The science behind compression clothing: Its benefits and application in sport
An introduction to compression clothing
Compression clothing has been growing in popularity since the late 1980’s. In fact, the sight of both athletes and fitness enthusiasts training or competing in tight-fitting garments is now commonplace across the world. From weekend runners to commuting cyclists, gym rats to Sunday league footballers, compression sportswear is everywhere.
But what exactly is compression clothing, and what benefits does it offer? In this article, we explore the history and science behind compression clothing, including its effects on performance, recovery, and injury prevention. We also discuss the different types of compression clothing available, and how to choose the right gear for your needs.
compression clothing: A brief history
The idea of compressive clothing was born in the 1950’s, developed by a German engineer named Conrad Jobst. Jobst suffered from chronic venous insufficiency, a condition where blood from the legs has difficulty returning to the heart. His solution: compression socks with a pressure gradient from bottom to top, encouraging blood to return up his leg and back towards the heart.
To this day, compression socks are prescribed by doctors to treat similar conditions, as well as post-operative lymphedema and even to reduce the risks of DVT from long-haul flights. Compression apparel made its way into sports in the 1980’s, primarily to help athletes recover faster for repeat training and performance. This was followed up by a famous study in 1987 [1], published in the American Journal of Physical Medicine, showing that athletes who wore compression stockings recovered significantly faster than those who didn’t.
Compression socks similar to those invented by Conrad Jobst were first worn by runners to increase blood flow and oxygen delivery to the muscles, as well as reducing jarring or stress from impacts. As these socks became more popular through the 90’s, brands started to release calf and leg sleeves, then shorts, leggings, and tops. These were adopted across a wider range of sports, with athletes from basketball to football, cycling to swimming finding benefits to wearing compression clothing. The late 1990’s saw both Skins and Under Armour being founded, eventually taking sports compression into the mass market. The rest, as they say, is history.
How does compression clothing work?
There are two primary mechanisms that go towards explaining the function of compression clothing. By applying pressure to target areas of the body, compression clothing aims to enhance blood flow, allowing for both improved oxygen delivery to, and waste product removal from muscles. At the same time, compression also aims to reduce muscle vibration, acting as a stabiliser during high-impact activity such as running.
Finally, the mechanical skin deformation created by the constant pressure is argued at least to some extent to support enhanced proprioceptive feedback. While there is some debate in the research over exactly how this works in practice, there is clearly some proprioceptive benefit to compression worth investigating.
WHAT DOES THE RESEARCH SAY - ARE THESE MECHANISMS REAL?
As you might expect, there is a wealth of research investigating the effects of compression clothing on blood flow and muscle vibration. This all started with more medical applications but has moved quickly into a sporting context, exploring the potential benefits to athletes across a range of activities.
IMPROVED BLOOD FLOW + VENOUS RETURN
A number of potential methods exist for researchers to assess the effects of compression clothing on circulation, both via direct measurement and indirect markers of effort. Among this enormous database of studies, positive effects of compression have been reported in markers of fatigue and muscle damage (including blood lactate [2], creatine kinase [3], and myoglobin concentrations[4]), arterial blood flow [5] and perfusion [6], muscle oxygenation [7], and venous flow [8] (including velocity, vein diameter, and pooling).
REDUCED MUSCLE VIBRATION
Evidence that compression reduces muscle vibration during exercise is relatively strong, with positive results from studies involving running [9], vertical jumps [10], cutting [11], squats [12], and even cycling [13]. This is strengthened by research indicating that wearing compression reduces muscle activation [14] during specific contraction or exercise modes, suggesting a reduced reliance on muscle tuning to dampen vibration, and ultimately improved contraction efficiency.
PROPRIOCEPTIVE FEEDBACK
Improvements in joint proprioception and repositioning sense [15], as well as balance and postural sway [16] while wearing compression clothing have been found in research. There is also some evidence to suggest that compression positively influences muscle fibre recruitment. The exact mechanisms behind this are not fully understood, although recent findings indicating that compression acts as a filter of non-specific sensory information to the nervous system [17] may start to explain these reported improvements.
Is there evidence for the direct benefits of compression in sport?
Research in this space has been growing since that famous recovery study in 1987 [1], with an ever-increasing range of potential benefits to athletes being investigated. For this article findings are split into five distinct categories: performance, recovery, post-recovery performance, perception, and injury prevention.
