Do Compression Garments Really Work?
I’ve been a fan of compression garments for a couple of years now. Whether or not they actually perform the function that’s declared has always been a lingering question in my mind. Are compression garments as effective as the Power Balance Band? Or will they really improve performance and accelerate muscle repair as claimed?
I should state the obvious and note that I’m not a sports physiologist and am not qualified to make conclusions based on the research I’ve found. I also acknowledge that my methods for reading and referencing research is lacking (keep in mind, this isn’t a scientific journal and I only have a couple of hours to write this stuff). However, I can tell you my own experience with compression garments, the opinions of qualified scientists I’ve spoken with, and I can refer you to some research that’s in the public domain.
Medical compression stockings have been used to treat poor blood flow for many years. These are usually worn to create a controlled, gradient compression on the leg (greatest at the ankle and diminishing up the length of the leg). The amount of compression is crucial, and therefore getting your size right is important.
The Skins website has a nice summary on the way that that compression garments are claimed to work:
When you apply compression to specific body parts in a balanced and accurate way, it accelerates blood flow. This gets more oxygen to your working muscles – and boosts your performance.
Better blood flow also helps your body to get rid of lactic acid and other metabolic wastes – which helps you work at a higher rate for longer. Plus, improved oxygenation reduces the effects of delayed onset muscle soreness and accelerates muscle repair. So BioAcceleration Technology™ plays a big part in helping you recover from exercise too.
(update) Reader Adam Trewin (B.Sc (Hons.) of Exercise Science) explained in simple terms how this actually works:
The circulatory system is comprised of both arterial and venous blood flow. Arterial blood is pumped from the heart/lungs, is oxygenated and flows at a high pressure (> ~120 mmHg – i.e. your systolic blood pressure). Correct fitting compression garments will not significantly impede this arterial blood flow.
Venous blood, however, (deoxygenated, having done it’s metabolic job passing through the capilleries and offloading oxygen and nutrients to the active muscle) flows at a much lower pressure (< ~20mmHg). These veins have special venous ‘one-way’ valves built in which allow blood to go back toward the heart, but not the other way. Musclular contractions squeeze the blood back to the heart which is the main mechanism for venous return. Compression garments utilise this same mechanism.
If you look around the lobby at a team hotel during a pro bike race you’ll see riders wearing the compression socks and tights everywhere. I’ve asked a few PROs about what they think of these garments and it’s always been positive feedback. One answer that sums up an athlete’s mindset is Koen de Kort’s response when I asked him about this topic:
“I use Skins. I like to think they help. I’m quite sure they help while travelling. You can see how inflated your legs get when you’re on the plane but I can notice a difference when I’m wearing the Skins. During the TdF I wore them after almost every stage. I don’t know…maybe it’s something that makes you feel like you’re working on it 100% every minute of the day. I guess it puts your mind at easy that you’ve done everything to make you as good as possible. Whether they really work or not is probably not that important at all [laughs].”
A lot of thought and money has gone into selling compression garments. Lots of effort has also gone into researching their effectiveness. While I was investigating this topic I spoke with Matt Driller from the Australian Institute of Sport. Matt is contracted to perform independent research into 2XU compression garments (note that the AIS and 2XU have a partnership together). I trust the integrity of the AIS’s research and can only assume that their code of ethics prevent any type of conflict of interest in situations like this. My critical mind is never at ease with this type of partnership though. Perhaps someone out there can explain how credibility is ensured with this research of this nature.
The AIS completed two studies on compression garments with cycling last year. One looking at the effect of compression on recovery and another one looking at cycling performance. Neither of these studies have been published yet but there were some positive findings that can be shared.
From the 2XU website:
Just over 12 months after its exclusive appointment as the Official Compression/Research + Development Partner of the Australian Institute of Sport (AIS), 2XU has been handed a series of powerful results from the first studies conducted by the AIS exclusively on its highly popular Compression Tights.
Conducted by the AIS Recovery Team over a period of six months, the studies investigated the effects of 2XU’s Compression Tights on performance and recovery. Carried out in state of the art AIS facilities independent of 2XU, researchers put highly trained cyclists to the test across different key indicators including; performance, heart rate, blood lactate, soreness and thigh girth.
AIS scientists were impressed with the performance of the 2XU Compression Tights and unveiled the following key findings:
- Improved performance in a 30-minute cycling bout when wearing 2XU Compression Tights
- Significantly lower heart rate during cycling when wearing 2XU Compression Tights
- Improved ability to maintain performance in a second cycling bout when wearing 2XU Compression Tights for recovery
- Greater reduction in blood lactate concentrations while wearing 2XU Compression Tights during recovery
- Decreased swelling in the thigh following wearing 2XU Compression Tights for recovery
- Perception of leg-muscle soreness less when wearing 2XU Compression Tights for recovery.
AIS Recovery Physiologist Matt Driller was particularly pleased with the significance of this 2XU Compression study.
“Based on the results of these studies, we would recommend that athletes can improve their performance during 30-minutes of high-intensity cycling by wearing 2XU Elite Compression Tights,” said Driller.
“Furthermore, the results suggest that athletes are able to maintain repeat cycling performance when wearing 2XU Compression Tights during a short term (~1hour) recovery period.”
Personally, one finding that can I definitely agree with is the fact that compression garments will reduce the perception of muscle soreness the day after a hard session on the bike. I don’t use my Skins all the time, but I’ll always put them on straight after I’ve had a big hit-out and want to do it again the next day. I find the difference between wearing them and not wearing them quite remarkable the next day.
