An Update on Compression Clothing...

I found the following information on Joe Friel's blog today. In my opinion it is the single best aggregation of information on the subject of compression that I've seen to date. As this is a hot topic and compression stockings, tights, sleeves, and other clothing are the trendiest products on the market (and can often cost a ridiculous amount of money), I thought I'd present you with this information in it's entirety as it can be found here - http://www.joefrielsblog.com/2011/02/an-update-on-compression-clothing.html#

Joe Friel really doesn't need an introduction as he has been coaching endurance athletes since 1980. But, I'm going to do it anyway. Joe is the founder of Training Peaks web-based training software (trainingpeaks.com) and Training Bible Coaching (trainingbible.com). He holds a masters degree in exercise science, is a USA Triathlon and USA Cycling certified Elite-level coach, and is a founder and past Chairman of the USA Triathlon National Coaching Commission. 

In my opinion, Joe's article is an example of the type of information a coach should provide his athletes and the general public on a regular basis. He provides his athletes with objective information gathered through hard work, experience, prevailing wisdom and objective data gathered from legitimate studies. He doesn't simply take information given to him my shoe, supplement and gear manufacturer's and present it as "research" while evangelizing for the brand(s).
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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 Physiol93(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 Res23(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 compressionstockings: 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 Res23(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 Physiol110(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 Physiol109(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.
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Thanks again for the excellent information Joe!

Strong Work!