Monday, February 1, 2016

Everything I Know (and Don’t Know) About Compression Garments - Part I

by Larry Creswell, M.D.

I remember seeing athletic compression garments (CG) for the first time at the expo for the Ironman New Zealand triathlon in 2007. An enthusiastic salesperson wanted to show me a full body compression suit and explain the many benefits for triathletes. I also remember very clearly thinking how silly it all seemed. I’m a skeptic at heart. Now, I’m not so sure. There may well be some benefits. Here’s what I know…

In the medical field, we’ve used CG of various sorts for decades. In their simplest form, CG for the upper or lower extremities continue to be used in patients because they are known to decrease or limit extremity swelling and decrease the chances of developing deep venous thrombosis (DVT, blood clot formation in the veins) in certain, usually relatively immobile patient populations. As an example, all of my heart surgery patients wear thigh-high compression stockings for the first few days after operation to limit swelling in the legs which might hinder walking.

In athletic circles, CG are now available in a wide variety of forms: socks, stockings, arm “stockings,” and even whole-body suits. Moreover, there is a wide range in the degree of compression offered in these garments. Manufacturers label the garments with measurements of developed pressure, but this only holds true if the garments are fitted properly. As a result, I’m sure there is no standardization about the amount -- or degree -- of compression provided by the various garments. This issue may well be an important determinant of their effectiveness.

Compression Garments and Performance and Recovery
Thinking back to the salesperson in New Zealand, he made many claims about the benefits of CG in terms of performance and recovery. Indeed, these claims are the underpinning for the popularity of these garments for endurance athletes.

In today’s column, I’m not going to focus on these aspects of CG. There’s an ever larger literature on the effects of CG and athletic performance and recovery and for those who are interested in more reading, I might suggest a series of blog posts by Joe Friel and a review article by Braid MacRae and colleagues and published earlier this year in Sports Medicine (see references below).

My impression from the accumulated evidence is that it’s been difficult to show performance benefits during training or competition that are due to CG. I’ll bet that if there is a performance benefit, it’s small -- and it might only accrue in certain situations or activities. In research studies, it’s also hard to get at the recovery benefits, and there are many, many studies with conflicting findings. Nonetheless, I’ll bet that there is a recovery benefit -- even if I can’t point to a reasonable physiologic explanation. I know from personal experience that I’m left feeling better if I wear compression stockings after strenuous run or biking workouts, especially if I have to be on my feet for extended periods after those workouts. That’s sufficient for me.

In part II of this article, I’ll cover compression garments and travel as well as CG effect on the heart.


References
MacRae BA, Cotter JD, Laing RM. Compression garments and exercise: Garment considerations, physiology and performance. Sports Med 2011. 41:815-843.
Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains The Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at lcreswell@umc.edu.
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