Sports Performance

Should I use compression gear?

A professional racer car driver asked me what my take is on Compression Gear. So I wrote an article about it.
The research on compression gear is mixed, the company claims are extraordinary, and athletes experiences range from „this is crap!“ to „I never travel without my compression pants“.
So lets cut through the confusion and look at what compression does to our physiology, and how you can apply compression in high performance sport. 

Fluid Return

Have you ever been swimming or diving and noticed that, all of a sudden, you have to pee? It seems to come out of nowhere. You were totally fine before, but as you jump in the water you feel like you haven’t peed in days. That is what compression does to you. More specifically this is what total body immersion in water does to you. In technical terms this is called immersion diuresis. The compression of your whole body squeezes fluids from your tissues back into your blood circulation, where it is immediately filtered through your kidneys (diuresis) and then you have to pee.

Post-Injury Applications

This „fluid return“ effect of water is very valuable when we deal with tissue swelling. I always like to do pool workouts with athletes after injuries, because the water pressure of the pool will reduce the swelling. Local compression has a very similar effect. When you injure your leg you want to use slight compression, so the fluids do not pool in the leg. Pooled fluids will lead to less exchange of nutrients and waste products. So what you want to do in case of an injury is take a flexible bandage and roll it around your leg with slight tension starting at the foot and rolling circularly towards your hip. Ideally, you start with strong pressure at the foot and decrease the pressure as you keep moving towards the hip. This pressure gradient will maximise the fluid return and most of the well-manufactured compressive socks/pants are produced with this principle in mind.
If you have leg surgery, the surgeon will put a compressive sock on your leg for a couple of days, because the benefits of this are well documented. But even in smaller injuries like a sprained ankle or a „Charlie horse“, we can use this effect by putting on compressive socks and/or pants.
My colleague, Dr. Markus Klingenberg (Orthopeadic Surgeon), uses sophisticated compression protocols after each surgery to reduce the recovery times after surgery to a healthy minimum. The data he collected over the last years shows that functional recovery of his patients in his clinic is much better than in other clinics who treat the same injuries.
So, when you have an injury, wearing compressive clothing in the days after the injury is very beneficial. Make sure, that the pressure gradient goes from the finger tips/or toes TO the heart, meaning there should be less and less pressure as you get closer to the heart. Pool workouts are also great to manage swelling, but when there is skin injury (scratches, abrasions, or sutures) we cannot always go into the pool. That is where compression clothing is very valuable.
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Travel Applications

Our body has two primary mechanisms to bring fluids from our legs/arms back to our heart. The first one is the lymphatic system. This system is responsible for bringing fluids from the tissues back into the blood circulation. Like a sponge that puts the water you spilled on the floor back in the bucket. The sponge soaks up the fluid by touching it, and releases the fluid by compression. Thats the „peeing in the pool“ effect we talked about earlier. 
The second mechanism to bring fluid back from our veins to our heart is called the „muscle-venous pump“. This is a pretty cool system that uses muscle movement to bring back the blood. Our veins are one-way streets. Blood can only go one direction, because every couple of centimetres there is a door in our veins. This door only opens in one direction „to the heart“, and not the other way. Its like a turnstile in a supermarket. Once you are in you can only exit through the registers (the heart). 
When we move our leg muscles, they press on the veins and thereby push the fluid back to the heart. 
Both of these systems are SUPPORTED by external compression, but it is important to keep in mind, that muscle movement is the key driver of fluid return to the heart.
This is especially important in long travel. You have probably heard that you should get up and move every once in a while when you are on a long flight. This is because when blood just stands still in your veins, then it can clot. This clot will most likely end up in your lungs and that is life-threatening. Blood clotting in young non-smoking people, who are not on oral contraceptives, is highly unlikely, but it is still a threat.
When we went on long trips with our athletes we experimented with different protocols to find a good balance of blood circulation and getting some sleep. Especially when coming back from an AWAY-Game it is important to not just fall in the bus and have your legs hanging and not moving for up to 8 hours. 
Before getting on the bus/plane you should move for 5-10 minutes with full range dynamic mobility exercises. This is have the “muscle-venous pump” pump lots of fluids out of your legs back to your heart. On the bus/plane wear compression pants to support the fluid return. On every bus stop, get out and do a very short dynamic mobility routine. 
Electric muscle stimulation is also very good for increasing fluid return on the bus/plane. We experimented with things like the FireFly, but the cost/benefit ratio ended up not being ideal for us. For some athletes the FireFly might be ideal for its easy usability. Re-usable EMS Systems, like the Compex offer good protocols to have the muscles twitching to fire up the „muscle-venous pump“. Wearing the EMS electrodes under the pants is uncomfortable sometimes. I am still waiting for a product with electrodes woven into compressive pants.

