Runners typically have two main goals:

1. To run faster and further
2. To not get injured in the process of trying to achieve the above.

The harder, and arguably the best, way to achieve performance goals is through hard work and intense training. But that sounds exhausting, so the fall-back method is to look for easier and quicker fixes.  Similarly, getting injured can put immediate brakes on any training.  Whilst injury prevention may be at the back of a runner’s mind, in most cases there is very minimal effort to do anything about it unless pain or discomfort is involved. Therefore it is safe to say performance is usually the primary goal. 

Sound familiar? 

Compression garments have increased in popularity ten-fold over the past few decades, particularly amongst runners and triathletes. Here we explain why compression garments have become a well-known running accessory and dig deeper into the science with regards to their alleged benefits. 

Hopefully this will help you decide whether or not you want to invest in a pair yourself, or decide to ditch the socks and head to the track. 

Proposed benefits of compression socks for runners: 

• Aid recovery 
• Improve performance
• Improve biomechanics and kinematics (running technique)
• Reduce DOMS (delayed onset muscle fatigue) by improving venous return
• Reduce lactic acid build up in the legs by augmenting lower limb pump action

History behind compression socks - Who came up with the idea and why? 

Compression socks are by no means new. There is evidence of compression garments being used for medical reasons all the way back to Hippocrates in 350 BC . Research later-on in the 1900’s confirmed their benefits by way of improving venous flow in the legs, reducing edema, and helping to prevent deep vein thrombosis (DVT).

For these reasons, they are still used frequently in the medical world to help improve deep venous velocity, venous return, and help reduce venous pooling in postoperative, inactive, hospital patients (Sperlich et al, 2010). 

The transition of compression garments into the world of sport is harder to pinpoint, but it appears to have started when a German engineer named Conrad Jobset wore them in the 1950s. The first published reference using compression socks in sport appeared in the 1980s. 

Compression Garments and Performance

Socks that can make you run faster? Sign me up! 

Of course, there is some logical reasoning behind these claims. The physiological benefits seen in clinical populations could be translated into some of the things we might want to address during sporting activity, and could therefore have a very positive impact on performance. 

However, despite the substantial amount of research investigating the effect of compression garments on immediate athletic improvement, there is very limited data indicating a positive effect for runners (Ali et al., 2011; Stanek, 2017). The one study that did find improvements in performance could have been influenced by the study protocol (lack of blinding) and also suggested triggers for motivational influences on performance results (Kemmler et al., 2009). 

Subsequent Exercise Benefits: 

However, the science looking at the benefits of compression garments post-exercise are more favourable. Armstrong et al. (2015) found that below-the-knee compression socks worn for 48-hours after a marathon resulted in a significant improvement for run time to exhaustion. Brophy-Williams et al. (2017) also found that compression socks might aid in the recovery between exercise performances and concluded in their recent follow up study that wearing compression garments during exercise can have a positive influence on subsequent performance (Brophy-Williams et al., 2019). 

Biomechanics and Kinematics - Can they change HOW you run? 

One study in 2011 aimed to determine if there was a change in kinematics (how someone runs) when wearing compression socks, but the results did not show any differences. (Varela-Sanz et al., 2011). Furthermore, Engel et al., (2016) speculated that there may be some biomechanical advantages in a 10km race as they found run time to exhaustion improved, but this has yet to be backed up by any significant data. 

What about Trail Runners? 

If you have ever been to a trail running event you’ll know that these runners wear compression socks A LOT- so maybe their effects are better on uneven surfaces over long distances? Vercruyssen et al., (2014) thought the same thing, but unfortunately the results did not prove to be significant and they found no change in performance or physiological effects when wearing compression socks during a trail run.

‍

‍

Compression Garments and Recovery 

Recovery after a run has had some more contradicting results.  

Wearing below the knee compression socks after a marathon for 48 hours was shown to improve ‘functional recovery’ and run times to exhaustion (Armstrong et al., 2015). More recently, Brophy-Williams et al., (2017) found runners had reduced calf muscle girth, caused by inflammation and swelling, as well as reduced perceived muscle soreness. They concluded that compression garments should be worn DURING high performance activity to augment post exercise recovery (Brophy-Williams 2019). Similarly, Brovenschen et al., (2013) found a reduction in leg volume after a maximum 10km running test.  One study also found that wearing graduated compression socks (GCS) lowered the % HR max reached during a time limited running test (at competition speeds) – however, further research has yet to make any links with this to translate into performance benefits. 

In contrast, Zaleski et al., (2015) looked at the effects of homeostatic balance using compression socks before, during and after running a marathon and concluded no physiological effects.  

The other physiological claims have been repeatedly disproven as well:

• No change in blood lactate levels ( Brophy-Williams et al., 2017, Brophy Williams et al., 2019)
• No change in oxygen consumption ( Brophy-Williams et al., 2019)
• No change in Red Blood Cells (Wahl, 2012)
• No other recovery benefits for distance runners (Moody et al., 2011)
• No change in Creatine Kinase Levels (the muscle damage marker) in marathon runners before, or after a marathon (Zaleski, 2019). 