PERFORMANCE
Since 2010 there has been a great deal of research in what is a very broad area of study. A 2022 review [18] identified 115 peer reviewed articles investigating the effects of compression garments on exercise performance and/or muscle function, with a further 59 exploring biomechanical and neuromuscular outcomes.
In terms of direct performance measures, ergogenic effects have been identified for activities including jump [19] and time trial [20] performance, with around 25-35% of researchers reporting a statistically significant positive influence of wearing compression. Incremental exercise performance is generally increased when wearing compression, with 66% of studies reporting significant positive findings. Some improvements in speed and distance travelled during sport-specific circuits [21], time to fatigue/exhaustion [22], and skill accuracy [23] are also reported.
When considering muscle function, compression has been found to have a beneficial effect on isometric and isokinetic strength, with 40-50% of researchers reporting a significant positive influence. Some evidence for improvements in in repetition maximum [24] and ballistic movement performance [3] are also apparent.
Neuromuscular outcomes also show a series of positive effects, with the vast majority of studies reporting reduced muscle vibration and activation [17] during exercise, leading to improved contraction efficiency and movement economy. As in the previous section, compression is also suggested to act as a filter for non-specific sensory information to the nervous system, positively influencing muscle fibre recruitment and motor control.
Biomechanical findings are less clear, with only a few studies reporting positive effects on kinematic outcomes and decreased impact force [25] or injury risk during landing.
RECOVERY
Traditionally recovery has been the primary area of investigation in the research, with many athletes relying on compression apparel as part of their post-performance routine.
Significant effects have been reported in terms of muscle swelling [26] and markers of muscle damage [9] after exercise, with 15-25% of studies finding a positive influence of compression. Markers of fatigue and damage in the blood, including lactate [2] and creatine kinase [3] have also been shown to significantly decrease, with 15-30% of researchers reporting a positive impact.
POST-RECOVERY PERFORMANCE
One of the primary reasons athletes wear compression is to speed up recovery, ultimately improving their repeated or next day performance.
Significant positive effects of wearing compression have been reported when investigating post-recovery power output (including squat [27], jump [28], throw [29], and cycling [30] outcomes), muscular strength (at the knee [31], hip [28], and elbow [32]), and endurance performance (cycling [30] and running [26]). Some positive influence on joint range of motion [32] post-fatigue is also apparent, indicative of reduced muscle damage or soreness.
It should be noted here that fatigue protocols, duration of wearing compression, and time gap between measurements varies substantially from study to study, making broad recommendations difficult.
PERCEPTION
Alongside physical and physiological measures, researchers commonly investigate a wearer’s perception of wearing compression.
Of the 100 studies identified in this area, around 60% reported a significant positive effect of compression on muscle soreness [27] and/or pain. A further 20% reported significant improvements in ratings of perceived exertion (RPE) [2], a measure of how hard an athlete is working, with some other positive findings for fatigue, recovery, posture, and support.
INJURY PREVENTION
Injury prevention is a notoriously challenging area to investigate, due to the longitudinal nature of any study, and the ethical conundrum around potentially increasing injury risk.
Despite this, two studies have attempted to explore the effects of compression clothing on injury rates, one in recreational runners [33], and the other in professional ski instructors [34], with both reporting reduced injury rates amongst the target population when wearing compression.
So what's the conclusion - should I wear compression or not?
Ultimately yes, there is evidence that compression clothing is doing what it’s supposed to, aiding with circulation and venous return, reducing muscle vibration, and having some positive impact on the sensorimotor system. This translates as some measurable benefits in performance and recovery across a range of groups and activities.
However, as anyone who is familiar with research in this space will know, overwhelming high-quality evidence can be pretty hard to come by. For every positive finding supporting the use of compression, there is a non-positive result creating uncertainty. Overall, the research is fragmented, with massive variability between studies in terms of methods, metrics, sample sizes, participants, garment types, and applied pressures.
But here’s the big takeaway for me. Almost no studies (in some estimations <1%) have found a negative impact of wearing compression. The trend is undeniably on the positive side of zero. Any effect you feel is very likely to be positive. Combine that with the strong anecdotal evidence from athletes and fitness fanatics, and you’ve got something that is absolutely worth trying for your sport.
How to choose the best compression gear for youR SPORT
Firstly, and most importantly, not all compression gear is created equal. Just because a garment is tight-fitting, it doesn’t automatically make it true compression apparel. Tight-fitting clothing comes in a massive range of shapes, sizes, and styles, with use-cases varying from simply making someone look good through to every potential benefit detailed above.