Competition Applications

Some athletes tend to get „heavy legs“ as the competition goes on. This is especially true for endurance runners. One of the reasons for that is that fluids become pooled in the legs over time. When you have done an 8 hour hike through the mountains you have probably noticed that your legs swole up a little bit. The better the integrity of your tissues in the legs, and the more functional the lymph system and/or the venous system is, the less swelling will occur. For athletes who struggle with that, compression gear can be very beneficial.
David Goggins seemed to do just fine without compression gear when he finished third in the 135 mile race through Death Valley in 2007


There have also been some reports on improved performance in terms of faster times in endurance events, when compression gear is being used. I can neither confirm nor deny this from my practical experience. The most likely reason for this performance benefit is that compression reduces the „jiggle“. When you run, all the muscles you are not using are jiggling. Also, all the fat you carry around is jiggling. Unless it is being compressed. More compression -> less free swinging jiggly mass -> improved performance. 
There were some theories out there regarding improved oxygen supply to the muscles etc., but that was not confirmed in a study they did on 16 pretty decent endurance runners.
Best Evidence-Based advice I can give you here is : Try it. If you feel and do better with it, use it. If not, toss it.

Increased Joint Awareness

Another effect of compression gear is increased sensory feedback through the skin. When there is constant pressure on your joints then your body gets constant feedback over joint position from the skin. This can be very valuable in some situations when joint sensation from INSIDE the joint is not functioning very well. 
One of the reasons massage, kinesiotaping, athletic taping, and joint flossing works is that all these techniques increase skin sensation around the joint. This will lead to more feedback from the joint to the brain, and in general : “more feedback -> less pain -> more range of motion.“
When athletes want their ankles taped, because they have a tendency to roll their ankles, I sometimes tape the ankle very lightly on purpose. By taping it very lightly it increases sensory feedback without restricting the ankle. The only situations I tape tightly is when there is marked instability of the joint because of a torn ligament.
In a similar way, very tight clothing increases sensory feedback from the skin. It can be a good additional tool to improve movement efficiency on competition day. The reason I would not rely on this principle in training is that I see the risk of the body adapting to it and relying more and more on the skin feedback, and less and less on the sensory input from INSIDE the joint.
When I still had my own gym in Bonn (Germany), I did not have any mirrors there. The reason was that I did not want my athletes to control movement with their eyes. Athletes tend to look at the mirror while they move. I do not want that, because I want them to FEEL the movement from the inside, and not rely on their visual system to control movement. In a similar fashion I would not want to use compression clothing in training.

Take Away

To summarize, I think compression is a great tool after injuries, during travel, and (if the athlete likes it) for competition. I do not think it is a good idea to wear it all the time in training. I do not see a big value in upper body compression. I see the biggest value in lower body compression. When choosing a compression pant, choose a model that has the pressure gradient in mind and that feels COMFORTABLE. It should not interfere with anything else you do. It should be an „invisible“ tool. If the seams or the pressure disturbs you, you should not be wearing it. 
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Tags : circulationclothingcompressionlymph systemperformance docrecoverytravel

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