Compression gear. Facts vs. Fiction

Athletes of all genres, including the running and triathlon communities have an interest in injury prevention and performance enhancement.  Products come along that are marketed at these groups with claims of scientific studies that prove their effectiveness.  Typically these claims are false and amount to nothing more than propaganda by the manufacturer.  A common claim is “increase performance and decrease injury”, all things an athlete wants.  However, these companies have no published research to support their claims.  As consumers we have a right to a reasonable expectation that a product does at least in part what it claims to do.  After reviewing compression gear companies websites it is apparent that they promote their products with the promises of “performance, recovery, agility” or “to make all athletes better”.  Nowhere on these websites do they provide any data to support their assertions.  Recently a wetsuit company claimed to have “medically inspired, lab tested and athlete proven” compression gear.  Again no clinical data to support the assertion, but it sounds good.  Most recently I review a company website called 2XU.  Their motto was “human performance, multiplied”.  They actually were quoting studies on compression that at first seemed to be positive.  However, upon further inspection I found their website research review to be inaccurate and in my opinion fraudulent and intentionally misleading!  I review the actual findings of the study below.

As a doctor, scientist, athletic trainer and strength and conditioning specialist I have been through thousands of hours of training in sports medicine, injury prevention, treatment and prophylactic devices such as braces.  After reviewing as much of the current published medical literature on the topic of compression I will not only give you the facts on compression garments but also explain some of the POSSIBLE reasons that athletes report benefits while wearing it.

Some reports suggest that compression clothing can positively influence healing of muscles and tendons following exercise.   The Journal of Orthopedic Sports and Physical Therapy, 2001, June; 31(6):282-90 undertook a study that compared wearing a compression sleeve to those wearing a “compression-less’ sleeve.  There were 10 non-athlete subjects in each group all given a questionnaire 5 days after exercising.  Those wearing the compression sleeve had greater range of motion, decreased perceived soreness, reduced swelling and greater force production.  The study appears to support the use of compression in the management of soft tissue injury.  It should be noted that the sample size was small (10 participants) and were non-athletic.
The journal Sports Medicine in 2006; 36(9):781-96 attempted to compare multiple recovery modalities between training sessions to see if athletes could benefit from one vs. another.  Recovery modalities such as stretching, ice, massage and compression have been purported to enhance the rate of blood lactate removal following exercise, reduce severity and duration of muscle injury and delayed onset muscle soreness (DOMS).  The researchers found “no substantial evidence to support the use of recovery modalities between training sessions in trained athletes”. The modalities reviewed were massage, hyperbaric oxygen chambers, ice therapy, hot-cold contrast bath therapy, nonsteroidal anti-inflammatory drugs (NSAID’s), stretching and compression garments. It should be noted that none of the above modalities were detrimental to recovery but did not appear to enhance it.
The British Journal of Sports Medicine Jul; 41(7):409-14 compared three types of compression garments on throwing and sprint performance.  They reported “no benefit when wearing compression garments for sprint or throwing performance; however, the use of garments as a recovery tool, when worn after exercise, may be beneficial to reduce post exercise trauma and perceived muscle soreness”.  The last statement in quotations was interesting.  The authors provided no evidence to support their claim that these garments are beneficial in reducing post exercise trauma or perceived muscle soreness.  This happens often in the world of published research. Future authors then go on to quote this paper erroneously as having proved that the compression garments were beneficial when in fact no proof was ever cited.
The journal of Sports Science 2008 Sep; 26(11):1135-45 studied the effect of recovery strategies on physical performance and fatigue on basketball players.  They had 3 recovery strategies.  Carbohydrates and stretching, ice bath and full leg compression garments.  Their conclusion was that “cold water immersion promotes better restoration of physical performance measures than carbohydrates and stretching or compression garments”.  It should be noted that the benefits of cold water immersion were also very small.  An athlete should always question recovery protocols that may require much effort and discomfort for a small and possibly insignificant amount of recovery when compared to doing nothing at all.
The Journal of Science Medicine and Sport 2009, Jan 6 compared the effects of compression garments on muscle performance following sprinting and plyometric exercise.  I obtained this article before it actually went to print. Their findings were “the effect of compression garments on performance and recovery were minimal.  However, reduced levels of perceived muscle soreness were reported following recovery in the compression garments”. Their findings support what I hinted at above.  Since the effect is minimal is it worthwhile?
Most athletes are eager to increase performance and decrease injury. Who would not be?  Others are looking for the next great thing to increase performance and to get that competitive edge.  Manufacturers are keen to this and cater to athletes needs and psyche.  They utilize words like “making all athletes better” or “medically inspired and lab tested” to help sell their products to unsuspecting consumers.  Compression products have NOT been shown to increase performance or decrease injury.  However, many athletes continue to wear and testify to the usefulness of these products.  It is possible that compression garments have a place in the world of athletics. For one compression garments typically fit like a “second skin” which proves to be comfortable for most athletes.  Compression garments form to the shape of the muscle and do not allow for air transfer as loose fitting clothing does.  This promotes a ‘warming’ effect.  Since muscles are partially fluid in nature and fluids tend to perform better under warmer conditions then it may be that compression garments help keep the muscles warmer and therefore more elastic which translates to an increase in comfort. Compression garments, by hugging the muscle and skin so closely also may work to reduce muscle vibration.  During running, impact causes vibration in muscles. The more the vibration the more muscle energy expended.  By “dampening” muscle vibration through compression the athlete may be reducing fatigue which again translates to being more comfortable.  In studies on comfort and muscular effort it has been established that the more uncomfortable an athlete is, the more they increase their muscular effort.  By increasing comfort muscular effort is reduced.  Think of this analogy.  If you have a rock in your shoe you will be uncomfortable and will alter your running thereby expending more energy in order to avoid the rock.  By simply removing the rock you will decrease your muscular effort and increase your comfort at the same time.

Compression garments may also play a role in the treatment of athletic injuries.  For example; when treating runners with Iliotibial Band Syndrome it is commonplace for me to place a compression band around their knee above the Iliotibial Band insertion.  By compressing above the painful insertion forces are redistributed around the painful site thus reducing the strain on the tendon and allowing the runner to continue to train.  However, by wearing the compression band you will not prevent the injury from occurring.  So compression garments might be useful in the treatment of an athletic injury as I have personally seen in my sports injury practice, but may not be useful in prevention or recovery.
At this time it does not appear that compression garments are useful in the prevention of injury, increasing performance or in recovery between exercise.  They do appear to decrease “perceived” muscle soreness and have a role in the treatment of athletic injuries.  Some of the common injuries I have personally seen compression garments have a positive effect on are Patella Tendonitis, Iliotibial Band Syndrome, Shin Splint Syndrome and muscle strains ranging from calf to gluteal strains.  Athletes would be wise to be skeptical of manufacturer claims of injury prevention, recovery and performance enhancement as there is currently no valid, clinical evidence to support their claims.  In fact there is evidence to the contrary.  Let the buyer beware!