Psychological Benefits

There is an alarming amount of evidence to show that despite the lack of physiological and performance changes, if there is a belief that they will make an impact, then results actually can be influenced (placebo effect)! 

Brophy-Williams (2017) describes a ‘belief effect’ where a participants perception of the garments’ benefits play a large role in their ability to provide any performance impact. This belief theory was also shown in a study by Engel et al., in 2016 where they found positive effects from the compression garments if the participants perceived they would help!

Negative effects of compression tights?

Only one study was found on the safety of wearing compression tights. They researched distance runners in the Boston Marathon and concluded that the socks show no negative impact and are therefore safe to use during prolonged endurance exercise. 

Phewph! 

Should you wear Compression Socks? 

Although there are arguments for both sides, it seems pretty clear that compression socks are not going to have an impact on your immediate performance. But, they might help to improve subsequent bouts of performance if you have multiple races back to back. 

As could be expected, there have been some positive results on their ability to help runners recover and therefore using them AFTER a run could be useful for injury prevention – although their impact on injuries isn’t very well documented yet. 

The bottom line is that they aren’t going to do you any harm, and if you THINK they might work? Well…they just might. 

References

Armstrong, S. Till, E., Maloney, S., & Harris, G., 2015, Compression Socks and Functional Recovery Following marathon running: a randomized controlled trial, Journal of Strength and Conditioning Research, Vol 29, No.2, pp. 528-533. 

Brophy-Williams, N., Driller, M., Kitic, C., Fell, J., & Halson, S. 2017, Effect of compression socks worn between repeated maximal running bouts, International journal of sports physiology and performance, Vol 12, pp. 621-627. 

Brophy-williams, N., Driller, M., Kitic, C., Fell J, & Halson, S. 2019, Wearing compression socks during exercise aids subsequent performance, Journal of Science and Medicine in Sport, Vol. 22, pp. 123-127.

Engel, F., Holmber, H.,  Sperlich, B., 2016, Is there evidence that runners can benefit from wearing compression clothing?, Sports Medicine, Vol. 46, pp. 1939-1952. 

Ali, A., Creasy, R., &Edge, J. 2011, The effect of graduated compression stockings on running performance, Journal of Strength and Conditioning Research, Vol. 25, pp. 1385-1392. 

Wahl, P., Bloch, W., & Mester J. 2012, Effects of different levels of compression during sub-maximal and high-intensity exercise on erythrocyte deformability, European Journal Applied Physiolology, Vol 112, pp. 2163-2169

Bovenschen, H., Booij, M., van der Vleuten, C. 2013, Graduated compression stockings for runners: friend, foe, or fake?, Journal of Athletic Training, Vol. 48, pp. 226-232. 

Varela-Sanz, A., Espan ˜a, J., & Carr, N. et al. 2011, Effects of gradual-elastic compression stockings on running economy, kinematics, and performance in runners, Journal of Strength and Conditioning Research, Vol. 25, pp. 2902-2910. 

MacRae, B., Cotter, J., & Laing, R., 2011, Compression garments and exercise: garment considerations, physiology and performance, Sports Medicine, Vol. 41, pp. 815-843. 

Stanek, J. 2017, The effectiveness of compression socks for athletic performance and recovery, Journal of Sport Rehabilitation, Vol 26, pp. 109-114. 

Vercruyssen, F., Easthop, C., Bernard, T., Hausswirth, C., Bleuzen, F., Gruet, M., et al, 2014, The influence of wearing compression stockings on performance indicators and physiological responses following a prolonged trial running exercise, European Journal of Sport Science, Vol. 14, No. 2, pp. 144-150.

Zaleski, A., Ballard, K., Pescatello, L., Panza, G., Kupchak, B., Dada, M., et al, 2015, The effect of compression socks worn during a marathon on hemostatic balance, The Physician and Sports Medicine, Vol. 43, No. 4, pp. 336-341. 

Zaleski, A., Pescatello, L, Ballard, K., Panza, G., Adams, W.,Hosokawa, Y., et al. 2019, The influence of compression socks during a marathon on exercise-associated muscle damage, Journal of Sport Rehabilitation, Vol 28, pp. 724-728. 

Kemmler, W., von Strengel, S., Kockkritz, C., Mayhew, J., Wassermann, A., & ZapF, J. 2009, Effect of compression stockings on running performance on men runners, Journal of Strength and Conditioning Research, Vol. 23, no.1, pp. 101-105.

‘Compression Socks’, Wikipedia, Available at http://en.wikipedia.org/wiki/compression_stockings (accessed November 20, 2020).  

Sperlich, B., Haegele, M., Achtzehn, S., Linville, J., Holmberg, H., & Mester, J. 2010, Different types of compression clothing do not increase sub-maximal and maximal endurance performance in well-trained athletes, Journal of Sports Sciences, Vol. 28, pp. 609-614.

‍