Compression Garments: Professional Athletes Are Wearing Them

J. R. Smith (the New York Knicks shooting guard) and my husband probably don’t have much in common, but one thing they do is that they both wear compression garments. My husband has been wearing a compression sock because he suffered a severe tear in his calf muscle a month ago while playing basketball, an injury that we were told happens mostly in those over 40.   While researching that injury and how to prevent it, I came across an article touting the benefits of compression garments.  I also started noticing the number of professional athletes (like J. R. Smith) who wear compression leggings or socks.  So I did a little digging, and what I found was intriguing.  In clinical studies, compression garments have been shown to improve blood flow to and oxygenation of the muscles, decrease exercise-induced muscle damage and soreness, decrease after-exercise swelling, and to improve muscle recovery after exercise.  All things that become important as we age while trying to stay active and injury-free.  So the next time you’re watching an NBA game, you may want to ask yourself if you’d benefit from wearing compression leggings.

What the research says:

While watching the New York Knicks play recently, I noticed that several of the players were wearing long compression tights and socks.  Being that my husband and I are both entering middle age (although I’ll stay mum regarding just how close we are to that mark) and that we like to exercise and remain active, I was intrigued.  My interest was especially piqued because my husband has been wearing a compression sock for the past month due to a severe tear in his calf muscle, the second such injury in two years, and one that has kept him relatively inactive.  Calf tears are called a “middle-age” malady, and are yet another symptom of getting older.  So I was intrigued by the fact that these athletes were wearing long tights and wondered why. 

I figured there must be a reason that professional athletes are choosing to endure the extra weight and heat associated with thick tights.  So I did a quick search and found several blogs and articles talking about the benefits, or lack thereof, of compression garments.  The conclusions were all over the place, with some authors concluding that compression garments were helpful and others finding no benefit.    That’s when I decided it was time to do a thorough publication search and dig deeper to find the truth.  Could there be a benefit to wearing compression garments? And if so, could they be the proverbial “fountain of youth” to prevent injuries for over-40 athletes like us?

I was surprised to find more than 35 published scientific articles examining the benefits of compression garments on exercise-related outcomes.  But the hard work began when I tried to make sense of the results.  The studies were all done differently; some using full-body garments, and others using compression shorts that only covered the thighs; some examining improvements in athletic performance during endurance events, while others looked at muscular recovery after heavy resistance exercises; some looking for improvements in measurable muscle fatigue or athletic performance, while others assessed changes in subjective measures of muscle soreness and exertion; some using collegiate-level athletes while others used middle-aged weekend warriors.   Consequently, the outcomes seemed to be inconsistent and contradictory.  But when I delved deeper and did an exhaustive comparison of the studies, the results were surprisingly consistent.   

What’s the verdict on compression garments?

Compression garments were shown to have the following benefits when worn during or after exercise:

  • Decreased muscle soreness.   People who wore compression garments while exercising [6, 7, 25, 32] or after exercising [2,9, 22, 23, 27, 32] had less muscle soreness. 
  • Decreased swelling and edema.   Compression garments were shown to decrease swelling and fluid retention in the lower body (typically the calf and/or ankle) when worn either while exercising [32] or after exercise [22, 32]. 
  • Improved blood-flow, muscle oxygenation, and cardiac output.   Compression garments were shown to improve muscle oxygenation [5, 10, 18, 21] and to increase blood flow to and from the muscle [10, 20].  The garments were also shown to improve cardiac output [14, 29] and to decrease heartrate while exercising [13, 19].  Lastly, participants wearing the garments also felt that they exerted themselves less when exercising [6, 15], or improved their performance times [11, 28]. 
  • Decreased muscle damage.   By measuring markers of muscle breakdown, investigators were able to determine whether or not compression garments could decrease the occurrence of muscle damage when exercising.  Interestingly, the compression garments were found to decrease the occurrence of muscle damage when worn either during exercise [7, 32] or afterwards [2, 32]. 
  • Improved muscle recovery.   When worn after exercising, compression garments were shown to improve muscle recovery [22, 23, 27] and to improve athletic output and strength in subsequent workouts [27].   This may be a by-product of having less muscle damage. 

The positive effects attributable to the garments varied from study to study, with some publications touting large effects and others only modest differences.  The one consistent theme, though, was that the garments were, at best, effective at modulating soreness, swelling, muscle recovery, and blood flow, and at worst, were ineffectual.  The garments were not found to hamper athletic performance in any way. 

So wearing the garments may not make you run faster or jump higher, but they may help you recover from a tough workout faster and may help decrease the likelihood that you’ll injure your muscles. 

