there MAY be a slight improvement of the incidence of EAMC on the upper legs with full-length compression gear.
Or there might not of course be an improvement because of the compression gear as I now stretch and brick train more...
However if you are prone to EAMC then a $50 pair of stockings might mean lower the risk of you having to stop (or worse) in a race because of EAMC/cramp. So, not a bad insurance policy.
Posted by: the5krunner | 02/22/2012 at 11:04 AM
Thanks for all the information! I love to ride and do triathlons... I just had surgery for breast cancer and the issue of lymphedema is now a major one for me, how to get back to sports and avoid it. So, while there might be debate about how these compression garments affect performance, there is no debate about how they help with avoiding lymphedema, and as mentioned by others, varicose veins etc... So, I am psyched that I can buy compression garments that don't look icky and medical-like - have you seen the medical grade compression stuff? :( not pretty!!) and not cheap!! I was just at a lymphedema workshop and there was an ugly "sleeve" that costs about $150 bucks billed to insurance. I am very happy that there are these more attractive options and I won't feel like I stick out like a sore thumb... so, for an athlete like me, I will gladly shell out money for these compression garments.
Posted by: climbergirl | 03/28/2012 at 08:09 AM
We are manufacturing a leg sleeve. do you know if there are requirements for calling a sleeve "compression"?
Posted by: Gayle | 10/15/2012 at 04:19 PM
Gayle--I have never seen anything on this but I expect there is a minimum for mm of Hg in order to qualify, at least in medical circles, as a "compression" garment. This undoubtedly varies with the type of product.
Posted by: Joe Friel | 10/17/2012 at 12:50 PM
Have there been any updates regarding the literature on compression sleeves or socks? I'm seeing more and more of these being worn during and after events. I think the best test will be just to try them out for myself but I'd like to take a more scientific approach.
Posted by: J R | 02/15/2013 at 07:52 AM
JR--I've not seen any but haven't checked for a few months either. If you run across something please send it my way. Thanks.
Posted by: Joe Friel | 02/15/2013 at 12:49 PM