Contributed by Dr. Steven T. Devor – Director of Performance Physiology for MIT and OhioHealth, and Associate Professor of Exercise Physiology, Department of Human Sciences, and Department of Physiology and Cell Biology, The Ohio State University
Endurance athletes of all ability levels have increasingly adopted the use of compression clothing over the course of the last ten years. One example of compression clothing, compression stockings, have been utilized successfully in medical and rehabilitation settings for decades. Physicians often prescribe them for patients with lower leg venous problems to increase blood flow return to the heart. Compression stockings are also frequently prescribed to increase blood flow for individuals that have suffered a lower leg blood clot. Finally, leg compression garments are routinely used following surgeries to increase blood flow and aid in the prevention of blood clot formation as a result of spending a good deal of time in bed during recovery.
Generally, the compression products utilized by endurance athletes include stockings, calf sleeves, thigh sleeves, and full tights. When I speak with endurance athletes about why they wear compression gear most indicate it is to either enhance performance, increase the speed of recovery following difficult training sessions or races, or both.
As with many clothing and nutritional products that are purported to enhance performance or hasten recovery, compression gear now benefits from several high profile endorsements from professional athletes. Unfortunately, the potentially biased comments of professional athletes far exceed the number of unbiased and careful scientific studies, and also garner far more attention. I believe the opinions of professional athletes must be weighed carefully, as they are often either paid to endorse a product and/or provided it free of charge.
Through the years I have found that when you ask someone that is using a product designed to either enhance endurance performance or hasten recovery if they believe it works for them, they typically answer positively. However, even for those of us that are not professional athletes it can be difficult to be completely unbiased when you have invested your own money into a product and then spent time using it while training. Additionally, when the performance enhancing ability of a product is potentially small, the placebo effect can have a significant influence on how one perceives an outcome.
In my opinion, it is not an easy task for an endurance athlete to make an informed decision about the potential performance enhancing and recovery properties of compression clothing. To help with this task, I have carefully reviewed several current and relevant scientific publications related to compression clothing. The results are summarized below.
There are two broad categories I focused on as I reviewed the published studies. First is how compression clothing potentially benefits athletic performance, and for this category I reviewed eight different studies (papers A – H below). Second is how compression clothing might hasten and enhance recovery, and for this category I also reviewed eight different studies (papers I – P below).
To be clear, I did not perform an exhaustive review of every published paper related to compression clothing and athletic performance and recovery. However, I know this literature well, and am confident this group of sixteen peer-reviewed, published scientific research papers represents a balanced and informed view of what we currently understand about the science of compression clothing.
Category #1: The influence of compression clothing on athletic performance.
A. Paper number one is entitled, “The effect of graduated compression stockings on running performance”. It was published in the Journal of Strength and Conditioning Research.
Nine very experienced male and three female runners (average VO2max of 68.7 milliliters of O2/kilogram of body mass/minute) ran four 10K time trials on a track over a period of several days. The subjects were required to wear standard stockings, or 12-15 mmHg compression stockings, or 18-21 mmHg compression stockings, or 23-32 mmHg compression stockings. For clarity, the higher the mmHg number the greater the pressure there is placed on the lower legs and ankles. The studies authors reported no significant differences in heart rates, blood lactate levels, or 10km times regardless of the compression level of the stocking the subjects wore.
B. Paper number two is entitled, “Physiological effects of wearing graduated compression stockings during running”. It was published in the European Journal of Applied Physiology.
Nine experienced male runners and one female runner were required to complete three separate 40-minute treadmill runs at 80% of their VO2max. They wore either 0 mmHg stockings, 12-15 mmHg compression stockings, or 23-32 mmHg compression stockings. The studies authors reported no significant differences in blood lactate levels, heart rate, or V02 during the runs regardless of what level of compression stocking was worn.
C. Paper number three is entitled, “Elastic stockings, performance and leg pain recovery in 63-year-old sportsmen”. It was published in the European Journal of Applied Physiology.
Twelve trained cyclists (average age of 63) were required to complete two five-minute maximum cycling intervals on a bicycle. Each set of two five- minute rides was separated by an 80-minute recovery period. So the subjects would do two five-minute intervals, then rest for 80 minutes, and then do two more five-minute intervals. During the recovery periods between the cycling efforts the subjects either wore compression stockings or did not. The authors reported that for every instance, the second interval always resulted in less power being produced on the bike. However, the decrease in power was less when the compression stockings were worn and blood lactate levels were also lower.
D. Paper number four is entitled, “The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise”. It was published in the Journal of Science and Medicine in Sport.
