In the second installment of my recovery series I will be discussing compression. If you missed the first article in this series about electrical muscle stimulation, you can check it out here.
What Is Compression?
Compression is the use of garments or devices to reduce the cross-sectional area of venous systems (veins?) in order to increase the velocity of blood flow. The idea is that by increasing blood flow velocity to an affected area, metabolic by products may be cleared faster, thereby improving recovery time and subsequent performance.
Types of compression and devices
There are quite a few options when it comes to compression, and I am going to cover 3 of the big players; 1.) Compression garments 2.) Compression devices and 3.) Acute compression/occlusion.
Compression garments
Compression garments, such as sleeves and leggings, are very popular among athletes as they are relatively cheap and can be used while still performing other tasks. Many athletes reflexively use them without really knowing whether they work or not, and as with any other passive recovery modality, if athletes feel more prepared and there are no negative effects there is probably some value in that. But, are there objective performance and/or metabolic benefits from the use of compression garments?
A meta analysis examined the use of compression garments, leg sleeves, arm sleeves, and full body garments, and their effect on performance measures of recovery. They found that strength recovery was improved by compression garments 2-8 hours after exercise, with greater benefits 24 hours or more after exercise (Brown et al., 2017). Their analysis also suggests greater benefits to the recovery of maximal strength and power rather than endurance measures (Brown et al., 2017). This is encouraging for athletes who rely on maximal strength or power, such as baseball players.
Some of the limitations of this analysis were the fact that they were unable to determine an optimal garment pressure. Overall, compression garments have a variable effect on performance metrics (i.e. strength vs endurance), but no negative effects have been documented.
Compression Devices
An example of a compression device is the Normatec Pulse. Various attachments are fitted over the desired body part, which will then fit to the individual body part’s shape during the “pre-inflate cycle.” Then, the session will start by compressing the bottom most portion of the attachment (hands, feet, or upper quads) and then using a pulsing pattern, or a compress and release pattern to work its way up the attachment. Normatec claims that their system is superior to static compression due to their pulsing pattern more closely imitating muscle pumps, thus enhancing the movement of fluid and metabolites out of the limbs.
One study performed on elite athletes at the Olympic Training Center found that peristaltic pulse dynamic compression (PPDC) improved trainees’ pressure to pain threshold (the minimum amount of force applied that produces pain) immediately after treatment and persisted through afternoon workouts (Sands et al., 2015).
Another study examined the effects of external pneumatic compression (EPC) (same idea as Normatec) on performance outcomes and molecular markers of recovery. They found that EPC did not improve strength recovery compared to the non-EPC group, but it did help better maintain flexibility, and reduced select markers of skeletal muscle oxidative stress and proteolysis (protein breakdown) (Haun et al., 2017).
Additionally, a study that compared EPC to a continuously worn compression sleeve (CS) for recovery found that EPC was more effective at reducing range of motion (ROM) disturbances than CS, and peak pain was also 39% lower in the EPC group than the CS group (Winke et al., 2018).
Acute Compression/Occulsion
“Voodoo” floss bands were made popular by Dr. Kelly Starrett in his book, Becoming a Supple Leopard and have migrated from CrossFit gyms and into other athletic fields. The idea is that you wrap a band around an affected joint for compression and partial vascular occlusion (partial blockage) while the joint is taken through a full ROM for 60 seconds or more. Starrett and others believe that this improves ROM, joint mechanics, and may break down adhesions through “fascial shearing.”
Joint flossing seems to be of particular interest to pitchers and a popular recovery tool post-throwing. Throwing is a violent and powerful motion, which can result in soreness and a decrease in ROM (loss of terminal elbow extension ROM is not uncommon).
While research is limited on floss bands and the number of participants in each study is relatively small, there have been a few interesting studies.
A 2017 study examined the use of floss bands on tennis players’ elbows for the purpose of improving joint ROM. The study found no significant improvement between the use of the floss band and no floss band (Hodeaux, 2017).
Other studies examined the effect of floss bands on ankle ROM and the effect on jump height (Driller et al., 2017), the effects of flossing on calf blood flow and plantarflexion and dorsiflexion strength (Bohlen et al., 2014), and the effectiveness of flossing on increasing upper extremity power and ROM (Plocker et al., 2015).