One thing to keep in mind that my mate Dr. Dominic Briscome (First Place Osteopathy) alerted me to was the fact that Delayed Onset of Muscle Soreness (DOMS) is a medical description of a cellular level injury to the muscle. This only occurs during eccentric exercise (such as running). Cycling has no eccentric (or weight bearing) component and is only concentric (or non-weight bearing). This isn’t saying that your muscles shouldn’t be sore the day after a hard ride, however it’s not technically DOMS that is causing this. If you’re looking for benefits to your cycling from compression garments, research that talks directly about DOMS may not be applicable for cyclists.
Another independent study that I found (which used Skins garments in their testing) links the influence of compression garments on athletic performance for cyclists:
The Effects of Wearing Lower-Body Compression Garments During Endurance Cycling
Scanlan, A., Dascombe, B., Reaburn, P., and Osbourne, M. (2008). The Effects of Wearing Lower-Body Compression Garments During Endurance Cycling. International Journal of Sports Physiology and Performance, 3(4).
This study examined the effects of Skins lower-body compression garments (LBCG) during a one-hour cycling time trial on twelve well-trained cyclists. Results showed increases in muscle oxygenation economy and improvements in cycling economy, suggesting Skins LBCG may delay the onset of fatigue and prolong optimal performance for well-trained endurance cyclists.
- 5.7 % increase in absolute power output (PO) at Anaerobic Threshold (AnT) during the one-hour cycling time trial.
- 4.2 % increase in relative power output (RPO) at Anaerobic Threshold (AnT) during the one-hour cycling time trial
- 9.3% increase in cycling economy in the first 15 minutes of one-hour time trial.
- 13.7% increase in mean muscle oxygenation economy over the one-hour time trial.
- The mean endurance level was increased by 5% (15 watts) when wearing Skins CG. This showed individual lactate and anaerobic threshold improvements. * Suggesting an improvement in lactate production to clearance ratio due to increased venous return and circulatory response from Skins gradient compression garments.
Personally, I’ve never used compression garments on my legs while cycling, but have used Skins compression bib knicks on many occasions. I can’t say that that they neither helped nor hindered my performance. However, they’re excellent knicks with a very comfortably chamois.
When speaking to a representative from Skins, he told me that the best way to get the most out of the garments while riding is to wear the full leggings with gradient compression. The second best option would be to wear the socks. The analogy he used was that it’s like pushing toothpaste out of it’s tube. You’ll get the most benefit from pushing from the bottom. This is allegedly why compression socks will still be beneficial. The calf muscle is the furthest large muscle away from the heart which will improve venous return when compressed.
Compression Garments For Air Travel
There’s no doubt in my mind that compression socks have effectively reduced the swelling of my legs and ankles when I fly. From what I’m told, compression tights should also help reduce swelling of the legs during air travel, however, for whatever reason this wasn’t what I experienced.
A couple of years ago when I flew overseas I wore my Skins full leg tights. Below is a photo of what my ankles looked like after I stepped off the plane. I can’t find the photo I took of my legs with my tights off, but they were so swollen they looked like tree trunks. This is similar to the way my legs build up fluid when flying and I’m not wearing a compression garment.
My ankles after a 15hr flight when wearing compression tights
A couple months ago I took a long flight and wore my Skins compression socks (the Skins A400 model). I found the socks to be much more comfortable than wearing the full tights because they weren’t as warm. This is what my legs looked like after:
My legs after a 15hr flight when wearing compression socks. And yes, I’m flexing…
Of course none of what I’m saying here is scientific research, but to me it gives me some firsthand evidence that helps me believe that compression socks help me during flying. Why the difference in the socks and the tights? I have no idea. Perhaps the tights were stretched and didn’t provide the proper compression anymore.
Here is a summary of one study done on compression garments and air travel:
A randomised, crossover, open-label study of the effectiveness of Skins – Travel and recovery garments in reducing in-flight ankle oedema. Hagan, M., Lambert, S. (2008). A randomised, crossover, open-label study of the effectiveness of SkinsTM – Travel and recovery garments in reducing in-flight ankle oedema. Medical Journal of Australia, 188(2), 81-84.
This study was prospective and measured 50 passengers on flights of greater than 5 hours. The measurements were conducted on both the outgoing and return flights for each passenger – one wearing Skins and one not wearing Skins. Results showed significant differences in ankle circumference and symptoms of Economy Class Syndrome. More specifically, results found that participants wearing gradient compression garments (Skins) during air travel experienced:
- 55% decrease in ankle swelling.
- 58% improvement in leg pain.
- 52% improvement in leg discomfort.
- 13% demonstrated improvement in alertness.
- 9% improvement in concentration.
- 14% improvements in energy levels.
- Improvements in fluid retention and improved post flight sleep.
- Significant reductions in flight oedema were evident and observed whilst wearing Skins CG
I can say with a high degree of confidence that compression garments have helped me in two ways. First, they help lower my perceived muscle soreness the day after a big day on the bike. If this is legitimate or if it is the placebo effect, I don’t think it matters. It works for me.
Second, there’s no doubt that the compression socks reduce the swelling of my legs after a long flight. This is important to me because I bring my bike with me almost everywhere I go and there’s nothing worse than having bloated, heavy legs for a few days after travelling.
Personally, I think it’s difficult to prove that an immediate performance gain can be linked to wearing compression garments. I have seen research on both sides of the fence. It will take a lot of convincing to get cyclists to adopt this look anyway:
A couple of years ago when I first posted something on compression garments for cycling I could not find much evidence to support the benefits. Now it seems we’re beginning to see more studies that support the claims. As always, the research on either side is filled with language such as “suggested” and “may be” which makes it difficult to determine how much confidence you can put into the conclusions. However, I dont think this is any different than a number of other performance enhancing topics including nutrition, training, bike fit, etc. You have to figure out what works for you and run with it.