Are compression garments useful?

Compression garments occupy an important place in the world of sports, whether it’s for their comfort, their aesthetic appeal, or their psychophysiological function. They are supposed to improve performance, reduce the risk of injury, and promote recovery—but what do they really do?

What is a compression garment?

Compression garments are tight and compressive pieces of clothing, typically made of Spandex and nylon. They’re worn not only by athletes to improve performance and recovery, but by amateur enthusiasts as well.

Despite their portrayal in the media and their general acceptance as an effective tool for improving your performance and recovery, only a small body of research supports the idea that they are truly useful. Furthermore, this research suffers from numerous methodological inconsistencies.

Do compression garments really improve performance and recovery? 

Effects on the inflammatory response

The effects of muscular pain following intense exercise are well documented; however, the principle mechanism responsible for this phenomenon is still not completely understood. While some believe that the muscle pain results from a disruption of the muscle fibers and surrounding tissues (2), others believe they are related to the inflammatory response (3). The most realistic theory is perhaps a simultaneous combination of disruption of the muscle fiber and surrounding tissues and effects related to the inflammatory response (4).

The inflammatory response is a process that follows tissue damage caused by intense activity. This response leads to an increase in osmotic pressure/swelling, an increase in sensitivity of the nociceptors (pain receptors), and causes the sensation of pain (5). It is thought that wearing compression garments exerts external pressure on the body, reducing osmotic pressure and thereby reducing the space available for swelling and hematomas. A reduction in osmotic pressure can also reduce the inflammatory response and the sensation of pain (1). However, due to a lack of concrete proof, this theory remains uncertain.

Effects on creatine kinase

Creatine kinase (CK) is a well-known biomarker of muscle damage (6). Wearing compression garments has proven to be an effective tool for reducing the concentration of CK after exercise (1). This reduction in CK concentration was linked to a reduction in the release of CK into the bloodstream, improved elimination of metabolites (waste), and improved muscle tissue repair (5, 7).

It has also been suggested that compression garments can improve circulation by potentially improving the performance of “skeletal-muscle pumps”, but this remains hypothetical (7). If this is true, compression garments could lead to an increase in venous return, which would facilitate the elimination of metabolites and, consequently, explain the reduction in CK concentrations. It is however important to note that there is significant disagreement between current studies – some conclude that compression garments can reduce CK concentrations, while others note no change (8, 9).

While there are a wide variety of mechanisms that are believed to be responsible for reducing the perception of muscle pain and the lower post-exercise concentrations of CK after use of compression garments, it has been demonstrated that muscular power and strength recover more rapidly when compression garments are used.

Effects on cardiovascular function

It has been shown that compression garments have very little effect on sub-maximum or maximum heart rates (7, 10), and on sub-maximum and maximum plasmatic concentrations of lactate (7, 11). Therefore, while it is evident that compression garments provide no improvement to the distribution and usage of oxygen during exercise, there is evidence to suggest that they can improve the conservation of sub-maximum function (12).

A study has shown that using compression garments improved the oxygen cost of running (running economy) by about 9% at speeds of 10, 12, 14, and 16 km/h (12). However, as it has been demonstrated that compression garments have no effect on cardiovascular response (7,11), compression garments could improve running economy by improving proprioception, muscle coordination, and propulsive force (12).

Effects on proprioception and muscular oscillations

Research has shown that compression bandages can improve proprioception through external pressure acting on cutaneous receptors, thereby improving proprioceptive abilities (13, 14). Although this may be possible, as far as we know this theory has not been directly tested with compression garments, only with compression bandages (13, 14).

It has also been shown that compression garments reduce muscular oscillations during dynamic activities such as vertical jumping (15, 16). Reducing muscular oscillations during exercise is thought to reduce muscular fatigue and tissue damage.

Effect on subjective responses to exertion

It is often thought that compression garments may have a positive psychological (i.e. placebo) effect on performance and recovery by reducing the perception of muscular pain (RPE). As previously discussed, the effects of compression garments on muscle pain are still unclear. This recovery method has also been shown many times to have very little effect on the evaluation of RPE during various running and sprinting protocols (7, 10, 16). This suggests that compression garments may have a weak or negligible placebo effect on recovery.

Improving performance

Compression garments are worn to improve ongoing recovery (between training sessions), but also as a way to improve intense recovery (during training sessions). A 2013 meta-analysis concluded that they can improve ongoing recovery of muscle strength and power between training sessions (1). However, there seems to be little proof supporting their ability to improve intense recovery while performing squats, jumps, sprints, and agility exercises (17, 18, 19, 20). While compression garments may not improve intense recovery during training sessions, it is important to note that wearing them has not been observed to lead to any negative effects on performance. This suggests that even if compression garments offer no extra recovery benefits, they have no negative impact on performance.

Current scientific studies indicate that compression garments improve:

• local blood circulation,
• the elimination of toxins,
• running economy,
• inflammation reduction
• as well as reduce post-exercise muscle pain without having a negative impact on performance.

However, it is important to highlight the fact that most of the current research contains numerous inconsistencies in their protocols and are not very present in scientific reviews. This information must therefore be taken with a grain of salt.

Issues encountered with compression garments

Perhaps one of the biggest current problems with compression garments is the sizing and pressure applied by the garments. As the products are generally called “compression garments”, it is obvious that the material’s pressurization effect is very important. However, there is a significant failure to mention the garment’s pressure gradient. For a real and optimal effect, the proper fit is indispensable. The manufacturer must ensure that the pressure around the ankle is between 20 and 25 mm of mercury, with a progressive reduction toward the top of the leg.

Among the documented research that mentions the pressure gradient, there are vast differences between these gradients, which makes it extremely difficult to draw any precise conclusions. Within the current body of research, typical pressure garment pressure gradients ranged from 10 to 30 mmHg (millimeters of mercury), while normal diastolic arterial pressure is about 80 mmHg (21). As far as this author is aware, there is no obvious choice of pressure gradient to optimize recovery.

Future research

To make it possible to reach more precise and practical conclusions regarding the use of pressure garments, more higher-quality research is required.

Additional research must also focus on:

• The effects of compression garments on subjective measures of recovery
• The underlying mechanisms responsible for improvements in recovery
• Varied pressure gradients and anatomical locations
• The effects on a diversified population (for example: both sexes, youth, the elderly, different athletic levels)
• The optimal period to wear compression garments after exercise
• The usefulness of wearing compression garments while sleeping after exercise

Practical applications

It seems that compression garments may have a positive effect on recovery and performance, although there is a dearth of information about the best way to use these products. Furthermore, nothing indicates that compression garments can have a negative impact on recovery or subsequent performance. As a result, it is suggested that athletes and fitness amateurs continue to use pressure garments both during and after exercise as an extra tool to improve performance and optimize recovery.

Conclusion

With research indicating that compression garments can improve:

• joint awareness,
• local blood flow,
• the elimination of waste products,
• the sub-maximum use of oxygen during exercise,
• inflammation reduction,
• muscular oscillation reduction,
• as well as reduce muscle pain after exertion,

They remain a recommended tool for improving performance and recovery.

However, it is important to recognize that the current body of research on this subject is of low quality and is riddled with inconsistencies. This implies that this information must be accepted with prudence.

Written by:
Guillaume Boitel – Doctor in Physiology, Bio-mechanics & Sports Sciences