Flossing was found to increase jump height and ankle ROM on the side on which the band was used, however, when I examined the statistics, the effect size (difference between the experimental group and control group) was very small. Meaning, that if flossing made any difference it was very small.
Plantarflexion and dorsiflexion strength were both found to be increased by the use of floss bands, while vascular function was unaffected (Bohlen et al., 2014). However, this study had only five participants of unknown athletic background.
Finally, flossing was not found to significantly increase upper extremity ROM (specifically internal and external rotation of the shoulder) or upper extremity power (Plocker et al., 2015). However, the investigators did note that the manufacturer’s wrapping technique did not effectively cover all muscle groups involved in IR and ER, which may have limited the protocol’s effectiveness.
Conclusions and recommendations
As with all recovery methods compression has limitations, but it does have some promising research behind it. Compression seems to be a useful addition as part of a recovery protocol, but which method is the best fit for your recovery?
The Normatec or external pneumatic compression definitely has some interesting data behind it, but not much in the way of improvements in performance metrics such as strength. Most of its benefits are in the form of a reduction in soreness, which definitely has value, but performance improvement is ultimately what we’re after. I would use this method if it was available to me, but I wouldn’t lose sleep over not having access to one. The price ranging from $1500 to $2500 makes compression devices less accessible than other methods, and with the relatively small benefits it seems like more of a luxury than a need for recovery.
Voodoo flossing does not have very much research to back up its effectiveness and I do have some concerns about its safety. Any time we’re talking about vascular occlusion, it’s extremely important to be careful, especially if it’s being used without the supervision of a professional. Additionally, others in the performance and sports medicine industry have expressed concerns about flossing the elbow and causing irritation of the ulnar nerve through the use of focused compression. With a lack of benefits being shown in the research at this point I would use this method sparingly, if at all.
Compression garments are basically a no-brainer for me. They have objective performance benefits in terms of strength and power recovery and they have a low price point, which makes them easily accessible. They also allow you to go about your day while wearing them, unlike EPC which forces you to be in one place.
Overall, compression is a useful passive recovery modality that may be an effective addition to your arsenal. Stay tuned as I continue to analyze recovery modalities next week.
Resources
Brown F, Gissane C, Howatson G, Van Someren K, Pedlar C, Hill J (2017) Compression Garments and Recovery from Exercise: A Meta-Analysis. Journal of Sports Medicine.
Sands WA, McNeal JR, Murray SR, Stone MH (2015) Dynamic Compression Enhances Pressure-to-Pain Threshold in Elite Athlete Recovery: Exploratory Study. Journal of Strength and Conditioning Research.
Cody T. Haun,#1 Michael D. Roberts,#1,2 Matthew A. Romero,1Shelby C. Osburn,1 Christopher B. Mobley,1 Richard G. Anderson,Michael D. Goodlett, David D. Pascoe,1 and Jeffrey S. Martin1 (2017) Does external pneumatic compression treatment between bouts of overreaching resistance training sessions exert differential effects on molecular signaling and performance-related variables compared to passive recovery? An exploratory study. Plos One, Peer Reviewed Open Access Journal.
Winke M, Williamson S (2018) Comparison of a Pneumatic Compression Device to a Compression Garment During Recovery from DOMS. International Journal of Exercise Science.
Hodeaux K (2017) The Effect of Floss Bands on Elbow Range of Motion in Tennis Players. University of Arkansas Thesis.
Plocker, D., Wahlquist, B., & Dittrich, B. (2015). Effects of tissue flossing on upper extremity range of motion and power. International Journal of Exercise Science: Conference Proceedings, 12(1), 37th ser.
Driller, M. W., & Overmayer, R. G. (2017). The effects of tissure flossing on ankle range of motion and jump performance. Physical Therapy in Sports
Bohlen, J., Arsenault, M., Deane, B., Miller, P., Guadagno, M., & Dobrosielski, D. (2007). Effects of applying floss bands on regional blood flow. International Journal of Exercise Science: Conference Proceedings, 9(2).