Handled: Do Compression Socks Really Work?

Published on October th, 2011

Handled is a feature to TRAVLETE where our resident Physical Therapist, Dr. Josh, answers your questions about all things endurance. 

Question: What’s your take on compression socks? I personally love them for recovery after a long run or race, but I see more and more athletes (including pros) wearing them DURING runs and races. There’s a lot of conflicting info and opinions about it. Does it just come down to personal preference, or is there real science behind it?

To wear, or not to wear, that seems to be the question on most endurance athletes’ minds lately. At least when referencing the latest trend to spend $40+ on a pair of compression socks.

The quick answer for those of you short on time:

Stick to wearing them for recovery only, if anything. If you have the money to spend, these socks may help you recover after a hard workout or race with a little less muscle soreness (the same thing you can do for free with ice!). That’s about it though.

The long version:

Compression socks and apparel have hit the market running (pun intended), and have seen a complete marketing push from companies touting their benefits. Pros are wearing them, so why shouldn’t I? Here’s why (besides the obvious fact that pros get paid to wear them so that you’ll buy them):

Even Shalane Flanagan has been known to try out compression socks.

The purported benefits of compression socks range from increasing cardiac output and venous return during exercise to decreasing blood lactate levels and heart rate during recovery. The manufacturers of these socks insist they have studies that support these claims; however, their findings are based more on case studies than randomized trials. In fact, there are no quality (randomized, controlled) studies showing any benefits from wearing compression socks during exercise. Any claimed benefits are shown only in the companies’ own research, and only for recovery purposes. Every independent study I could find, including the most recent that is about to be published in the European Journal of Applied Physiology this month (Wahl, et al), showed no significant difference in any measure (heart rate, blood pressure, blood lactate levels, erythrocyte deformation, cardiac output, stroke volume — basically every measure you would want to improve by wearing them). On top of not showing a benefit in any measure, they can actually DECREASE your performance on some of those same measures if the compression is not graded correctly. Basically that means the socks must apply more pressure distally at the foot, with less pressure as you go up the calf, in order to avoid constricting blood flow and venous return (the major claimed benefit of wearing said socks). More importantly, and even less discussed in the literature, there is a very fine line between harm and any benefit at all with these socks. 10mmHg pressure can mean the difference between aiding in blood flow and constricting blood flow. Every individual is different, and if the size isn’t exactly correct for you and your body, you run the risk of too much compression. This will constrict your blood flow and venous return, thereby decreasing your overall performance (not to mention possibly causing tingling/numbness problems).

Just an aside: If you are a healthy, active individual, with no circulatory problems, you do not need compression socks to constrict your vessels to aide in venous return. Your body’s calves work as a muscle pump with each and every step you take. Also, there is something to be said for breaking muscle down during endurance training. It makes you stronger and it makes the muscle able to adapt to take on the rigors of training in new and different environments. Do you really want to take that away? Say you’ve only been doing long runs with compression socks on, then you forget them one day. Is your body going to be able to take the strain? Or will you end up with an overuse injury because your calves are used to being unnaturally supported? I don’t know the answer to this question, and there isn’t any quality research to aide in answering it, from either perspective.

If you have the means, don’t mind looking silly, and/or have an aversion to ice (which can give you the same constricting recovery benefits the socks claim), then by all means wear them. For recovery. Only. The research is still too new and inconsistent to warrant wearing compression during performance. Couple that with the possibility for over-compressing, and it just doesn’t make sense to wear them during training or an event. Unless you’re a masochist and really like trying to struggle into them in T2, save them for the podium/couch/bar after.

Thanks, and keep your questions coming!

-Josh

Dr. Joshua Grahlman DPT, FAFS, Cert SMT, ART cert

TRX Suspension Training Specialist

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