So having looked at the findings with compression garments on the recovery of muscle damage and physical performance, the final potential area to consider is perceptual recovery.

Perceptual Recovery

Despite inconclusive research into inflammation and physical recovery, there appears to be a strong case in the literature for enhanced perceptual recovery when using compression garments.  Reduced ratings of muscle soreness were reported when wearing compression garments up to 24 hours following high intensity sprint and plyometric exercise (Duffield et al, 2010), throwing and repeated sprint exercise in cricket players (Duffield and Portus, 2007) and up to 48 hours following simulated team sport exercise (Duffield et al, 2008; Hamlin et al, 2012).  However, as is noted by Duffield et al (2008), a placebo effect cannot be discounted by wearing a garment but no compression as the control.  It has been suggested that electro stimulation in addition to compression can enhance the effect on perceptual recovery with more positive responses in self-reported energy and enthusiasm than with a compression garment alone (Beaven et al, 2013) although a placebo effect also cannot be excluded.

In the first meta-analysis to examine the efficacy of compression garments in recovery from damaging exercise, Hill et al (2014) concluded that their use enhances recovery of muscle soreness with 66% of the population likely to experience reduced delayed onset of muscle soreness (DOMS).  Once again however, the wide variation in selection criteria must be considered as previously discussed for this study.

Focussing on team sport research, compression garments only had a trivial effect on improving perceived muscle soreness during a basketball tournament, whereas cold water immersion treatment led to large and very large decreases (Montgomery et al, 2008).  Although it should be considered this study used a small sample size and was applied during an intensive 3 day tournament so may not reflect the usual demands of a one or two game per week schedule of in-season team sports.  The intensive nature of the competition also led to repeated exposure to recovery strategies which may have had a compounding effect.

The use of compression garments was one strategy chosen within varying combination of post AFL match strategies that had an increased probability of reporting greater perceptual recovery in the following week (Bahnert et al, 2013).  The authors conclude that compression garments were likely to add to the increase in perceptual recovery as they were part of the combination in two of the association rules.  Although the combination of strategies makes it difficult to disseminate the findings, this study is more realistic to the professional team sport setting.

There were significant differences in perceived recovery and perceived muscle soreness between compression garments and control trials with trends for main effects for treatment for recovery (p=0.005) and soreness (p=0.053) following the LIST protocol used with highly trained hockey players (Pruscino et al, 2013)  Not only did subjects always feel better when compression garments were worn but when considering the individual data, six out of the eight subjects strongly agreed that they were ‘ready to perform at their best’ after wearing compression garments 48 hours post exercise, compared to only one subject for the control group.  The authors propose compression garments may provide mechanical stability and a reduction in the displacement of functioning muscles may attenuate feelings of pain and stiffness following EIMD.

Regardless of the mechanism or the subsequent effect on muscle function, it is widely accepted that a reduction in DOMS is beneficial to athletes and may improve readiness to carry out subsequent physical activity (Duffield et al, 2008).  Given that DOMS typically peaks 24-72 hours following exercise (McRae et al, 2011) this may impact subsequent training or potentially match play in professional team sports.  Noting this, most of the studies in this review measured up to 24 or 48 hours post, given this time-frame perhaps future studies should also incorporate 72 hours post exercise.

Conclusion

As this review series has shown, it is difficult to ascertain a consensus across the literature on the effectiveness of compression garments on recovery in view of the variation in garment type and body area covered, pressures applied, the measurement of actual pressure values, exercise protocol used, timing and duration of compression garment worn, training status of the subjects, sample sizes and outcome measures assessed.  Although the use of combinations of recovery modalities may confound results in academic studies this approach is closer to the applied High Performance setting.  There also remains the difficulty in blinding subjects and consequently minimising the placebo effect in studies with compression garments although having said that a placebo effect in the applied setting may be enough to justify its use.

Despite differences in the body of research there may be a trend in reducing muscle damage in higher levels of EIMD with compression garments, although this effect is varied.  However, the improvement of subsequent muscle function brought about by this remains to be seen.  Without doubt, the strongest case for the use of compression garments is the evidence available for improving perceptual recovery.  It is widely accepted that a reduction in perceived muscle soreness is beneficial to athletes and may improve readiness, therefore this may be enough to justify their use with team sport athletes, particularly those who have subsequent competition or training within the usual timeframe of DOMS of 24-72 hours following exercise.

Considerations for the applied setting include the practicality and resources required to measure all individual athletes and provide tailored sizes, as well as replacement as per the lifetime of the garment, which is currently unknown.  Having said that, they are a relatively inexpensive option for recovery compared to some modalities and are very easily transported, in contrast to other modalities which are not always available, such as pool facilities only available for 50% of all games across an AFL season (Bahnert et al, 2013).

This review has focused on the use of compression garments post exercise as a recovery modality.  However, research exists regarding their effect on exercise during and they may have a role to play in immediate recovery with this approach (Bieuzen et al, 2014).

The use of compression garments is widespread in the High Performance environment, possibly due to the large amount of anecdotal evidence.  Despite fragmented findings in the literature for compression garments as a recovery modality, there appears to be no impeding of the recovery process (Halson, 2013) or negative effect on performance (Nédélec et al, 2013).  Future research should focus on establishing mechanical insights to the compression process, blinding subjects with a suitable placebo garment, utilising a realistic exercise protocol and wear duration, whilst measuring the actual pressures applied (MacRae et al, 2011).

I hope you have enjoyed reading this series on compression garments - all comments are welcome!

Jo Clubb

References

Bahnert A, Norton K and Lock P. (2013) Association between post-game recovery protocol, physical and perceived recovery, and performance in elite Australian Football League players. J Sci Med Sport 16: 151-156.

Beaven CM, Cook C, Gray D, et al. (2013) Electrostimulation’s enhancement of recovery during a rugby preseason. Int J Sports Physiol Perform 8: 92-98.

Duffield R and Portus M. (2007) Comparison of three types of full-body compression garments on throwing and repeat-sprint performance in cricket players. Br J Sports Med 41: 409-414.

Duffield R, Cannon J and King M. (2010) The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise. J Sci Med Sport 13: 136-140.

Duffield R, Edge J, Merrells R, et al. (2008) The effects of compression garments on intermittent exercise performance and recovery on consecutive days. Int J Sports Physiol Perform 3: 454-468.

Halson SL (2013) Recovery techniques for athletes. Sports Science Exchange 26: 1-6.

Hill J, Howatson G, van Someren K, et al. (2014) Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Br J Sports Med 48: 1340-1346.

MacRae BA, Cotter JD and Laing RM. (2011) Compression garments and exercise: garment considerations, physiology and performance. Sports Med 41: 815-843.

Montgomery PG, Pyne DB, Cox AJ, et al. (2008) Muscle damage, inflammation, and recovery interventions during a 3-day basketball tournament. Eur J Sports Sci 8: 241-250.

Nédélec M, McCall A, Carling C, et al. (2013) Recovery in Soccer Part II – Recovery Strategies. Sports Med 43: 9-22.

Pruscino CL, Halson SL and Hargreaves M. (2013) Effects of compression garments on recovery following intermittent exercise. Eur J Appl Physiol 113: 1585-1596.