How do these garments work?

Compression stockings have been used medically for more than 50 years to assist patients with poor venous flow.  The garments are graded in compression, meaning the degree of compression is highest at the ankle and decreases as you move up the garment with the lowest degree of compression at the top of the garment. Because fluids naturally flow from areas of high pressure to areas of low pressure, gradient compression promotes the flow of blood from the ankle back toward the heart. Hence the use of compression stockings to assist with venous blood flow in patients with congestive heart failure or deep vein thrombosis.  The translation of these benefits in to the areas of sports and exercise has been attempted relatively recently, and is the reason behind these studies.

Are all compression garments created equal?

Compression garments of all types were examined in these studies.  However, the results obtained were relatively consistent, with full-body garments, waist-to-ankle leggings, and compression socks all showing benefits (see Figure 1 below).  The only garments tested that did not demonstrate any benefit were waist-to-thigh compression shorts. 

What does this all mean?

Not only do compression garments look cool, but they may also help you during and after your workout by decreasing muscle soreness, swelling, and muscle damage while improving muscle recovery and blood flow.  Those benefits aren’t certain to occur, but they are possible based on published reports.  And for those of us who are over 40, those benefits could be the difference between tearing a calf-muscle and making it through a 3-hour game of pick-up basketball successfully.

 Figure 1: Summary of clinical benefits related to compression garments.

Figure 1: Summary of clinical benefits related to compression garments.

References:

1.     Bringing light into the dark: effects of compression clothing on performance and recovery. Born DP, Sperlich B, Holmberg HC. Int J Sports Physiol Perform. 2013 Jan;8(1):4-18.

2.     Comparison of three types of full-body compression garments on throwing and repeat-sprint performance in cricket players. Duffield R, Portus M. Br J Sports Med. 2007 Jul;41(7):409-14;

3.     Compression garments and exercise: garment considerations, physiology and performance. MacRae BA, Cotter JD, Laing RM. Sports Med. 2011 Oct 1;41(10):815-43.

4.     Compression Garments do not Enhance High Intensity Exercise in Hot Radiant Conditions. Barwood MJ, Corbett J, Feeney J, Hannaford P, Henderson D, Jones I, Kirke J. Int J Sports Physiol Perform. 2013 Jan 23.

5.     Compression sleeves increase tissue oxygen saturation but not running performance. Ménétrier A, Mourot L, Bouhaddi M, Regnard J, Tordi N. Int J Sports Med. 2011 Nov;32(11):864-8.

6.     Different types of compression clothing do not increase sub-maximal and maximal endurance performance in well-trained athletes. Sperlich B, Haegele M, Achtzehn S, Linville J, Holmberg HC, Mester J. J Sports Sci. 2010 Apr;28(6):609-14.

7.     The effects of compression garments on recovery. Davies V, Thompson KG, Cooper SM. J Strength Cond Res. 2009 Sep;23(6):1786-94.

8.     The effects of compression garments on intermittent exercise performance and recovery on consecutive days. Duffield R, Edge J, Merrells R, Hawke E, Barnes M, Simcock D, Gill N. Int J Sports Physiol Perform. 2008 Dec;3(4):454-68.

9.     The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise. Duffield R, Cannon J, King M. J Sci Med Sport. 2010 Jan;13(1):136-40.

10. Effects of compression on muscle tissue oxygenation at the onset of exercise. Coza A, Dunn JF, Anderson B, Nigg BM. J Strength Cond Res. 2012 Jun;26(6):1631-7.

11. Effect of compression stockings on running performance in men runners. Kemmler W, von Stengel S, Köckritz C, Mayhew J, Wassermann A, Zapf J.  J Strength Cond Res. 2009 Jan;23(1):101-5.

12. The effect of graduated compression stockings on running performance. Ali A, Creasy RH, Edge JA.  J Strength Cond Res. 2011 May;25(5):1385-92

13. Effects of gradual-elastic compression stockings on running economy, kinematics, and performance in runners. Varela-Sanz A, España J, Carr N, Boullosa DA, Esteve-Lanao J. J Strength Cond Res. 2011 Oct;25(10):2902-10.

14. Effect of Lower-Limb Compression Clothing on 400-m Sprint Performance. Faulkner JA, Gleadon D, McLaren J, Jakeman JR.  J Strength Cond Res. 2013 Mar;27(3):669-676.

15. Effect of lower body compression garments on submaximal and maximal running performance in cold (10°C) and hot (32°C) environments. Goh SS, Laursen PB, Dascombe B, Nosaka K. Eur J Appl Physiol. 2011 May;111(5):819-26.