Eleven subjects were required to complete two different exercise bouts that were separated by seven days. Each workout required the subjects to do one 20-meter sprint followed by 10 box jumps every minute. During one workout the subjects wore compression stockings, and for the other workout seven days later they did not wear the compression stockings. Sprint and box jump speed was measured. Additionally, before each workout, immediately after, 2 hours after, and 24 hours after each workout skeletal muscle force, blood lactate, heart rate, and muscle soreness were all measured. The authors reported no difference in sprint or box jump performance, muscle force, blood lactate, or heart rate between the subjects that wore the compression stockings and those that did not. However, muscle soreness was reported to be less in those that wore the compression stockings.
E. Paper number five is entitled, “Effects of wearing compression garments on physiological and performance measures in a simulated game-specific circuit for netball”. It was published in the Journal of Science and Medicine in Sport.
Experienced and competitive netball (a very old and traditional English version of American basketball) players wore either: 1.) traditional netball clothing; 2.) compression clothing; or, 3.) placebo garments. Data were collected in all three groups for blood lactate levels, heart rate, speed of movement, and distance covered during a game (using GPS technology). The studies authors reported the subjects wearing the compression clothing covered increased distances during the course of the game and also exhibited and increased velocities. The differences reported were small but meaningful.
F. Paper number six is entitled, “Effect of compression stockings on running performance in men runners”. It was published in the Journal of Strength and Conditioning Research.
In this study twenty-one male runners each completed a two separate VO2max tests, with a one-week period between each test. One VO2max test was done while wearing compression stockings and the other without. The VO2max test that was done with compression stockings resulted in a 2.1% increase in the anaerobic threshold.
G. Paper number seven is entitled, “The effects of wearing lower-body compression garments during endurance cycling”. It was published in the International Journal of Sports Physiology and Performance.
This study focused on cycling. Twelve male cyclists (average VO2 max of 70.5 milliliters of O2/kilogram of body mass/minute), were required to complete two VO2max tests and two one-hour time trial rides. For one of the VO2max tests and one of the time trials the cyclists wore full length compression tights, for the other VO2max test and time trial ride they did not. During the VO2max test when the compression tights were worn the cyclists had an increase of 5% in their anaerobic threshold. There were no differences in the time trial rides.
H. Paper number eight is entitled, “Different types of compression clothing do not increase sub-maximal and maximal endurance performance in well-trained athletes”. It was published in the Journal of Sports Science.
This study focused on fifteen well-trained athletes that were required to complete three sets of performance tests that included a 20-minute moderate intensity treadmill run followed by a treadmill VO2max test. For each set of tests the subjects wore different compression clothing. For the first set they wore compression stockings, the second set compression tights, and for the third set a whole-body compression suit. The authors reported no differences in VO2max test performance, blood lactate levels, or the subjects self reported levels of muscle soreness.
Category #1 summary: After reading and considering the data in this set of published scientific studies my belief is the benefits are minor with regard to how compression clothing influences actual athletic performance. My opinion is that being more focused on productive, purpose driven training, and paying closer attention to quality, whole food, nutrient dense daily nutritional intake will likely benefit actual performance to a greater extent than compression clothing.
Category #2: The influence of compression clothing on recovery.
I. Paper number nine is entitled, “Graduated compression stockings: Physiological and perceptual responses during and after exercise”. It was published in the Journal of Sports Science.
In this study trained male runners were required to complete two 10K runs, one with compression stockings and one without. Each run was separated by one week. The authors reported that when the runners wore the compression stockings they experienced a reduction in delayed-onset muscle soreness 24 hours later.
J. Paper number ten is entitled, “Effects of graduated compression stockings on blood lactate following an exhaustive bout of exercise”. It was published in the Journal of Physical Medicine.
This study involved a more complicated experimental design. Twelve well-trained males participated in two separate experiments, both focused on recovery from vigorous exercise. During the first experiment six of the twelve subjects were required to complete a treadmill VO2max test while wearing compression stockings, the other six subjects did the VO2max test without compression stockings. For the second experiment, all twelve of the subjects completed 3 x 3-minute maximum efforts on a stationary bicycle. On the first of these 3-minute efforts they wore compression stockings during the test and during recovery from the test. For the second 3-minute maximum effort they wore compression stockings during the test, but not during the recovery. And during the third 3-minute effort they did not use compression stockings during the ride or during recovery from the ride. The authors reported lower blood lactate levels following the VO2max tests when the subjects wore the compression stockings. Additionally, during the second experiment with the 3-minute maximum cycling efforts, the authors noted that blood lactate levels were lowest for the subjects that wore the compression stockings during the ride and during recovery from the ride.
