How effective are compression stockings during workouts?

At races, you’ll meet more and more participants wearing colourful knee-high socks. These compression stockings are designed to facilitate blood flow and create pressure on lower leg tissue. All with the goal of improving recovery and performance.

Research on compression stockings has become more important, especially in recent years. Many brands such as Rohner and Asics have already invested in compression stockings, offering them in various sizes and colours. In addition, manufacturers promise that compression stockings increase performance and improve recovery. There are differing opinions on how compression stockings affect muscle function during exercise regarding oxygenation and muscle health, and whether or not they can be beneficial for healthy individuals. Various studies show positive effects and promise less muscle soreness, less muscle damage or a better oxygen supply to the tissue [1-5]. However, there are also studies that have shown the negative effects of wearing compression stockings during exercise. Specifically, on oxygen uptake, heart rate, blood pressure, calf muscle tissue oxygenation, partial pressure, and muscle soreness assessments as well as muscle damage markers compared to regular socks [6-12]. Research hasn’t yet arrived at a consensus.

Study examines intramuscular pressure and oxygen supply

In a study [13], Rennerfelt et al. for the first time directly measured intramuscular pressure and continuous oxygen supply to the muscles before, during and after running. For this purpose, 20 experienced runners (10 healthy men and women each, aged 22-35) were asked to complete a distance of 10 kilometres on a treadmill at a speed of 10 to 12 km/h. The test was performed twice, once with and once without wearing compression stockings. Thus, the runners served as their own control group. During the run, intramuscular pressure in the anterior tibialis muscle (m. tibialis anterior) was recorded using a catheter and local oxygen supply in the muscle was recorded using sensors on the skin. The values were measured before, during and after the run.

No evidence of improved performance

As soon as the participants put on compression stockings, a significant increase in pressure was observed in the lower leg muscles. During the run with the stockings, average intramuscular pressure was 22 mmHg (medical unit for pressure of body fluids) higher, while oxygen supply to the muscles was 11 per cent lower than during the run without compression stockings. The study also measured myoglobin and creatine kinase (two markers of muscle damage) in the blood. Blood samples showed no reduction in muscle damage markers when runners wore compression stockings. This finding and reduced oxygen supply to the muscles indicate that compression stockings don’t reduce muscle damage in healthy individuals. Moreover, they also didn’t lead to any increase in performance.

On your feet – but with stockings?

Whether you wear compression stockings or regular sports socks when you go running is up to you. If you choose compression stockings, it’s important they’re the right size, especially in the ankle area, where pressure is the highest. Also, their tightness and size should be optimised to you.

References

1. Kraemer WJ, Bush JA, Wickham RB, Denegar CR, Gómez AL, Gotshalk LA, et al. Influence of Compression Therapy on Symptoms Following Soft Tissue Injury from Maximal Eccentric Exercise. 2001;31: 282–290. doi:10.2519/JOSPT.2001.31.6.282

2. Kraemer WJ, Flanagan SD, Comstock BA, Fragala MS, Earp JE, Dunn-Lewis C, et al. Effects of awhole body compression garment on markers of recovery after a heavy resistance workout in men and women. J Strength Cond Res. 2010;24: 804–814. doi:10.1519/JSC.0B013E3181D33025

3. Ménétrier A, Mourot L, Bouhaddi M, Regnard J, Tordi N. Compression sleeves increase tissue oxygen saturation but not running performance. Int J Sports Med. 2011;32: 864–868. doi:10.1055/S-0031-1283181

4. Coza A, Dunn JF, Anderson B, Nigg BM. Effects of compression on muscle tissue oxygenation at the onset of exercise. J Strength Cond Res. 2012;26: 1631–1637. doi:10.1519/JSC.0B013E318254885B

5. Bringard A, Denis R, Belluye N, Perrey S. Effects of compression tights on calf muscle oxygenation and venous pooling during quiet resting in supine and standing positions. J Sports Med Phys Fitness. 2006;46: 548–554. Available: Study

6. Ali A, Creasy RH, Edge JA. Physiological effects of wearing graduated compression stockings during running. Eur J Appl Physiol. 2010;109: 1017–1025. doi:10.1007/S00421-010-1447-1/METRICS

7. del Coso J, Areces F, Salinero JJ, González-Millán C, Abián-Vicén J, Soriano L, et al. Compression stockings do not improve muscular performance during a half-ironman triathlon race. European Journal of Applied Physiology 2013 114:3. 2013;114: 587–595. doi:10.1007/S00421-013-2789-2

8. Book J, Prince CN, Villar R, Hughson RL, Peterson SD. Investigating the impact of passive external lower limb compression on central and peripheral hemodynamics during exercise. Eur J Appl Physiol. 2016;116: 717–727. doi:10.1007/S00421-016-3331-0

9. MacRae BA, Laing RM, Niven BE, Cotter JD. Pressure and coverage effects of sporting compression garments on cardiovascular function, thermoregulatory function, and exercise performance. Eur J Appl Physiol. 2012;112: 1783–1795. doi:10.1007/S00421-011-2146-2

10. Sperlich B, Haegele M, Achtzehn S, Linville J, Holmberg HC, Mester J. Different types of compression clothing do not increase sub-maximal and maximal endurance performance in well-trained athletes. J Sports Sci. 2010;28: 609–614. doi:10.1080/02640410903582768

11. Stein PD, Matta F, Akkad MW, Hoppe CL, Patel YR, Sivakumar S. Effect of graduated compression stockings on venous blood velocity in supine resting hospitalized patients. Clin Appl Thromb Hemost. 2014;20: 693–697. doi:10.1177/1076029613479821

12. Vercruyssen F, Easthope C, Bernard T, Hausswirth C, Bieuzen F, Gruet M, et al. The influence of wearing compression stockings on performance indicators and physiological responses following a prolonged trail running exercise. Eur J Sport Sci. 2014;14: 144–150. doi:10.1080/17461391.2012.730062

13. Rennerfelt K, Lindorsson S, Brisby H, Baranto A, Zhang Q. Effects of Exercise Compression Stockings on Anterior Muscle Compartment Pressure and Oxygenation During Running: A Randomized Crossover Trial Conducted in Healthy Recreational Runners. Sports Med. 2019;49: 1465–1473. doi:10.1007/S40279-019-01103-Y