16. Effects of wearing compression garments on physiological and performance measures in a simulated game-specific circuit for netball. Higgins T, Naughton GA, Burgess D. J Sci Med Sport. 2009 Jan;12(1):223-6.

17. Effects of wearing compression garments on thermoregulation during simulated team sport activity in temperate environmental conditions. Houghton LA, Dawson B, Maloney SK. J Sci Med Sport. 2009 Mar;12(2):303-9.

18. The effects of wearing lower-body compression garments during endurance cycling. Scanlan AT, Dascombe BJ, Reaburn PR, Osborne M. Int J Sports Physiol Perform. 2008 Dec;3(4):424-38.

19. The Effects of Wearing Lower-body Compression Garments During a Cycling Performance Test. Driller MW, Halson SL. Int J Sports Physiol Perform. 2012 Sep 19.

20. The effects of wearing undersized lower-body compression garments on endurance running performance. Dascombe BJ, Hoare TK, Sear JA, Reaburn PR, Scanlan AT. Int J Sports Physiol Perform. 2011 Jun;6(2):160-73.

21. The effects of whole-body compression garments on prolonged high-intensity intermittent exercise. Sear JA, Hoare TK, Scanlan AT, Abt GA, Dascombe BJ. J Strength Cond Res. 2010 Jul;24(7):1901-10.

22. Effects of a whole body compression garment on markers of recovery after a heavy resistance workout in men and women. Kraemer WJ, Flanagan SD, Comstock BA, Fragala MS, Earp JE, Dunn-Lewis C, Ho JY, Thomas GA, Solomon-Hill G, Penwell ZR, Powell MD, Wolf MR, Volek JS, Denegar CR, Maresh CM. J Strength Cond Res. 2010 Mar;24(3):804-14.

23. Efficacy of lower limb compression and combined treatment of manual massage and lower limb compression on symptoms of exercise-induced muscle damage in women. Jakeman JR, Byrne C, Eston RG. J Strength Cond Res. 2010 Nov;24(11):3157-65.

24. Evaluation of a lower-body compression garment. Doan BK, Kwon YH, Newton RU, f J, Popper EM, Rogers RA, Bolt LR, Robertson M, Kraemer WJ. J Sports Sci. 2003 Aug;21(8):601-10.

25. Graduated compression stockings: physiological and perceptual responses during and after exercise. Ali A, Caine MP, Snow BG. J Sports Sci. 2007 Feb 15;25(4):413-9.

26. Influence of moderate prophylactic compression on sport performance. Bernhardt T, Anderson GS. J Strength Cond Res. 2005 May;19(2):292-7.

27. Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. Jakeman JR, Byrne C, Eston RG. Eur J Appl Physiol. 2010 Aug;109(6):1137-44.

28. Positive effect of lower body compression garments on subsequent 40-kM cycling time trial performance. de Glanville KM, Hamlin MJ. J Strength Cond Res. 2012 Feb;26(2):480-6.

29. Pressure and coverage effects of sporting compression garments on cardiovascular function, thermoregulatory function, and exercise performance. MacRae BA, Laing RM, Niven BE, Cotter JD. Eur J Appl Physiol. 2012 May;112(5):1783-95.

30. Wearing a sports compression garment on the performance of visuomotor tracking following eccentric exercise: a pilot study. Pearce AJ, Kidgell DJ, Grikepelis LA, Carlson JS. J Sci Med Sport. 2009 Jul;12(4):500-2.

31. “Compression garments: Does tight mean right?”, written by Lenny Bernstein,  The Seattle Times, Sunday, December 16, 2012. 

32. “The Effects of compression garments on the recovery of long distance runners after prolonged exercise”, Thesis Dissertation by Karen Bindemann, Stellenbosch University.

33. Compression Garments: Influence on Muscle Fatigue.  William J. Kraemer, Jill A. Bush, N. Travis Triplett-McBride, L. Perry Koziris, Lisa C. Mangino, Andrew C. Fry, Jeffrey M. McBride, John Johnston, Jeff S. Volek!, Christopher A. Young, Ana L. Gomez, and Robert U. Newton. Journal of Strength and Conditioning Research, 1998, 12(4),211-215. 

34. Compression garments and recovery from eccentric exercise: a 31P-MRS Study.  Michael I. Trenell, Kieron B. Rooney, Carolyn M. Sue and Campbell H. Thompson.  Journal of Sports Science and Medicine (2006) 5, 106-114.