K. Paper number eleven is entitled, “The effects of compression garments on recovery”. It was published in the Journal of Strength and Conditioning Research.
Subjects in this study were required to complete two workouts, each separated by one week, which included several different sets of exercises designed to induce muscle soreness. Following the first workout the subjects wore compression tights, and after the second workout the subjects wore traditional gym clothing. The authors had the subjects self report their levels of muscle soreness after each workout using a standard 1 – 10 scale. All subjects reported less muscle soreness when the compression tights were worn following the workouts.
L. Paper number twelve is entitled, “The effects of contrast bathing and compression therapy on muscular performance”. It was published in the journal Medicine and Science in Sports and Exercise.
In this study twenty-six untrained male subjects completed three sets of full range of motion squats with a heavy weight in an effort to induce muscle soreness. They were evaluated for strength performance as an indication of recovery 48 hours after the workout. During the 48 hours of rest the subjects either: 1.) alternated hot and cold baths; 2.) wore compression stockings; or, 3.) rested passively. The authors reported the subjects that wore the compression stockings had no less muscle soreness than those that either rested passively or those that were required to take the hot and cold contrast baths.
M. Paper number thirteen is entitled, “Effect of pressure intensity of graduated elastic compression stocking on muscle fatigue following calf-raise exercise”. It was published in the Journal of Electromyography and Kinesiology.
The authors study design required fourteen subjects to do 15 sets of 10 repetitions of toe raises designed to target the calf muscles, at two different time points. The subjects wore either standard stockings, or compression stockings of 21-25 mmHg at the calf and 30 mmHg at the ankle, or compression stockings of 12-14 mmHg at the calf and 18 mmHg at the ankle. The results indicated that the subjects who wore the highest level of compression stockings reported the lowest levels of calf muscle fatigue. The compression stockings lowered levels of fatigue.
N. Paper number fourteen is entitled, “Effects of compression stockings during exercise and recovery on blood lactate kinetics”. It was published in the European Journal of Applied Physiology.
In this study eight endurance trained male athletes were required to complete two VO2max bicycle tests while either wearing standard stockings or compression stockings. Each VO2max test was separated by 4 days. The authors reported that blood lactate levels were reduced more rapidly following the VO2max test when the athletes wore the compression stockings.
O. Paper number fifteen is entitled, “Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females”. It was published in the European Journal of Applied Physiology.
In this study seventeen experienced female athletes were required to complete 100 plyometric drop jumps in a row from a 30-inch box to induce muscle soreness. For the first 12 hours post-exercise, eight of the female athletes wore compression stockings. The other nine subjects did not wear the compression stockings following the exercise bout. Recovery from the exercise bout was measured using self-reported muscle soreness. The results indicated the athletes that wore the compression stockings had lower values for self-reported muscle soreness.
P. Paper number sixteen is entitled, “Effects of a whole body compression garment on markers of recovery after a heavy resistance workout in men and women”. It was published in the Journal of Strength and Conditioning Research.
The authors required twelve-experienced male and twelve experienced female athletes to perform a very heavy resistance-training workout consisting of full range of motion squats, dead lifts, and overhead barbell press. For 24 hours after the workout half of each group (6 males and 6 females) wore a full-body compression garment. The subjects that wore the compression garment reported less muscle soreness and also lower levels of psychological fatigue when compared with the subjects that did not wear the compression garment.
Category #2 summary: After reading and considering the data in this set of published scientific studies, my belief is with regard to facilitating and enhancing recovery from challenging workouts or races, compression garments provide the individual that is wearing them a significant benefit. The compressive effect the garments have on the legs increases blood flow, and this enhanced blood flow accelerates the removal of blood lactate following exercise. In my opinion, wearing compression clothing to hasten and enhance recovery following a workout or a competition is a wise decision for an athlete.
In conclusion, the ability of compression clothing to actually enhance athletic performance appears to be small. However, I believe the placebo effect is real. If you believe you are receiving a performance advantage by wearing compression clothing during your training or races, I encourage you to continue. There does not appear to be any performance decline as a result of wearing compression clothing.
It appears the greatest advantage for athletes when wearing compression clothing comes from how the compression hastens and enhances recovery from challenging workouts or races. Related to enhanced recovery is the very effective method employed by athletic trainers known as RICE (Rest, Ice, Compression, Elevation). My advice is to utilize compression clothing during recovery that also easily facilitates the use of ice to decrease tissue swelling and further enhance the recovery process.