The latest research on compression garment effectiveness

The main reasons to wear compression garments, like compression socks, would be to: 1) improve athletic performance or 2) improve recovery. Is compression wear worth the hype in either of these cases?


A 2016 review on the effects of multiple types of compression garments (Engel et al.) examined 32 studies performed between 1987 and 2015. In eight of the studies they found no significant improvement in race completion time with compression for any distance from 400 meters to marathon. In seven studies, they did find a small improvement in time to exhaustion while wearing compression. Four studies reported improved running economy values. Sixteen of the studies were associated with improvements in psychological variables.

Despite being financially supported by a garment manufacturer, a 2015 study by Areces et al. found no benefit of compression socks in post-marathon exercise performance or race times.

In a 2015 literature review of four studies by Stanek, compression socks were reported to have no effect on several physiological measures like heart rate, perceived exertion, and lactate levels. Although one of the four studies noted an improvement in maximal running speed.


Performance improvements are often based on perception of effectiveness. In a 2016 study by Brophy-Williams et al. the participants were asked about their perceptions on the usefulness of compression socks in enhancing exercise recovery. This article is ahead of print, but according to the abstract (yes, I know that’s bad science) the participants performed better if they believed the compression was going to be helpful in recovery. Thank you placebo effect.

The 2016 Engel review of 32 studies found nine articles reporting large positive changes in exercise or post-exercise muscle soreness.  

A 2013 meta-analysis by Hill et al. revealed some benefit in reducing the pain of delayed onset muscle soreness. They also found that muscle strength and muscle power measures recovered more quickly with compression usage.

A 2016 meta-analysis by Marqués-Jiménez et al. identified several studies indicating multiple biochemical markers were improved following exercise if compression garments were worn. In five studies, muscle swelling was also improved. Another eight studies indicated improvements in exercise recovery in muscle strength and five studies in muscle power.

Anecdotally, I don’t find compression to change anything about my personal running performance. Maybe I would notice a change if I used it more often. But I definitely do like the way compression feels for a day or so after a hard workout or race. I really love the way compression feels at super high levels with a compressive device - above 80 mm Hg, which isn’t what these studies and reviews analyzed. Even if compression garments aren’t changing recovery on a physiological level, they are all capable of decreasing the sensation of soreness.

It appears that the most recent research evidence supports the use of compression in decreasing the intensity of delayed onset muscle soreness. The helpfulness of these garments may be event greater in an individual that must spend more time on their legs during the post-exercise period of soreness. Let’s say in a multi-day event or going back to work on Monday.

Could you make arguments for using compression using the latest literature? Sure. Would I use it in every race or workout? Nope. The reality is that if you think it helps you, then keep using it.


Training errors in the athlete, part 6

Too much, too soon, particularly after an injury. Most athletes understand that progressing too quickly in their regular training can cause injury. What they don’t often understand is how to return to sport after an injury. This is the easiest time to go too hard or too long. You can have the “I’m all better” concept down too well.

Injured or not, the body is only capable of adapting at a certain rate. Some tissues can adapt in a few days (cardiovascular system, nervous system pathways), some in a few weeks (muscles), and others in a couple months (tendon, bone). Depending on the location of the injury you must consider what are known as “tissue healing constraints.” For example, a tendon overuse injury can take 1-3 months to resolve with correct progression. A low-grade muscle strain could take 1-4 weeks.

If a runner has tendon pain from a new tendinitis that has been present for 3-4 weeks then I would expect it is going to take weeks, not days, before returning to their pre-injury mileage. It doesn’t always mean you can’t run at all during recovery. It must be a controlled progression. And there is always some type of cross training you can do.

The first day back to running should not be a 5 or 7 mile long run, regardless of terrain or intensity. And that’s what I see many people try to do when they return from injury. They want to get right back up that mountain quicker than they came down it. Stay in the valley for a couple days. For every week away from running I would expect a need for at least a 30% drop in average weekly mileage upon return.

It’s going to take at least a week of no exercise before you actually have a loss of fitness. The fitness losses from 2 weeks of inactivity are similar to those of 4 weeks. And I’m sure you have been cross training to minimize those losses. Point being, don’t rush back into it simply to regain fitness that doesn’t really need to be regained.

Not listening to your body’s warning signs of insufficient recovery. This is similar to what I mentioned last week about not respecting a specific injury early. But you also need to consider a whole body factor. Something is up when your muscles have been feeling constantly tired before, during, and after workouts. You might wake up more groggy than usual or old injuries start to reappear. You need to consider what your body is trying to tell you.

It’s normal to feel a little stiff and achy in your muscles when you start to push them. But when a slow, easy warm-up doesn’t put some pep back in your step after 20-30 minutes then there’s a good chance you could be digging yourself into a hole. If you feel good at that point, then a hard workout is reasonable. If you still feel slower than normal and better yet, are actually slower than your normal, then it’s not a day to push your effort.

For the uninjured, refrain from making any judgments about how your workout is going to proceed until your system is well warmed-up, at least 15 minutes into exercise.

image courtesy

image courtesy

Not performing regular soft tissue maintenance like foam rolling, massage, and compression in recovery, especially after the hardest and longest efforts. Repetitive wear and tear beats up your muscles. Unhealthy muscle tissue equals decreased performance and even pain. As athletes, we surely can’t expect that pushing into exercise-related discomfort multiple days per week generates only 100% positive adaptations in the muscles and other tissues. There are gradual negative adaptations too, like trigger points, adhesions, and loss of muscle tissue length.

Show those muscles a little love with self-massage. Help your lymphatic system function at its best by preventing fluids from accumulating in the spaces around your muscles and other tissues with compression. Options for compression include compression socks or for a more massage-like treatment, a pneumatic compression system, like the Normatec. Most athletes find that massage and compression simply feel good after prolonged exercise.

Shaq gets it!

Shaq gets it!

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