Choosing the right gear for your specific needs is a challenge. To help you out, we’ve created a few guidelines below to make sure you get the perfect kit for your sport.
1. DETERMINE YOUR COMPRESSION NEEDS
Compression ranges are designed with different activities in mind. Established brands have several grades, each for a distinct use-case.
As a rule of thumb, the higher impact your activity, the higher the level of compression you should consider. If you’re purchasing purely for recovery, either from exercise or medical procedures, you may want an even higher compression level with thicker and warmer fabric.
To give an example, if you’re participating in high-impact activities like road running and CrossFit, you would likely benefit more from a greater level of compression than someone doing yoga or Pilates at home. In this case, the higher compression garments work to limit muscle vibration and damage from repetitive impact with the ground, which simply isn’t needed in lower impact activities where the goal might be more comfort and body awareness.
2. WHICH AREAS OF THE BODY NEED COMPRESSION THE MOST
Next you should consider the areas of the body in which you might need compression. To go back to the road running and CrossFit example, a runner likely only requires compression around their lower body, specifically the calves, quads, glutes, and hamstrings, as these are by far the hardest working muscle groups. Many runners are seen wearing leggings or shorts and calf sleeves for this exact reason. As a whole-body activity, CrossFitters might consider compression across more of their body, working to stabilise the arms and shoulders during targeted upper body activities.
3. GRADUATED COMPRESSION
The final consideration in the purely compression section is graduation. Put simply, this can be defined as apparel that gets tighter the further you get from the heart. For example, in a pair of leggings, compression around the calf would be greater than around the quad and hamstring. This is thought to further aid with venous return and support for the smaller muscle groups, which may be particularly relevant for running-based activities. Not many brands execute this graduation well in their ranges, so keep an eye out before purchasing.
4. ANY SPECIFIC REQUIREMENTS
As with any clothing purchase, compression apparel needs to fit in with specific requirements of the activity you plan to wear it for, and what else you plan to wear it with. Consider a marathon runner who is worried about the heat, or a cyclist who needs to carry gels. They may require extra ventilation, or pockets built in.
Oftentimes these requirements are covered by over-layers, allowing the compression gear to perform its function without compromising for other considerations. But keeping this in mind while purchasing will help avoid any surprises.
5. MATERIALS AND QUALITY
We’ve all heard the old saying, ‘buy once, buy well’. This applies just as much to compression clothing as it does anywhere else in our purchasing behaviours.
Over time any compression apparel will deteriorate due to the high stretch and repeated washing after exercise. But in this case, you really do get what you pay for. A high-quality garment will last far longer than a cheap equivalent, while also likely providing greater benefit during use. Premium fabrics and strong seams will recover fully after use, ensuring you get the same high-quality compression and comfort wear after wear.
6. GET THE RIGHT SIZE AND FIT
Predictably, the size and fit of compression apparel is vital to its function. Brands offering a range of sizes and specific fit recommendations based on your body measurements are at a distinct advantage here, ensuring you get maximum benefit and optimal comfort from your chosen product.
7. LOOK FOR ADDITIONAL FUNCTIONALITY
By offering something different, something over and above what other manufacturers provide, brands can truly have a positive impact on athletic performance.
That is exactly what we’ve done at O+A, combining performance grade compression with our patented Neuromuscular Performance System to create the ultimate performance apparel. Offering all the benefits of traditional compression clothing, as well as providing targeted muscle and joint support, and helping you consciously connect with every movement.
THE FUTURE OF COMPRESSION CLOTHING IN SPORT
Although the scientific evidence isn’t yet 100% conclusive, research highlights several areas in which compression in its current form benefit athletes both physically and physiologically.
At O+A we believe this is just the start of compression apparel design and its application in sport. There is so much more to come in this space. As brands continue to innovate, and researchers dive deeper into the responses and outcomes associated with compressive apparel, athletes will start to feel even more benefit.
Over the next decade we can expect to see products tapping more into the body’s nervous system, designing apparel that supports efficient neuromuscular and motor control as well as limiting muscle vibration and aiding circulation. We also expect to see innovations in customisation, allowing wearers to not only customise the look of a garment, but also the size, fit, and level of support provided. Finally, keep an eye out for integration of physical support into compression garments, combining the functionality of a joint brace into the design of the apparel, allowing individuals to participate perhaps where they couldn’t before.
Much of this work is already underway, and at O+A we are proud to be leading the charge in terms of innovating in this space. The future of compression clothing and its application in sport is bright.
References
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